Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong.
Br J Psychiatry. 2021 Jul;219(1):375-382. doi: 10.1192/bjp.2020.248.
Schizophrenia patients have markedly elevated prevalence of diabetes compared with the general population. However, risk of mortality and diabetes-related complications among schizophrenia patients with co-occurring diabetes is understudied.
We investigated whether schizophrenia increased the risk of overall mortality, complications and post-complication mortality in people with diabetes.
This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68 682 patients with incident diabetes only between 2001 and 2016 in Hong Kong using a medical record database of public healthcare services. Association between schizophrenia and all-cause mortality was examined with a Cox proportional hazards model. Effect of schizophrenia on first-year complication occurrence following diabetes diagnosis and post-complication mortality rates were evaluated.
Schizophrenia was associated with increased all-cause mortality (adjusted hazards ratio [aHR] 1.11, 95% CI 1.05-1.18), particularly among men and older age groups. Schizophrenia patients with diabetes had higher metabolic complication rate (aHR 1.99, 95% CI 1.63-2.42), lower microvascular complication rate (aHR 0.75, 95% CI 0.65-0.86) and comparable macrovascular complication rate (aHR 0.93, 95% CI 0.85-1.03), relative to patients with diabetes only. Among patients with diabetes complications, schizophrenia was associated with elevated all-cause mortality after macrovascular (aHR 1.19, 95% CI 1.04-1.37) and microvascular (aHR 1.33, 95% CI 1.08-1.64) complications. Gender-stratified analyses revealed that a significant effect of schizophrenia on heightened post-complication mortality was observed in men only.
Schizophrenia patients with co-occurring diabetes are at increased risk of excess mortality, including post-complication mortality. Further research identifying effective interventions is warranted to optimise diabetes-related outcomes in this vulnerable population.
与普通人群相比，精神分裂症患者的糖尿病患病率明显升高。然而，同时患有精神分裂症和糖尿病的患者的死亡率和糖尿病相关并发症风险仍研究不足。
我们旨在研究精神分裂症是否会增加糖尿病患者的总体死亡率、并发症发生率和并发症后死亡率。
本项基于人群的倾向评分匹配（1:10）队列研究，使用香港公共医疗服务的医疗记录数据库，于 2001 年至 2016 年间，共纳入 6991 例患有新发糖尿病和既往精神分裂症的患者和 68682 例仅患有新发糖尿病的患者。采用 Cox 比例风险模型评估精神分裂症与全因死亡率之间的关系。评估精神分裂症对糖尿病诊断后第一年并发症发生率和并发症后死亡率的影响。
精神分裂症与全因死亡率增加相关（调整后的风险比[aHR]1.11，95%置信区间[CI]1.05-1.18），尤其是在男性和老年人群中。与仅患有糖尿病的患者相比，患有糖尿病的精神分裂症患者的代谢并发症发生率更高（aHR 1.99，95%CI 1.63-2.42），微血管并发症发生率更低（aHR 0.75，95%CI 0.65-0.86），大血管并发症发生率相似（aHR 0.93，95%CI 0.85-1.03）。在患有糖尿病并发症的患者中，精神分裂症与大血管（aHR 1.19，95%CI 1.04-1.37）和微血管（aHR 1.33，95%CI 1.08-1.64）并发症后的全因死亡率升高相关。性别分层分析显示，精神分裂症对男性患者的并发症后死亡率升高的影响显著。
同时患有精神分裂症和糖尿病的患者死亡风险增加，包括并发症后死亡率。需要进一步研究确定有效的干预措施，以优化这一脆弱人群的糖尿病相关结局。
