Yorke Elisabeth, Toulany Alene, Chiu Maria, Gandhi Sima, Guttmann Astrid, Emerson Scott D, Kurdyak Paul, Vigod Simone, Fung Kinwah, Saunders Natasha
Department of General Academic Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada.
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
J Adolesc Health. 2023 Oct;73(4):715-723. doi: 10.1016/j.jadohealth.2023.05.031. Epub 2023 Jul 4.
To measure trends in the rates and costs of hospitalizations over a 15-year period among young adults with physical and/or psychiatric disorders.
This population-based, repeated cross-sectional study identified all 18- to 26- year-olds hospitalized in Ontario, Canada from April 1, 2003 and March 31, 2018 (fiscal years 2003-2017). Using discharge diagnoses, we assigned hospitalizations to one of four categories: 1) psychiatric disorder only; 2) primary psychiatric disorder with comorbid physical illness; 3) primary physical with comorbid psychiatric disorder; and 4) physical illness only. We compared health service utilization and changes in rates of hospitalizations over time using restricted cubic spline regression. Secondary outcome measures included change in hospital costs for each hospitalization category over the study period.
Of 1,076,951 hospitalizations in young adults (73.7% female), 195,726 (18.2%) had a psychiatric disorder (either primary or comorbid). There were 129,676 hospitalizations (12.0%) with psychiatric disorders only, 36,287 (3.4%) with primary psychiatric and comorbid physical disorders, 29,763 (2.8%) with primary physical and comorbid psychiatric disorders, and 881,225 (81.8%) with physical disorders only. Rates of hospitalization for psychiatric disorders only increased 81% from 4.32 to 7.84/1,000 population, and those with physical health disorders with comorbid psychiatric disorders increased 172% from 0.47 to 1.28/1,000 population. Substance-related disorders were the most common comorbid psychiatric disorders among youth hospitalized for physical illness and increased 260% from 0.9 to 3.3/1,000 population.
Hospitalizations among young adults with primary and comorbid psychiatric disorders have increased significantly over the past 15 years. Health system resources should be adequately directed to meet the shifting and complex needs of hospitalized young adults.
测量15年间患有身体和/或精神疾病的年轻成年人的住院率及住院费用趋势。
这项基于人群的重复横断面研究确定了2003年4月1日至2018年3月31日（2003 - 2017财年）在加拿大安大略省住院的所有18至26岁的年轻人。利用出院诊断，我们将住院情况分为四类之一：1）仅患有精神疾病；2）患有原发性精神疾病并伴有躯体疾病；3）患有原发性躯体疾病并伴有精神疾病；4）仅患有躯体疾病。我们使用受限立方样条回归比较了卫生服务利用情况以及住院率随时间的变化。次要结局指标包括研究期间各住院类别住院费用的变化。
在1,076,951例年轻成年人住院病例中（73.7%为女性），195,726例（18.2%）患有精神疾病（原发性或合并性）。仅患有精神疾病的住院病例有129,676例（12.0%），患有原发性精神疾病并伴有躯体疾病的有36,287例（3.4%），患有原发性躯体疾病并伴有精神疾病的有29,763例（2.8%），仅患有躯体疾病的有881,225例（81.8%）。仅患有精神疾病的住院率从4.32/1000人口增加到7.84/1000人口，增长了81%，患有躯体健康疾病并伴有精神疾病的住院率从0.47/1000人口增加到1.28/1000人口，增长了172%。物质相关障碍是因躯体疾病住院的年轻人中最常见的合并精神疾病，从0.9/1000人口增加到3.3/1000人口，增长了260%。
在过去15年中，患有原发性和合并性精神疾病的年轻成年人的住院率显著增加。卫生系统资源应得到合理分配，以满足住院年轻成年人不断变化的复杂需求。
