酒精和其他物质使用障碍对饮食失调患者死亡率的影响：一项基于全国登记的回顾性队列研究。

The Impact of Alcohol and Other Substance Use Disorders on Mortality in Patients With Eating Disorders: A Nationwide Register-Based Retrospective Cohort Study.

作者信息

Mellentin Angelina Isabella, Mejldal Anna, Guala Maria Mercedes, Støving René Klinkby, Eriksen Lene Stryhn, Stenager Elsebeth, Skøt Lotte

机构信息

Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager).

出版信息

Am J Psychiatry. 2022 Jan;179(1):46-57. doi: 10.1176/appi.ajp.2021.21030274.

DOI:10.1176/appi.ajp.2021.21030274

PMID:34974750

Abstract

OBJECTIVE

Research is lacking on the contribution of different types of substance use disorders (SUDs) to excess mortality across the full spectrum of eating disorders. The authors assessed the association of alcohol use disorders and other SUDs with mortality in anorexia nervosa, bulimia nervosa, and unspecified eating disorder compared with matched control subjects.

METHODS

A retrospective cohort study was conducted using Danish nationwide registers. The study included 20,759 patients with eating disorders and 83,036 matched control subjects. Hazard ratios were calculated to compare all-cause mortality risk between eating disorder patients and control subjects both with and without a lifetime SUD diagnosis (abuse or dependence of alcohol, cannabis, or hard drugs).

RESULTS

For patients with each type of eating disorder, a higher risk of all-cause mortality was observed relative to control subjects without SUDs among those who abused alcohol and/or cannabis (adjusted hazard ratios for the anorexia nervosa, bulimia nervosa, and unspecified eating disorder patients, respectively, were 11.28 [95% CI=7.01, 18.16], 5.86 [95% CI=3.37, 10.1], and 10.86 [95% CI=6.74, 17.50]), or hard drugs alone or in combination with alcohol and/or cannabis (adjusted hazard ratios, respectively, were 22.34 [95% CI=15.13, 33.00], 11.43 [95% CI=7.14, 18.28], and 15.53 [95% CI=10.15, 23.78]), than in those without SUDs (adjusted hazard ratios, respectively, were 3.21 [95% CI=2.43, 4.23], 1.24 [95% CI=0.88, 1.77], and 4.75 [95% CI=3.57, 6.31]). Control subjects with SUDs also exhibited an elevated risk of all-cause mortality relative to control subjects without SUDs, although to a much lesser extent than eating disorder patients with SUDs.

CONCLUSIONS

SUDs have an additive effect on excess mortality in patients with eating disorders. The prevention and treatment of SUDs in this patient group is thus imperative to reduce mortality.

摘要

目的

关于不同类型物质使用障碍（SUDs）对全谱系饮食失调患者超额死亡率的影响，目前研究尚缺。作者评估了酒精使用障碍及其他SUDs与神经性厌食症、神经性贪食症及未特定的饮食失调患者死亡率之间的关联，并与匹配的对照受试者进行比较。

方法

利用丹麦全国登记系统进行了一项回顾性队列研究。该研究纳入了20759例饮食失调患者及83036例匹配的对照受试者。计算风险比，以比较有或无终生SUD诊断（酒精、大麻或硬性毒品滥用或依赖）的饮食失调患者与对照受试者之间的全因死亡风险。

结果

对于每种类型的饮食失调患者，与无SUDs的对照受试者相比，滥用酒精和/或大麻者（神经性厌食症、神经性贪食症及未特定的饮食失调患者的校正风险比分别为11.28[95%CI=7.01,18.16]、5.86[95%CI=3.37,10.1]和10.86[95%CI=6.74,17.50]），或单独滥用硬性毒品或与酒精和/或大麻联合滥用者（校正风险比分别为22.34[95%CI=15.13,33.00]、11.43[95%CI=7.14,18.28]和15.53[95%CI=10.15,23.78]）的全因死亡风险更高，高于无SUDs者（校正风险比分别为3.21[95%CI=2.43,4.23]、1.24[95%CI=0.88,1.77]和4.75[95%CI=3.57,6.31]）。有SUDs的对照受试者与无SUDs的对照受试者相比，全因死亡风险也有所升高，尽管程度远低于有SUDs的饮食失调患者。