Jayatilleke N, Hayes R D, Dutta R, Shetty H, Hotopf M, Chang C-K, Stewart R
Institute of Psychiatry, Psychology, and Neuroscience, Psychological Medicine Dept, King's College London, PO Box 92, De Crespigny Park, SE5 8AF London, United Kingdom.
Institute of Psychiatry, Psychology, and Neuroscience, Psychological Medicine Dept, King's College London, PO Box 92, De Crespigny Park, SE5 8AF London, United Kingdom.
Eur Psychiatry. 2017 Jun;43:109-115. doi: 10.1016/j.eurpsy.2017.02.487. Epub 2017 Mar 17.
The life expectancy gap between people with severe mental illness (SMI) and the general population persists and may even be widening. This study aimed to estimate contributions of specific causes of death to the gap. Age of death and primary cause of death were used to estimate life expectancy at birth for people with SMI from a large mental healthcare case register during 2007-2012. Using data for England and Wales in 2010, death rates in the SMI cohort for each primary cause of death category were replaced with gender- and age-specific norms for that cause. Life expectancy in SMI was then re-calculated and, thus, the contribution of that specific cause of death estimated. Natural causes accounted for 79.2% of lost life-years in women with SMI and 78.6% in men. Deaths from circulatory disorders accounted for more life-years lost in women than men (22.0% versus 17.4%, respectively), as did deaths from cancer (8.1% versus 0%), but the contribution from respiratory disorders was lower in women than men (13.7% versus 16.5%). For women, cancer contributed more in those with non-affective than affective disorders, while suicide, respiratory and digestive disorders contributed more in those with affective disorders. In men, respiratory disorders contributed more in non-affective disorders. Other contributions were similar between gender and affective/non-affective groups. Loss of life expectancy in people with SMI is accounted for by a broad range of causes of death, varying by gender and diagnosis. Interventions focused on multiple rather than individual causes of death should be prioritised accordingly.
患有严重精神疾病（SMI）的人群与普通人群之间的预期寿命差距依然存在，甚至可能在扩大。本研究旨在估算特定死因对这一差距的影响。利用2007年至2012年期间大型精神卫生保健病例登记册中SMI患者的死亡年龄和主要死因，估算其出生时的预期寿命。使用2010年英格兰和威尔士的数据，将SMI队列中每种主要死因类别的死亡率替换为该死因的性别和年龄特异性标准。然后重新计算SMI患者的预期寿命，从而估算该特定死因的影响。自然原因导致SMI女性患者损失79.2%的生命年，男性患者损失78.6%的生命年。循环系统疾病导致女性损失的生命年比男性更多（分别为22.0%和17.4%），癌症导致的生命年损失也是如此（8.1%和0%），但呼吸系统疾病导致女性损失的生命年比男性少（13.7%和16.5%）。对于女性，癌症在非情感性障碍患者中造成的影响更大，而自杀、呼吸系统和消化系统疾病在情感性障碍患者中造成的影响更大。对于男性，呼吸系统疾病在非情感性障碍患者中造成的影响更大。性别和情感性/非情感性障碍组之间的其他影响相似。SMI患者预期寿命的损失是由多种死因造成的，因性别和诊断而异。因此，应优先采取针对多种而非单一死因的干预措施。
