Family Medicine Residency Program, Kaiser Permanente, San Diego, CA.
Division of Biostatistics, Department of Research & Evaluation, Kaiser Permanente, Pasadena, CA.
Mayo Clin Proc. 2019 Oct;94(10):1983-1993. doi: 10.1016/j.mayocp.2019.04.037. Epub 2019 Aug 16.
To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population.
Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls.
In the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls.
Compared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits.
在一个大型美国代表性人群中，比较自杀死者与生存对照者在自杀前一年的医疗保健使用情况。
病例（n=1221）和对照（n=3663）属于 2009 年 1 月 1 日至 2014 年 12 月 31 日期间的一个综合医疗保健系统。病例和对照者按照年龄和性别以 1:3 的比例匹配，使用诊断和/或计费代码来列举和分类自杀前一年的医疗保健就诊情况。通过条件逻辑回归对就诊类型与自杀的关联进行匹配分析。使用广义估计方程模型比较病例和对照者就诊时间和频率。
在死亡前一年，病例有更高的住院和急诊非心理健康就诊的可能性（比值比 [OR]，1.55；95%置信区间 [CI]，1.27-1.88；P<.001 和 OR，1.42；95%CI，1.26-1.60；P<.001），但非心理健康门诊就诊可能性没有增加（OR，1.00；95%CI，0.99-1.01；P=.63）。与对照组相比，死者更接近自杀死亡，自杀前 3 个月的就诊次数明显更多（6 次比 2 次；P=.01），但自杀前 9 至 12 个月就诊次数没有差异（4 次比 2 次；P=.07）。在所有时间点，病例比对照组使用更多的心理健康保健服务。
与对照组相比，自杀死者的急诊就诊和更多的住院治疗，包括心理健康和非心理健康相关的治疗。随着死亡的临近，病例的医疗保健使用频率增加。病例和对照组唯一没有差异的类别是门诊非心理健康就诊的频率。
