加拿大安大略省的精神卫生服务索赔与成人哮喘发病

Mental Health Services Claims and Adult Onset Asthma in Ontario, Canada.

机构信息

Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Chronic Disease and Pharmacotherapy Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

出版信息

J Allergy Clin Immunol Pract. 2017 Sep-Oct;5(5):1388-1393.e3. doi: 10.1016/j.jaip.2017.02.016. Epub 2017 Apr 7.

DOI:10.1016/j.jaip.2017.02.016

PMID:28396111

Abstract

BACKGROUND

Living with asthma is associated with a decrease in quality of life due to reductions in activities of daily living and increased psychological stress, both of which are associated with poor mental health outcomes.

OBJECTIVE

The objective of this study was to quantify the burden of mental disorders on the adult asthma population and compare the risk of mental health services claims (MHSCs) in the 1 year before and 1 year after asthma diagnosis.

METHODS

Ontario residents aged 25 to 65 years with incident physician-diagnosed asthma between April 1, 2005, and March 31, 2012, were included. MHSCs, which consisted of hospitalizations, emergency department (ED), and outpatient physician visits, were identified from universal health administrative data. Poisson regression models with repeated measures were used to estimate the relative risk (RR) of MHSCs for 2 time periods: 1 year after asthma diagnosis compared with the 1 year before and 2 years after compared with 2 years before.

RESULTS

A total of 145,881 adults had incident asthma. In the 1 year after asthma diagnosis, 27% had an MHSC. The risk of ED visits for any mental disorders increased by 13% in the 1 year after asthma diagnosis compared with the 1 year before (adjusted RR [aRR], 1.13; 95% confidence interval [CI], 1.06-1.21). This increased risk of ED visits was not found when comparing 2 years after asthma diagnosis with 2 years before. The risk for outpatient physician visits for substance-related disorders increased by 21% at 1 year (aRR, 1.21; 95% CI, 1.14-1.28) and 37% at 2 years (aRR, 1.37; 95% CI, 1.28-1.46).

CONCLUSIONS

The significant comorbid burden of mental disorders in adults with newly diagnosed asthma highlights the need for primary care physicians to assess mental health needs and provide appropriate care.

摘要

背景

由于日常生活活动减少和心理压力增加，哮喘患者的生活质量下降，这两者都与心理健康不良结局有关。

目的

本研究旨在量化精神障碍对成年哮喘人群的负担，并比较哮喘诊断前 1 年和后 1 年心理健康服务索赔 (MHSCs) 的风险。

方法

本研究纳入了 2005 年 4 月 1 日至 2012 年 3 月 31 日期间，有医生诊断的新发性哮喘的 25 至 65 岁安大略省居民。从全民健康管理数据中确定了 MHSCs，包括住院、急诊 (ED) 和门诊医生就诊。使用重复测量泊松回归模型来估计 MHSCs 在两个时间段的相对风险 (RR)：哮喘诊断后 1 年与前 1 年相比，以及后 2 年与前 2 年相比。

结果

共有 145881 名成年人患有新发性哮喘。在哮喘诊断后的 1 年内，有 27%的人有 MHSC。与前 1 年相比，在哮喘诊断后 1 年内，任何精神障碍的 ED 就诊风险增加了 13%（调整后 RR [aRR]，1.13；95%置信区间 [CI]，1.06-1.21）。当比较哮喘诊断后 2 年与前 2 年时，并未发现这种 ED 就诊风险增加。在 1 年内，物质相关障碍的门诊医生就诊风险增加了 21%（aRR，1.21；95%CI，1.14-1.28），在 2 年内增加了 37%（aRR，1.37；95%CI，1.28-1.46）。