双相障碍患者道路伤害的风险及其与药物治疗的关系：基于人群的匹配队列研究。

Risks of road injuries in patients with bipolar disorder and associations with drug treatments: A population-based matched cohort study.

机构信息

Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.

School of Medicine, Chang Gung University, Taoyuan, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health, Taipei, Taiwan.

出版信息

J Affect Disord. 2018 Jan 15;226:124-131. doi: 10.1016/j.jad.2017.09.029. Epub 2017 Sep 23.

DOI:10.1016/j.jad.2017.09.029

PMID:28972929

Abstract

OBJECTIVE

Using a nation-wide, population-based dataset, we aimed to investigate the risk of road injury among individuals with bipolar disorder (BD) compared to individuals without BD. In addition, we investigated the putative moderating effects of prescription for lithium, anticonvulsants, antidepressants, and/or first- or second-generation antipsychotic agents on the association between BD and risk of road injury.

METHOD

As part of an16-year longitudinal cohort study, we compared the risk of road injuries among study subjects aged 16 and above with a diagnosis of BD, with ten age- and sex-matched sample of individuals without BD. Individuals were compared on measures of incidence on road injuries using medical claims data based on the ICD-9-CM codes: E800~~807, E810~~817, E819~~830, E840~~848. Time dependent Cox regression models were used to adjust for time-varying covariates such as age, and medication uses. Hazard ratios before and after adjusting for age, sex, other comorbidities, and drug use were calculated.

RESULTS

3953 people with BD were matched with 39,530 controls from general population. Adjusted hazard ratios revealed a 1.66-fold (95% CI 1.40-1.97) increase in risk of road injuries among bipolar subjects when compared to controls. Female gender, older age (i.e. over 80), residence in areas of highest levels of urbanization, and use of antidepressants were associated with a lower risk of road injuries.

CONCLUSIONS

In this large, national, population-based cohort, BD was associated with an elevated risk of road injuries. However, prescriptions of antidepressants might help mitigate the foregoing risk.

摘要

目的

利用全国性的基于人群的数据集，我们旨在调查与未患双相情感障碍（BD）的个体相比，个体患有双相情感障碍的道路伤害风险。此外，我们还研究了锂、抗惊厥药、抗抑郁药和/或第一代或第二代抗精神病药物处方对 BD 与道路伤害风险之间关联的潜在调节作用。

方法

作为一项为期 16 年的纵向队列研究的一部分，我们比较了患有 BD 的年龄在 16 岁及以上的研究对象与未患 BD 的年龄和性别匹配的 10 名个体的道路伤害风险。使用基于 ICD-9-CM 代码的医疗索赔数据（E800~~807、E810~~817、E819~~830、E840~~848）来比较个体在道路伤害发生率方面的差异。使用时间依赖 Cox 回归模型来调整年龄、药物使用等随时间变化的混杂因素。计算了调整年龄、性别、其他合并症和药物使用后之前和之后的风险比。

结果

3953 名 BD 患者与普通人群中的 39530 名对照者相匹配。调整后的风险比显示，与对照组相比，双相情感障碍患者发生道路伤害的风险增加了 1.66 倍（95%CI 1.40-1.97）。女性性别、年龄较大（即 80 岁以上）、居住在城市化水平最高的地区以及使用抗抑郁药与较低的道路伤害风险相关。