Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's General Practice Research Database
Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's General Practice Research Database
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DOI：
10.1001/archpsyc.64.2.242
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发表时间：
2007-02-01
影响因子：
--
通讯作者：
King, Michael B.
中科院分区：
文献类型：
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作者：
Osborn, David P. J.;Levy, Gus;King, Michael B.
背景：患有严重精神疾病(SMI)的人似乎有更高的心血管疾病死亡风险，但关于癌症死亡率的结果相互矛盾。目的：估计这一超额死亡率以及抗精神病药物、吸烟和社会剥夺的贡献。设计：回溯性队列研究。设置：英国全科医学研究数据库。患者：比较了两个队列：有SMI诊断的人和没有此类诊断的人。主要观察指标：冠心病(CHD)、中风和英国最常见的7种癌症的死亡率。结果：共有46 136名SMI患者和300 426名非SMI患者参与研究。与对照组相比，18~49岁组、50~75岁组和75岁以上组的冠心病死亡风险比分别为3.22(95%可信区间，1.99~5.21)、1.86(95%可信区间，1.63~2.12)和1.05(95%可信区间，0.92~1.19)。在卒中死亡方面，50岁以下者的RR为2.53(95%CI，0.99~6.47)，50~75岁者为1.89(95%CI，1.50~2.38)，75岁以上者为1.34(95%CI，1.17~1.54)。癌症死亡的唯一显著结果是50至75岁人群呼吸道肿瘤的未调整HR为1.32(95%CI，1.04-1.68)，在控制吸烟和社会剥夺后，这一结果失去了统计学意义。在随访期间，冠心病死亡率的增加与性别、SMI诊断或抗精神病药物处方无关。然而，处方剂量越大的抗精神病药物预示着更大的冠心病和中风死亡风险。结论：这个大的社区样本表明，患有SMI的人死于冠心病和中风的风险增加，这并不完全可以用抗精神病药物、吸烟或社交剥夺评分来解释。非呼吸系统癌症的死亡率没有上升。关于预防这种死亡率还需要进一步的研究，包括心血管风险评估、抗精神病药物的监测以及对饮食和锻炼的关注。
Context: People with severe mental illness (SMI) appear to have an elevated risk of death from cardiovascular disease, but results regarding cancer mortality are conflicting.Objective: To estimate this excess mortality and the contribution of antipsychotic medication, smoking, and social deprivation.Design: Retrospective cohort study.Setting: United Kingdom's General Practice Research Database.Patients: Two cohorts were compared: people with SMI diagnoses and people without such diagnoses.Main Outcome Measure: Mortality rates for coronary heart disease (CHD), stroke, and the 7 most common cancers in the United Kingdom.Results: A total of 46 136 people with SMI and 300 426 without SMI were selected for the study. Hazard ratios (HRs) for CHD mortality in people with SMI compared with controls were 3.22 (95% confidence interval [CI], 1.99-5.21) for people 18 through 49 years old, 1.86 (95% CI, 1.63-2.12) for those 50 through 75 years old, and 1.05 (95% CI, 0.92-1.19) for those older than 75 years. For stroke deaths, the HRs were 2.53 (95% CI, 0.99-6.47) for those younger than 50 years, 1.89 (95% CI, 1.50-2.38) for those 50 through 75 years old, and 1.34 (95% CI, 1.17-1.54) for those older than 75 years. The only significant result for cancer deaths was an unadjusted HR for respiratory tumors of 1.32 (95% CI, 1.04-1.68) for those 50 to 75 years old, which lost statistical significance after controlling for smoking and social deprivation. Increased HRs for CHD mortality occurred irrespective of sex, SMI diagnosis, or prescription of antipsychotic medication during follow-up. However, a higher prescribed dose of antipsychotics predicted greater risk of mortality from CHD and stroke.Conclusions: This large community sample demonstrates that people with SMI have an increased risk of death from CHD and stroke that is not wholly explained by antipsychotic medication, smoking, or social deprivation scores. Rates of nonrespiratory cancer mortality were not raised. Further research is required concerning prevention of this mortality, including cardiovascular risk assessment, monitoring of antipsychotic medication, and attention to diet and exercise.