Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.
CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
Soc Psychiatry Psychiatr Epidemiol. 2024 Nov;59(11):2093-2103. doi: 10.1007/s00127-024-02645-x. Epub 2024 Mar 1.
To characterize the register of a secondary diagnosis of mental illnesses in all chronic obstructive pulmonary disease (COPD) hospitalizations registered in Portugal from 2008 to 2015 and explore their impact on hospitalization outcomes.
A retrospective observational study was conducted. Hospitalizations of patients with at least 40 years old, discharged between 2008 and 2015 with a primary diagnosis of COPD (ICD-9-CM codes 491.x, 492.x and 496) were retrieved from a national administrative database. Comorbid psychiatric diagnoses were identified and defined by the HCUP Clinical Classification Software (CCS) category codes 650-670 (excluding 662). Length of hospital stay (LoS), admission type, in-hospital mortality, and estimated hospital charges were analyzed according to psychiatric diagnostic categories using sex and age-adjusted models.
Of 66,661 COPD hospitalizations, 25,869 (38.8%) were episodes with a registered psychiatric comorbidity. These were more likely to correspond to younger inpatients (OR = 2.16, 95%CI 2.09-2.23; p < 0.001), to stay longer at the hospital (aOR = 1.08, 95%CI 1.05-1.12; p < 0.001), to incur in higher estimated hospital charges (aOR = 1.37, 95%CI 1.33-1.42; p < 0.001) and to be urgently admitted (aOR = 1.33, 95%CI 1.23-1.44; p < 0.001). After adjustment for age, in-hospital mortality was lower for episodes with psychiatric diagnoses (aOR = 0.90; 95%CI 0.84-0.96; p < 0.001), except for organic and neurodegenerative diseases category and developmental disorders, intellectual disabilities and disorders usually diagnosed in infancy, childhood, or adolescence category.
These findings corroborate the additional burden placed by psychiatric disorders on COPD hospitalizations, highlighting the importance of individualizing care to address these comorbidities and minimize their impact on treatment outcomes.
描述 2008 年至 2015 年在葡萄牙登记的所有慢性阻塞性肺疾病（COPD）住院患者的精神疾病二级诊断记录，并探讨其对住院结局的影响。
这是一项回顾性观察研究。从国家行政数据库中检索了至少 40 岁、2008 年至 2015 年期间以 COPD（ICD-9-CM 代码 491.x、492.x 和 496）为主要诊断出院的患者的住院记录。使用 HCUP 临床分类软件（CCS）类别代码 650-670（不包括 662）确定并定义合并的精神科诊断。根据性别和年龄调整模型，根据精神科诊断类别分析住院时间（LoS）、入院类型、住院内死亡率和估计住院费用。
在 66661 例 COPD 住院患者中，25869 例（38.8%）为有记录的合并精神疾病的住院患者。这些患者更可能是年轻的住院患者（OR=2.16，95%CI 2.09-2.23；p<0.001），住院时间更长（aOR=1.08，95%CI 1.05-1.12；p<0.001），估计住院费用更高（aOR=1.37，95%CI 1.33-1.42；p<0.001），且更紧急入院（aOR=1.33，95%CI 1.23-1.44；p<0.001）。在校正年龄后，有精神科诊断的住院患者的院内死亡率较低（aOR=0.90，95%CI 0.84-0.96；p<0.001），但有机和神经退行性疾病类别以及发育障碍、智力残疾和通常在婴儿、儿童或青春期诊断的障碍类别除外。
这些发现证实了精神疾病对 COPD 住院患者的额外负担，强调了个体化治疗以解决这些合并症并最大限度地减少其对治疗结果的影响的重要性。
