Clalit Research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel; Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom.
Parkinsonism Relat Disord. 2017 Oct;43:92-96. doi: 10.1016/j.parkreldis.2017.07.032. Epub 2017 Aug 1.
The purpose of this study was to evaluate the relationship between adherence to antidepressants (AD) and all-cause mortality in a population-based cohort of patients with Parkinson's Disease (PD).
From a database of more than 4 million people, 8553 patients with PD who purchased an AD at least once between the years 2008-2011 were retrospectively followed for all-cause mortality over 4-years. Adherence was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n = 1566), poor (20%-50%, n = 1184), moderate (50%-80%, n = 1584), and good (>80%, n = 4219) adherence. Multivariable survival analyses adjusted for demographic and clinical variables including physical comorbidities known to influence mortality were conducted, however there was no adjustment for other psychiatric disorders and medications.
Unadjusted mortality rates were 20.4%, 25.1%, 23.4% and 25.6% in those classified as non-adherent, poor, moderate and good adherence respectively (χ2 = 18.45, p < 0.0001). The non-adherent and poor adherence groups had significantly increased adjusted mortality hazard ratios (HR) of 1.43 (CI: 1.26-1.62) and 1.26 (CI: 1.1-1.44) respectively compared to the good adherence group. Using the same model, the adjusted HR for death among males was 1.49 [95% CI: 1.36-1.62] compared to females. People with PD and Charslon's Comorbidity Index score of 3-4 (HR 1.3, P < 0.001) and 5+ (HR 1.78, P < 0.001) were more likely to die than those with 0-2 comorbidities.
Our findings suggest that poor adherence to AD is associated with increased all-cause mortality in people with PD. Given the high prevalence of depression and AD effectiveness, efforts to promote adherence should be prioritized in clinical practice.
本研究旨在评估在帕金森病（PD）患者的基于人群队列中，抗抑郁药（AD）依从性与全因死亡率之间的关系。
从一个超过 400 万人的数据库中，回顾性地随访了 2008 年至 2011 年间至少购买过一次 AD 的 8553 名 PD 患者，随访 4 年全因死亡率。依从性以配药与处方持续时间的比值来衡量，并分为：不依从（<20%，n=1566）、差（20%-50%，n=1184）、中（50%-80%，n=1584）和高（>80%，n=4219）。进行了多变量生存分析，调整了包括已知影响死亡率的身体合并症在内的人口统计学和临床变量，但未对其他精神障碍和药物进行调整。
未调整的死亡率分别为不依从、差、中、高组的 20.4%、25.1%、23.4%和 25.6%（χ2=18.45，p<0.0001）。与高依从性组相比，不依从和差依从组的调整后全因死亡率的危险比（HR）分别显著增加 1.43（95%CI：1.26-1.62）和 1.26（95%CI：1.1-1.44）。使用相同模型，与女性相比，男性 PD 患者的调整后死亡 HR 为 1.49[95%CI：1.36-1.62]。Charlson's 合并症指数评分 3-4（HR 1.3，P<0.001）和 5+（HR 1.78，P<0.001）的 PD 患者比 0-2 种合并症患者更有可能死亡。
我们的研究结果表明，PD 患者 AD 依从性差与全因死亡率增加相关。鉴于抑郁症和 AD 有效性的高患病率，应优先在临床实践中努力提高依从性。
