Hayward S E, Kristensen K L, Deal A, Petersen J H, Lillebaek T, Hargreaves S, Norredam M, Friedland J S
Institute for Infection and Immunity, School of Health and Medical Sciences, City St George's, University of London, London, UK.
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
IJTLD Open. 2024 Dec 1;1(12):564-570. doi: 10.5588/ijtldopen.24.0260. eCollection 2024 Dec.
TB and mental illnesses are public health priorities that often co-exist, with migrants in high-income countries being at risk for both conditions. This study investigates whether mental illness influences TB risk and examines the impact of migration status.
A nationwide prospective cohort study was conducted in Denmark from 1994-2015, involving migrants matched 1:6 to Danish-born individuals. Cox regression models, adjusted for age, sex and migrant status, were used to assess the effect of mental disorders on TB risk.
Both migrants and non-migrants with mental disorders showed elevated TB incidence ( = 1,189,273). After adjusting for age and sex, the hazard ratio (HR) for TB in those with any mental disorder was 3.62 (95% CI 2.99-4.39, < 0.001) compared to those without mental disorders. The effect was more substantial in Danish-born individuals (HR 15.51, 95% CI 12.05-19.95, < 0.001) than in migrants (HR 1.37, 95% CI 0.99-1.90, = 0.055). Sub-analyses highlighted a significant effect of substance use (HR 5.49, 95% CI 4.46-6.76, < 0.001) and psychosis (HR 4.19, 95% CI 1.74-10.08, = 0.001) and borderline significance for affective/anxiety/stress-related disorders (HR 1.64, 95% CI 0.98-2.73, = 0.058) on TB risk.
People with mental illnesses, particularly psychotic and substance use disorders, have increased TB incidence and represent a high-risk population for targeted screening and treatment. TB programmes should integrate holistic mental health care.
结核病和精神疾病是公共卫生重点关注的问题，且常常并存，高收入国家的移民面临这两种疾病的风险。本研究调查精神疾病是否会影响结核病风险，并探讨移民身份的影响。
1994年至2015年在丹麦进行了一项全国性前瞻性队列研究，将移民与丹麦出生的个体按1:6进行匹配。使用经年龄、性别和移民身份调整的Cox回归模型来评估精神障碍对结核病风险的影响。
患有精神障碍的移民和非移民的结核病发病率均有所升高（n = 1,189,273）。在调整年龄和性别后，与没有精神障碍的人相比，患有任何精神障碍的人患结核病的风险比（HR）为3.62（95%CI 2.99 - 4.39，P < 0.001）。丹麦出生的个体的影响更为显著（HR 15.51，95%CI 12.05 - 19.95，P < 0.001），而移民的影响则较小（HR 1.37，95%CI 0.99 - 1.90，P = 0.055）。亚组分析突出了物质使用（HR 5.49，95%CI 4.46 - 6.76，P < 0.001）和精神病（HR 4.19，95%CI 1.74 - 10.08，P = 0.001）以及情感/焦虑/压力相关障碍的临界显著性（HR 1.64，95%CI 0.98 - 2.73，P = 0.058）对结核病风险的影响。
患有精神疾病的人，尤其是精神病和物质使用障碍患者，结核病发病率增加，是进行针对性筛查和治疗的高危人群。结核病防治项目应整合全面的精神卫生保健。
