生育期患有和不患有风湿性疾病的女性产后抑郁症：基于人群的匹配队列研究。

Postpartum Depression in Reproductive-Age Women With and Without Rheumatic Disease: A Population-Based Matched Cohort Study.

机构信息

D. Shridharmurthy, MMBS, MPH, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, Massachusetts.

K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts.

出版信息

J Rheumatol. 2023 Oct;50(10):1287-1295. doi: 10.3899/jrheum.2023-0105. Epub 2023 Jul 1.

DOI:10.3899/jrheum.2023-0105

PMID:37399461

Abstract

OBJECTIVE

To examine postpartum depression (PPD) among women with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) in comparison with a matched population without rheumatic disease (RD).

METHODS

A retrospective analysis using the 2013-2018 IBM MarketScan Commercial Claims and Encounters Database was conducted. Pregnant women with axSpA, PsA, or RA were identified, and the delivery date was used as the index date. We restricted the sample to women ≤ 55 years with continuous enrollment ≥ 6 months before date of last menstrual period and throughout pregnancy. Each patient was matched with 4 individuals without RD on: (1) maternal age at delivery, (2) prior history of depression, and (3) duration of depression before delivery. Cox frailty proportional hazards models estimated the crude and adjusted hazard ratios (aHR) and 95% CI of incident postpartum depression within 1 year among women with axSpA, PsA, or RA (axSpA/PsA/RA cohort) compared to the matched non-RD comparison group.

RESULTS

Overall, 2667 women with axSpA, PsA, or RA and 10,668 patients without any RD were included. The median follow-up time in days was 256 (IQR 93-366) and 265 (IQR 99-366) for the axSpA/PsA/RA cohort and matched non-RD comparison group, respectively. Development of PPD was more common in the axSpA/PsA/RA cohort relative to the matched non-RD comparison group (axSpA/PsA/RA cohort: 17.2%; matched non-RD comparison group: 12.8%; aHR 1.22, 95% CI 1.09-1.36).

CONCLUSION

Postpartum depression is significantly higher in women of reproductive age with axSpA/PsA/RA when compared to those without RD.

摘要

目的

比较患有中轴型脊柱关节炎（axSpA）、银屑病关节炎（PsA）或类风湿关节炎（RA）的女性与无风湿性疾病（RD）的匹配人群的产后抑郁症（PPD）。

方法

使用 2013-2018 年 IBM MarketScan 商业索赔和就诊数据库进行回顾性分析。确定患有 axSpA、PsA 或 RA 的孕妇，并将分娩日期作为索引日期。我们将样本限制为≤55 岁的女性，其在末次月经前 6 个月及整个妊娠期间连续入组。每位患者与无 RD 的 4 名个体进行匹配：（1）分娩时的产妇年龄；（2）既往抑郁症病史；（3）分娩前抑郁症的持续时间。Cox 脆弱性比例风险模型估计了 axSpA、PsA 或 RA 女性（axSpA/PsA/RA 队列）与匹配的无 RD 对照组相比，在产后 1 年内发生产后抑郁症的粗风险比（crude hazard ratio，cHR）和调整后风险比（adjusted hazard ratio，aHR）及其 95%置信区间。

结果

总体而言，纳入了 2667 名 axSpA、PsA 或 RA 女性和 10668 名无任何 RD 的患者。axSpA/PsA/RA 队列和匹配的无 RD 对照组的中位随访天数分别为 256（IQR 93-366）和 265（IQR 99-366）。与匹配的无 RD 对照组相比，axSpA/PsA/RA 队列中 PPD 的发病更为常见（axSpA/PsA/RA 队列：17.2%；匹配的无 RD 对照组：12.8%；aHR 1.22，95%CI 1.09-1.36）。