感知压力、多种疾病并存与门诊医疗敏感疾病住院风险：一项基于人群的队列研究。

Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions: A Population-based Cohort Study.

作者信息

Prior Anders, Vestergaard Mogens, Davydow Dimitry S, Larsen Karen K, Ribe Anette R, Fenger-Grøn Morten

机构信息

*The Research Unit and Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark †Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.

出版信息

Med Care. 2017 Feb;55(2):131-139. doi: 10.1097/MLR.0000000000000632.

DOI:10.1097/MLR.0000000000000632

PMID:27579911

Abstract

BACKGROUND

Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population.

OBJECTIVES

To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality.

RESEARCH DESIGN AND MEASURES

Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data on Cohen's Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories.

RESULTS

Being in the highest perceived stress quintile was associated with a 2.13-times higher ACSC-related hospitalization risk (95% CI, 1.91, 2.38) versus being in the lowest stress quintile after adjusting for age, sex, follow-up time, and predisposing conditions. The associated risk attenuated to 1.48 (95% CI, 1.32, 1.67) after fully adjusting for multimorbidity and socioeconomic factors. Individuals with above reference stress levels experienced 1703 excess ACSC-related hospitalizations (18% of all). A dose-response relationship was observed between perceived stress and the ACSC-related hospitalization rate regardless of multimorbidity status. Being in the highest stress quintile was associated with a 1.26-times insignificantly increased adjusted risk (95% CI, 0.79, 2.00) for ACSC rehospitalizations and a 1.43-times increased adjusted risk (95% CI, 1.13, 1.81) of mortality within 30 days of admission.

CONCLUSIONS

Elevated perceived stress levels are associated with increased risk for ACSC-related hospitalization and poor short-term prognosis.

摘要

背景

精神障碍与非卧床护理敏感疾病（ACSC）相关住院风险增加有关，但对于一般人群中更普遍的非综合征性应激个体而言，情况是否如此仍不清楚。

目的

确定感知到的压力是否与ACSC相关住院和再住院以及住院后30天死亡率相关。

研究设计与测量

基于人群的队列研究，参与者来自2010年丹麦国家健康调查的118410人，其中包括科恩感知压力量表的数据，随访时间为2010年至2014年，并结合了关于住院和死亡率的个人层面国家登记数据。使用健康登记信息评估39种疾病类别内的诊断和药物处方来评估多重疾病。

结果

在调整年龄、性别、随访时间和易患疾病后，处于感知压力最高五分位数组的ACSC相关住院风险比处于最低压力五分位数组高2.13倍（95%CI，1.91，2.38）。在对多重疾病和社会经济因素进行全面调整后，相关风险降至1.48（95%CI，1.32，1.67）。压力水平高于参考水平的个体经历了1703例额外的ACSC相关住院（占总数的18%）。无论多重疾病状况如何，在感知压力与ACSC相关住院率之间观察到剂量反应关系。处于最高压力五分位数组与ACSC再住院的调整风险无显著增加1.26倍（95%CI，0.79，2.00）以及入院后30天内死亡调整风险增加1.43倍（95%CI，1.13，1.81）相关。