Department of Psychological Medicine, King's College London, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2019 Jul;54(7):813-821. doi: 10.1007/s00127-019-01667-0. Epub 2019 Feb 11.
Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality.
We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score.
A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates.
These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.
神经性贪食症（BN）与死亡率增加有关。BN 的常见合并症包括物质使用障碍、情感障碍和人格障碍（PD）。这些合并症可能会增加死亡率的额外风险。
我们使用南伦敦和莫兹利国民保健信托基金会（SLaM）通过其临床记录交互搜索（CRIS）数据资源从匿名健康记录数据中检索到的从 2007 年 1 月至 2016 年 3 月对 1501 名 BN 患者进行的观察，研究了这些精神合并症对全因死亡率的影响，将人口统计学和社会经济因素作为混杂因素。通过与国家统计局（ONS）管理的全国追踪系统每月进行链接来确定死亡率。我们使用 Cox 比例风险回归计算危险比（HR）及其 95%置信区间（CI）。还进行了多变量分析，以在控制混杂因素（年龄、性别、种族、行政区、婚姻状况和贫困评分）时估计效果。
在观察期间，共有 18 名 BN 患者死亡。我们研究队列的标准化死亡率（SMR）与 2012 年英格兰和威尔士的人口标准相比为 2.52（95%CI 1.49-3.97）。Cox 回归显示死亡率与年龄较大和男性性别显著相关。合并 PD（HR：3.36；95%CI 1.05-10.73）与全因死亡率显著相关，即使在控制了人口统计学和社会经济混杂因素后也是如此。
这些结果强调了 BN 患者死亡率增加的情况，以及识别和治疗 BN 患者 PD 的重要性。
