精神分裂症和双相情感障碍中的心脏代谢合并症、再入院情况及费用：一项真实世界分析

Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis.

作者信息

Correll Christoph U, Ng-Mak Daisy S, Stafkey-Mailey Dana, Farrelly Eileen, Rajagopalan Krithika, Loebel Antony

机构信息

Hofstra North Shore LIJ School of Medicine, Manhasset, NY USA.

The Zucker Hillside Hospital, Glen Oaks, NY USA.

出版信息

Ann Gen Psychiatry. 2017 Feb 10;16:9. doi: 10.1186/s12991-017-0133-7. eCollection 2017.

DOI:10.1186/s12991-017-0133-7

PMID:28203265

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5301338/

Abstract

BACKGROUND

Serious mental illnesses are associated with increased risk of cardiometabolic comorbidities. The objective of this study was to evaluate the prevalence of cardiometabolic comorbidity and its association with hospitalization outcomes and costs among inpatients with schizophrenia or bipolar disorder.

METHODS

This retrospective database analysis reviewed patients with an inpatient diagnosis of schizophrenia or bipolar disorder from the Premier Perspective® Database (4/1/2010-6/30/2012). Patients were categorized into 4 cohorts based on the number of ICD-9-CM cardiometabolic comorbidities (i.e., 0, 1, 2, or 3+). Outcomes included length of stay, mortality during the index hospitalization, healthcare costs, and 30-day all-cause readmission rates.

RESULTS

Of 57,506 patients with schizophrenia, 66.1% had at least one cardiometabolic comorbidity; 39.3% had two or more comorbidities. Of 124,803 patients with bipolar disorder, 60.5% had at least one cardiometabolic comorbidity; 33.4% had two or more. Average length of stay was 8.5 (for patients with schizophrenia) and 5.2 (for patients with bipolar disorder) days. Each additional cardiometabolic comorbidity was associated with an increase in length of stay for patients with bipolar disorder ( < .001) but not for patients with schizophrenia. Mortality rates during the index hospitalization were 1.2% (schizophrenia) and .7% (bipolar disorder). Each additional cardiometabolic comorbidity was associated with a significant increase in mortality for patients with bipolar disorder (OR 1.218, < .001), and a numerical increase in mortality for patients with schizophrenia (OR 1.014, = .727). Patients with more cardiometabolic comorbidities were more likely to have a 30-day readmission (schizophrenia = 9-13%; bipolar disorder = 7-12%), and to incur higher costs (schizophrenia = $10,606-15,355; bipolar disorder = $7126-13,523) (all < .01).

CONCLUSIONS

Over 60% of inpatients with schizophrenia or bipolar disorder had cardiometabolic comorbidities. Greater cardiometabolic comorbidity burden was associated with an increased likelihood of readmission and higher costs among patients with schizophrenia or bipolar disorder, and an increase in length of stay and mortality for patients with bipolar disorder.

摘要

背景

严重精神疾病与心血管代谢合并症风险增加相关。本研究的目的是评估精神分裂症或双相情感障碍住院患者中心血管代谢合并症的患病率及其与住院结局和费用的关联。

方法

这项回顾性数据库分析对Premier Perspective®数据库（2010年4月1日至2012年6月30日）中诊断为精神分裂症或双相情感障碍的住院患者进行了回顾。根据ICD-9-CM心血管代谢合并症的数量（即0、1、2或3种以上）将患者分为4组。结局包括住院时间、索引住院期间的死亡率、医疗费用和30天全因再入院率。

结果

在57506例精神分裂症患者中，66.1%至少有一种心血管代谢合并症；39.3%有两种或更多种合并症。在124803例双相情感障碍患者中，60.5%至少有一种心血管代谢合并症；33.4%有两种或更多种。平均住院时间为8.5天（精神分裂症患者）和5.2天（双相情感障碍患者）。每增加一种心血管代谢合并症，双相情感障碍患者的住院时间就会增加（P<0.001），但精神分裂症患者则不然。索引住院期间的死亡率分别为1.2%（精神分裂症）和0.7%（双相情感障碍）。每增加一种心血管代谢合并症，双相情感障碍患者的死亡率显著增加（OR 1.218，P<0.001），精神分裂症患者的死亡率有数值上的增加（OR 1.014，P=0.727）。心血管代谢合并症更多的患者更有可能在30天内再入院（精神分裂症患者为9%-13%；双相情感障碍患者为7%-12%），且费用更高（精神分裂症患者为10606美元至15355美元；双相情感障碍患者为7126美元至13523美元）（均P<0.01）。