Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Aliat Hanoar 13, Hod Hasharon, Israel.
Department of Behavioral Sciences, Ariel University, 40700, Israel; Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Aliat Hanoar 13, Hod Hasharon, Israel.
Schizophr Res. 2019 Oct;212:121-125. doi: 10.1016/j.schres.2019.07.058. Epub 2019 Aug 6.
Schizophrenia patients smoke at three times the rate of the general population, and are more susceptible to smoking-related illnesses. The goal of the current study was to evaluate the cumulative probability of chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) following first documentation of smoking among schizophrenia patients as compared to smoking healthy controls.
A nationally representative cohort study was designed to assess the odds and cumulative probability of COPD and IHD among individuals with schizophrenia (n = 10,502) and a matched-sample of smoking healthy controls (n = 10,502). Hierarchical logistic regressions and Kaplan-Meier regression models were used to compare odds and cumulative probabilities across the two groups.
After adjusting for clinical and demographic factors, smoking schizophrenia patients had a higher probability of receiving a diagnosis of COPD than smoking healthy controls (OR 2.14, 95%CI 1.51-3.01, p < 0.001). The probability of having COPD increased more rapidly in smoking schizophrenia patients, yet the opposite trajectory prevailed for IHD, showing a decreased cumulative probability in smoking schizophrenia patients compared to smoking healthy controls.
Schizophrenia has a unique contribution to the facilitation of COPD, which extends beyond the effect of smoking, or other clinical and demographic risk factors. Differential smoking patterns could potentially account for this effect. The differential pattern of IHD should be subjected to further research, as our results might indicate that schizophrenia patients are underdiagnosed with IHD, and may be even less diagnosed as a function of time and chronicity.
精神分裂症患者吸烟的比率是普通人群的三倍，并且更容易患上与吸烟相关的疾病。本研究的目的是评估首次记录吸烟后精神分裂症患者发生慢性阻塞性肺疾病（COPD）和缺血性心脏病（IHD）的累积概率，并与吸烟的健康对照者进行比较。
本研究采用全国代表性队列研究，旨在评估精神分裂症患者（n=10502）和匹配的吸烟健康对照者（n=10502）中 COPD 和 IHD 的比值比和累积概率。采用分层逻辑回归和 Kaplan-Meier 回归模型比较两组的比值比和累积概率。
在调整临床和人口统计学因素后，吸烟的精神分裂症患者比吸烟的健康对照者更有可能被诊断为 COPD（OR 2.14，95%CI 1.51-3.01，p<0.001）。吸烟的精神分裂症患者发生 COPD 的概率增加更快，但 IHD 的轨迹相反，与吸烟的健康对照者相比，吸烟的精神分裂症患者的累积概率降低。
精神分裂症对 COPD 的促进作用具有独特性，这种作用超出了吸烟或其他临床和人口统计学危险因素的影响。不同的吸烟模式可能是导致这种作用的原因。IHD 的不同模式应该进一步研究，因为我们的结果可能表明精神分裂症患者被漏诊为 IHD，并且随着时间和慢性的推移，他们的诊断率可能更低。
