Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Scotland, United Kingdom.
Schizophr Res. 2020 Feb;216:408-415. doi: 10.1016/j.schres.2019.10.061. Epub 2019 Nov 28.
Single physical comorbidities have been associated with the premature mortality in people with schizophrenia-spectrum disorders (SSD). We investigated the association of physical multimorbidity (≥two physical health conditions) with mortality in people with SSD.
A retrospective cohort study between 2013 and 2017. All people with a diagnosis of SSD (ICD-10: F20-F29), who had contact with secondary mental healthcare within South London during 2011-2012 were included. A novel semantic search system captured conditions from electronic mental health records, and all-cause mortality were retrieved. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for associations between physical multimorbidity and all-cause mortality.
Among the 9775 people with SSD (mean (SD) age, 45.9 (15.4); males, 59.3%), 6262 (64%) had physical multimorbidity, and 880 (9%) died during the 5-year follow-up. The top three physical multimorbidity combinations with highest mortality were cardiovascular-respiratory (HR: 2.23; 95% CI, 1.49-3.32), respiratory-skin (HR: 2.06; 95% CI, 1.31-3.24), and respiratory-digestive (HR: 1.88; 95% CI, 1.14-3.11), when adjusted for age, gender, and all other physical disease systems. Combinations of physical diseases with highest PAFs were cardiovascular-respiratory (PAF: 35.7%), neurologic-respiratory (PAF: 32.7%), as well as respiratory-skin (PAF: 29.8%).
Approximately 2/3 of patients with SSD had physical multimorbidity and the risk of mortality in these patients was further increased compared to those with none or single physical conditions. These findings suggest that in order to reduce the physical health burden and subsequent mortality in people with SSD, proactive coordinated prevention and management efforts are required and should extend beyond the current focus on single physical comorbidities.
单一躯体共病与精神分裂症谱系障碍（SSD）患者的过早死亡相关。我们研究了躯体多病（≥两种身体健康状况）与 SSD 患者死亡率之间的关系。
这是一项 2013 年至 2017 年进行的回顾性队列研究。所有在 2011-2012 年期间在伦敦南部二级精神卫生保健机构就诊并被诊断为 SSD（ICD-10：F20-F29）的患者均纳入研究。一个新的语义搜索系统从电子心理健康记录中捕获了病症，并且检索了所有原因的死亡率。计算了躯体多病与全因死亡率之间的关联的风险比（HR）和人群归因分数（PAF）。
在 9775 名 SSD 患者中（平均（SD）年龄 45.9（15.4）；男性占 59.3%），6262 名（64%）患者患有躯体多病，880 名（9%）在 5 年随访期间死亡。死亡率最高的三种躯体多病组合是心血管-呼吸系统（HR：2.23；95%CI，1.49-3.32）、呼吸系统-皮肤（HR：2.06；95%CI，1.31-3.24）和呼吸系统-消化系统（HR：1.88；95%CI，1.14-3.11），调整年龄、性别和所有其他躯体疾病系统后。具有最高 PAF 的躯体疾病组合是心血管-呼吸系统（PAF：35.7%）、神经-呼吸系统（PAF：32.7%）以及呼吸系统-皮肤（PAF：29.8%）。
大约 2/3 的 SSD 患者存在躯体多病，与无躯体疾病或仅有一种躯体疾病的患者相比，这些患者的死亡风险进一步增加。这些发现表明，为了降低 SSD 患者的身体健康负担和随后的死亡率，需要采取积极主动的协调预防和管理措施，并且应该超越目前对单一躯体共病的关注。
