Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia.
Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia.
J Psychiatr Res. 2019 Apr;111:104-109. doi: 10.1016/j.jpsychires.2019.01.015. Epub 2019 Jan 21.
In the general population, people with mental disorders have increased mortality. This association, however, has not been explored in a population who at some time were inpatients of a public hospital.
The sampling frame was patients admitted to an Australian regional public hospital 1996-2010. Those with known mental disorder were compared with an equal number of randomly selected patients without known mental disorder, matched for age, sex, and year of admission. Mortality outcomes were determined by linkage of hospital data and the National Death Index.
We identified 15,356 patients with mental disorder and 15,356 without known mental disorder, 25.2% of the former and 17.3% of the latter died during the study period. The odds ratio (OR) for death in those with mental disorder was 2.20 (95% confidence interval: 2.01-2.41) after adjusting for confounders, and their mean age at death was 4.6 years younger (p < 0.001). Other independent risk factors for mortality were being Indigenous (OR 1.72, 1.32-2.24), not partnered (OR 1.55, 1.36-1.76) or having multiple comorbidities (OR 1.65, 1.43-1.90). In the model that included multiple interactions, the ORs for death in Indigenous patients with mental disorder were markedly higher (6.6-9.5), regardless of other risk factors.
Among patients with a history of public hospital admission, those with mental disorders have higher mortality than those without mental disorders. This gap in life expectancy mandates increased attention, by clinicians and health services alike, to preventable causes of death in people with mental illness.
在一般人群中，患有精神障碍的人群死亡率较高。然而，这一关联尚未在曾经住院的人群中进行研究。
抽样框架是 1996 年至 2010 年在澳大利亚一家地区公立医院住院的患者。将已知患有精神障碍的患者与数量相等、年龄、性别和入院年份相匹配的无已知精神障碍的随机选择患者进行比较。通过医院数据和国家死亡指数的链接确定死亡率结果。
我们确定了 15356 名患有精神障碍和 15356 名无已知精神障碍的患者，前者中有 25.2%，后者中有 17.3%在研究期间死亡。在调整混杂因素后，患有精神障碍的患者死亡的优势比（OR）为 2.20（95%置信区间：2.01-2.41），他们的平均死亡年龄年轻了 4.6 岁（p<0.001）。死亡率的其他独立危险因素包括土著人（OR 1.72，1.32-2.24）、非伴侣（OR 1.55，1.36-1.76）或多种合并症（OR 1.65，1.43-1.90）。在包含多个相互作用的模型中，患有精神障碍的土著患者的死亡风险比明显更高（6.6-9.5），无论其他危险因素如何。
在有公立医院住院史的患者中，患有精神障碍的患者死亡率高于没有精神障碍的患者。这种预期寿命差距需要临床医生和卫生服务机构共同关注，以预防精神疾病患者的可预防死因。
