Prevalence and risk factors for HIV, hepatitis B, and hepatitis C in people with severe mental illness: a total population study of Sweden.
Prevalence and risk factors for HIV, hepatitis B, and hepatitis C in people with severe mental illness: a total population study of Sweden.
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患有严重精神疾病患者的艾滋病毒，乙型肝炎和丙型肝炎的患病率和危险因素：瑞典的人口研究。
DOI：
10.1016/s2215-0366(17)30253-5
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发表时间：
2017-09
期刊：
影响因子：
--
通讯作者：
Hayes JF
中科院分区：
文献类型：
--
作者：
Bauer-Staeb C;Jörgensen L;Lewis G;Dalman C;Osborn DPJ;Hayes JF
严重精神疾病与发病率和死亡率的增加有关。严重精神疾病患者的血液传播病毒（BBV）风险升高令人担忧，但这一问题的全部程度尚不清楚。我们的目的是确定BBV在严重精神疾病患者中的患病率和危险因素。在这项全国性、基于人群的横断面研究中，我们估计了重度精神疾病患者（包括瑞典总成人（≥18岁））中HIV、B型肝炎（HBV）和丙型肝炎（HCV）的点患病率。根据瑞典版《国际疾病统计分类》第8、9或10版，我们将严重精神疾病定义为精神分裂症、情感障碍、双相情感障碍或其他精神病的临床诊断。我们使用多变量logistic回归来确定BBV在严重精神疾病患者中相对于普通人群的几率，并确定BBV感染的独立风险因素（年龄，性别，移民身份，社会经济地位，教育和药物滥用）。我们还进行了敏感性分析，排除了在引入传染病控制登记册（1997年）之前进行的BBV诊断。在瑞典的6815931名成年人中，有97797人（1.43%）被诊断患有严重精神疾病。 BBV在严重精神疾病患者中的患病率升高，其中230人（0.24%）患有HIV，518人（0.53%）患有HBV，4476人（4.58%）患有HCV。在考虑了社会人口学特征后，艾滋病毒感染的几率为2·57（95% CI 2.25 - 2.94，p<0.0001）倍于一般人群，而HBV的几率为2.29（2.09 - 2.51，p<0.0001）倍，HCV感染几率高6.18（5.98 - 6.39，p<0.0001）倍。药物滥用对BBV风险增加贡献最大：调整后，HIV的比值比为1.61（1.40 - 1.85，p<0.0001），HBV为1.28（1.16 - 1.41，p<0.0001），HCV为1.72（1.67 - 1.78，p<0.0001）。我们的研究结果强调了需要解决严重精神疾病患者中BBV患病率较高的问题，并确定预防感染的干预措施。针对共病药物滥用将对降低BBV在该人群中的患病率产生特别的影响。医学研究理事会和瑞典研究理事会。
Severe mental illness is associated with increased morbidity and mortality. The elevated risk of blood-borne viruses (BBVs) in people with severe mental illness is of concern, but the full extent of this problem is unclear. We aimed to determine the prevalence of and risk factors for BBVs in people with severe mental illness. In this nationwide, population-based, cross-sectional study, we estimated the point prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV) in people with severe mental illness, including the total adult (≥18 years) Swedish population. We defined severe mental illness as a clinical diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or other psychotic illness according to the Swedish version of the International Statistical Classification of Diseases version 8, 9, or 10. We used multivariable logistic regression to determine the odds of BBVs in individuals with severe mental illness, relative to the general population, and to identify independent risk factors (age, sex, immigration status, socioeconomic status, education, and substance misuse) for BBV infection. We also did a sensitivity analysis excluding BBV diagnoses made before the introduction of the Register for Infection Disease Control (1997). Of 6 815 931 adults in Sweden, 97 797 (1·43%) individuals had a diagnosis of severe mental illness. Prevalence of BBVs was elevated in people with severe mental illness, of which 230 (0·24%) had HIV, 518 (0·53%) had HBV, and 4476 (4·58%) had HCV. After accounting for sociodemographic characteristics, the odds of HIV were 2·57 (95% CI 2·25–2·94, p<0·0001) times higher in people with severe mental illness than in the general population, whereas the odds of HBV were 2·29 (2·09–2·51, p<0·0001) times higher and the odds of HCV were 6·18 (5·98–6·39, p<0·0001) times higher. Substance misuse contributed most to the increased risk of BBV: after adjustment, odds ratios were 1·61 (1·40–1·85, p<0·0001) for HIV, 1·28 (1·16–1·41, p<0·0001) for HBV, and 1·72 (1·67–1·78, p<0·0001) for HCV. Our results highlight the need to address the issue of higher prevalence of BBVs in people with severe mental illness and identify interventions preventing infection. Targeting of comorbid substance misuse would have particular effect on reduction of BBV prevalence in this population. Medical Research Council and Swedish Research Council.