在精神科和综合医疗环境中接受治疗的成年精神障碍患者的超额死亡率：一项基于日本市政医疗索赔数据的人群队列研究。

Excess mortality among adults with mental disorders treated in psychiatric and general medical settings: A population-based cohort study using municipal medical claims data in Japan.

作者信息

Kuroda Naoaki, Tamiya Nanako

机构信息

Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan; Health Department, Tsukuba City, 1-1-1 Kenkyu-Gakuen, Tsukuba, Ibaraki 305-0817, Japan; Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan.

Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan.

出版信息

Asian J Psychiatr. 2023 Oct;88:103719. doi: 10.1016/j.ajp.2023.103719. Epub 2023 Jul 31.

DOI:10.1016/j.ajp.2023.103719

PMID:37567083

Abstract

OBJECTIVES

To estimate the excess mortality associated with serious mental illnesses (schizophrenia and bipolar disorder) and common mental disorders (depression and anxiety) at the population level.

METHODS

We conducted a population-based, retrospective cohort study in Tsukuba, Japan. Individuals aged 20-74 years and insured for at least 12 months by the National Health Insurance or Late Elders' Health Insurance as of April 2015 were included (n = 41,618, 29% of the city's population aged 20-74 years). Individuals with mental disorders (International Classification of Diseases-10 code: F00-F99) were identified in psychiatric and general medical services using medical claims during the 12-month baseline period and classified into mutually exclusive diagnostic subgroups. Their age/sex-adjusted all-cause mortality rate ratios (aMRRs) were estimated and compared to those of individuals without mental disorders.

RESULTS

Altogether, 12.0% of participants had mental disorders (general medical service: 7.2% vs. psychiatric service: 4.8%). Common mental disorders were the most prevalent (8.1%). During the median 48 months of observation, 225 deaths were observed in people with mental disorders. The aMRR was 1.98 (95%CI: 1.70-2.29) for all mental disorders, with a higher rate ratio in psychiatric service than in general medical service users (aMRR: 2.64 [2.12-3.29] vs. 1.70 [1.42-2.04]), 3.57 (2.71-4.70) for serious mental illness, with a higher rate ratio in psychiatric inpatient service than in outpatient service users (aMRR: 5.74 [3.76-8.78] vs. 2.84 [2.00-4.04]), and 1.53 (1.27-1.84) for common mental disorders.

CONCLUSION

Serious and common mental disorders in psychiatric and general health services are associated with increased mortality in Japan.

摘要

目的

在人群层面评估与严重精神疾病（精神分裂症和双相情感障碍）及常见精神障碍（抑郁症和焦虑症）相关的超额死亡率。

方法

我们在日本筑波开展了一项基于人群的回顾性队列研究。纳入2015年4月年龄在20 - 74岁且参加国民健康保险或老年人健康保险至少12个月的个体（n = 41,618，占该市20 - 74岁人口的29%）。在12个月的基线期内，通过医疗理赔在精神科和普通医疗服务中识别出患有精神障碍（国际疾病分类第10版编码：F00 - F99）的个体，并将其分为相互排斥的诊断亚组。估计他们的年龄/性别调整后的全因死亡率比（aMRRs），并与无精神障碍个体的进行比较。

结果

共有12.0%的参与者患有精神障碍（普通医疗服务中：7.2% vs. 精神科服务中：4.8%）。常见精神障碍最为普遍（8.1%）。在中位48个月的观察期内，精神障碍患者中有225人死亡。所有精神障碍的aMRR为1.98（95%CI：1.70 - 2.29），精神科服务使用者的死亡率比高于普通医疗服务使用者（aMRR：2.64 [2.12 - 3.29] vs. 1.70 [1.42 - 2.04]），严重精神疾病的aMRR为3.57（2.71 - 4.70），精神科住院服务使用者的死亡率比高于门诊服务使用者（aMRR：5.74 [3.76 - 8.78] vs. 2.84 [2.00 - 4.04]），常见精神障碍的aMRR为1.53（1.27 - 1.84）。