精神障碍与后续医疗状况的关联。
Association between Mental Disorders and Subsequent Medical Conditions.
机构信息
From the National Center for Register-based Research (N.C.M., O.P.-R., E.A., M.K.C., S.D., J.-C.P.G.D., T.M.L., P.B.M., K.L.M., C.B.P., L.V.P., B.V., N.W., J.J.M.), Center for Integrated Register-based Research (E.A., P.B.M., C.B.P.), the Departments of Biomedicine-Human Genetics (A.D.B.) and Public Health (M.K.C., M.F.-G., K.M.I., M.V., A.P.), the Center for Integrative Sequencing (A.D.B.), and the Big Data Center for Environment and Health (C.B.P.), Aarhus University, the Lundbeck Foundation Initiative for Integrative Psychiatric Research (E.A., A.D.B., S.D., O.M., P.B.M., K.L.M., M.N., C.B.P., L.V.P., A.J.S., B.V., T.W.), the Center for Genomics and Personalized Medicine (A.D.B.), the Department of Neurology (J.-C.P.G.D.), and the Research Unit, Department of Psychosis (O.M.), Aarhus University Hospital, and the Research Unit for General Practice (M.F.-G., A.R.R., M.V., A.P.), Aarhus, the Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital (M.E.B., M.N., H.J.S.), Psychiatric Center Copenhagen (L.V.K.), Faculty of Health and Medical Sciences (L.V.K.), the Department of Clinical Medicine (T.W.), and the Lundbeck Foundation GeoGenetics Center, GLOBE Institute (T.W.), University of Copenhagen, Copenhagen, and the Institute of Biological Psychiatry, Mental Health Center Sankt Hans, Mental Health Services Capital Region, Roskilde (A.J.S., T.W.) - all in Denmark; the National Drug and Alcohol Research Centre, University of New South Wales, Sydney (L.D.), the Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, VIC (J.M.G.), and the Queensland Brain Institute (C.C.W.L., S.S., J.J.M.), Queensland Centre for Mental Health Research, the Park Centre for Mental Health (C.C.W.L., S.S., T.J.S., H.A.W., J.J.M.), and the School of Public Health, Faculty of Medicine (H.A.W.), University of Queensland, Brisbane - all in Australia; the Departments of Psychology (P.J.) and Developmental Psychology (A.M.R.), Heymans Institute, and the Interdisciplinary Center, Psychopathology and Emotion Regulation (P.J., A.M.R.), University of Groningen, Groningen, the Netherlands; the Department of Health Care Policy, Harvard Medical School, Boston (R.C.K.); the Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ (A.J.S.); the Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (K.M.S.); Sievert Consulting, Minneapolis (C.S.); and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (H.A.W.).
出版信息
N Engl J Med. 2020 Apr 30;382(18):1721-1731. doi: 10.1056/NEJMoa1915784.
BACKGROUND
Persons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions.
METHODS
We used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses.
RESULTS
A total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder.
CONCLUSIONS
Most mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753.).
背景
与一般人群相比，精神障碍患者随后发生某些医疗状况的风险更高。
方法
我们使用丹麦全国登记处的一项基于人群的队列，该队列包含了 1900 年至 2015 年期间出生于丹麦的 590 多万人的数据，并对他们进行了从 2000 年到 2016 年的随访，总计 8390 万人年。我们评估了 10 种广泛类型的精神障碍和 9 种广泛类别的医疗状况（包括 31 种具体疾病）。我们使用 Cox 回归模型，在调整年龄、性别、日历时间和既往精神障碍后，计算精神障碍和医疗状况对之间的总体危险比和时间依赖性危险比。使用竞争风险生存分析来估计绝对风险。
结果
在 5940299 人中，有 698874 人（11.8%）被确定为患有精神障碍。总人群的中位年龄在进入队列时为 32.1 岁，在最后一次随访时为 48.7 岁。与无精神障碍者相比，有精神障碍者有更高的风险发生 90 对精神障碍与医疗状况对中的 76 对。精神障碍与医疗状况之间关联的中位危险比为 1.37。最低的危险比为 0.82，见于器质性精神障碍和癌症的广泛类别（95%置信区间 [CI]，0.80 至 0.84），最高的危险比为 3.62，见于进食障碍和泌尿生殖系统疾病（95%CI，3.11 至 4.22）。一些特定的配对显示出风险降低（例如，精神分裂症与肌肉骨骼疾病）。风险随精神障碍诊断后时间的不同而变化。在精神障碍诊断后 15 年内发生医疗状况的绝对风险，从发育障碍患者的泌尿生殖系统疾病的 0.6%到器质性精神障碍患者的循环系统疾病的 54.1%不等。
结论
大多数精神障碍与随后发生医疗状况的风险增加相关；危险比范围为 0.82 至 3.62，且随精神障碍诊断后时间的不同而变化。（由丹麦国家研究基金会等资助；COMO-GMC ClinicalTrials.gov 编号：NCT03847753。）
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