InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia.
Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
Epidemiol Psychiatr Sci. 2021 Mar 10;30:e22. doi: 10.1017/S204579602100007X.
Mental health (MH) service users have increased prevalence of chronic physical conditions such as cardio-respiratory diseases and diabetes. Potentially Preventable Hospitalisations (PPH) for physical health conditions are an indicator of health service access, integration and effectiveness, and are elevated in long term studies of people with MH conditions. We aimed to examine whether PPH rates were elevated in MH service users over a 12-month follow-up period more suitable for routine health indicator reporting. We also examined whether MH service users had increased PPH rates at a younger age, potentially reflecting the younger onset of chronic physical conditions.
A population-wide data linkage in New South Wales (NSW), Australia, population 7.8 million. PPH rates in 178 009 people using community MH services in 2016-2017 were compared to population rates. Primary outcomes were crude and age- and disadvantage-standardised annual PPH episode rate (episodes per 100 000 population), PPH day rate (hospital days per 100 000) and adjusted incidence rate ratios (AIRR).
MH service users had higher rates of PPH admission (AIRR 3.6, 95% CI 3.5-3.6) and a larger number of hospital days (AIRR 5.2, 95% CI 5.2-5.3) than other NSW residents due to increased likelihood of admission, more admissions per person and longer length of stay. Increases were greatest for vaccine-preventable conditions (AIRR 4.7, 95% CI 4.5-5.0), and chronic conditions (AIRR 3.7, 95% CI 3.6-3.7). The highest number of admissions and relative risks were for respiratory and metabolic conditions, including chronic obstructive airways disease (AIRR 5.8, 95% CI 5.5-6.0) and diabetic complications (AIRR 5.4, 95% CI 5.1-5.8). One-quarter of excess potentially preventable bed days in MH service users were due to vaccine-related conditions, including vaccine-preventable respiratory illness. Age-related increases in risk occurred earlier in MH service users, particularly for chronic and vaccine-preventable conditions. PPH rates in MH service users aged 20-29 were similar to population rates of people aged 60 and over. These substantial differences were not explained by socio-economic disadvantage.
PPHs for physical health conditions are substantially increased in people with MH conditions. Short term (12-month) PPH rates may be a useful lead indicator of increased physical morbidity and less accessible, integrated or effective health care. High hospitalisation rates for vaccine-preventable respiratory infections and hepatitis underline the importance of vaccination in MH service users and suggests potential benefits of prioritising this group for COVID-19 vaccination.
精神健康（MH）服务使用者患有心血管疾病和糖尿病等慢性身体疾病的比例较高。潜在可预防的住院治疗（PPH）是身体健康状况的一个指标，反映了卫生服务的可及性、整合程度和效果，在对 MH 患者的长期研究中也有所升高。我们旨在研究在更适合常规健康指标报告的 12 个月随访期间，MH 服务使用者的 PPH 率是否升高。我们还研究了 MH 服务使用者是否在更年轻的时候就有更高的 PPH 率，这可能反映出慢性身体疾病的发病年龄更早。
这是一项在澳大利亚新南威尔士州（NSW）进行的全人群数据关联研究，该州人口为 780 万。2016-2017 年，比较了 178009 名使用社区 MH 服务的人群的 PPH 率与人群率。主要结局指标是未经年龄和劣势调整的年度 PPH 发病例数（每 10 万人中的发病例数）、PPH 日数（每 10 万人中的住院天数）和调整后的发病率比值比（AIRR）。
MH 服务使用者的 PPH 入院率（AIRR 3.6，95%CI 3.5-3.6）和住院天数（AIRR 5.2，95%CI 5.2-5.3）均高于其他新南威尔士州居民，这是由于入院的可能性增加、每人入院次数增加和住院时间延长所致。疫苗可预防疾病（AIRR 4.7，95%CI 4.5-5.0）和慢性疾病（AIRR 3.7，95%CI 3.6-3.7）的增幅最大。呼吸道和代谢性疾病（包括慢性阻塞性气道疾病（AIRR 5.8，95%CI 5.5-6.0）和糖尿病并发症（AIRR 5.4，95%CI 5.1-5.8）的入院人数和相对风险最高。MH 服务使用者中，25%的多余潜在可预防床位日是由疫苗相关疾病引起的，包括疫苗可预防的呼吸道疾病。在 MH 服务使用者中，与年龄相关的风险增加发生得更早，尤其是慢性疾病和疫苗可预防疾病。20-29 岁的 MH 服务使用者的 PPH 率与 60 岁及以上人群的 PPH 率相似。这些显著差异不能用社会经济劣势来解释。
MH 患者的身体健康状况的 PPH 显著增加。短期（12 个月）PPH 率可能是身体健康恶化和医疗服务可及性、整合程度或效果降低的有用指标。疫苗可预防呼吸道感染和肝炎的高住院率强调了 MH 服务使用者接种疫苗的重要性，并表明优先为这一人群接种 COVID-19 疫苗可能会带来益处。
