Premature mortality among people with severe mental illness - New evidence from linked primary care data
Premature mortality among people with severe mental illness - New evidence from linked primary care data
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DOI：
10.1016/j.schres.2018.04.009
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发表时间：
2018-09-01
影响因子：
4.5
通讯作者：
Lloyd, Keith
中科院分区：
文献类型：
--
作者：
John, Ann;McGregor, Joanna;Lloyd, Keith
评估严重精神疾病（SMI）患者过早死亡的研究通常基于一种环境，医院（二级护理住院患者和/或门诊患者）或社区（初级护理）。这可能会导致确认偏差。本研究旨在估计与普通人群相比，来自相关初级和二级护理人群的SMI患者的全因和特定原因死亡率的标准化死亡率比（SMR）。SMRs是使用间接方法计算的，2004年至2013年期间联合王国人口近400万。与一般人群相比，从二级护理住院确定的队列中的全因SMR（SMR：2.9; 95% CI：2.8-3.0）高于初级护理（SMR：2.2; 95% CI：2.1-2.3）。联合队列的SMR为2.6（95%CI：2.5-2.6）。在合并队列中，与一般人群相比，SMI患者的病因特异性SMR尤其升高，原因包括不明确和未知原因、自杀、药物滥用、帕金森病、事故、痴呆、感染和呼吸系统疾病（特别是肺炎）以及阿尔茨海默病。迄今为止，仅基于住院的研究在文献中占主导地位，有些高估了SMI患者的过早死亡率。患有重度精神障碍的人更有可能死于不明确和未知的原因，自杀和其他不太常见且经常被低估的原因。死亡率的全面特征对于为政策和实践提供信息以及区分环境以允许适当的干预措施来解决这种健康不公正现象非常重要。(c)2018作者由Elsevier B. V.发布。这是CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Studies assessing premature mortality in people with severe mental illness (SMI) are usually based in one setting, hospital (secondary care inpatients and/or outpatients) or community (primary care). This may lead to ascertainment bias. This study aimed to estimate standardised mortality ratios (SMRs) for all-cause and cause-specific mortality in people with SMI drawn from linked primary and secondary care populations compared to the general population. SMRs were calculated using the indirect method for a United Kingdom population of almost four million between 2004 and 2013. The all-cause SMR was higher in the cohort identified from secondary care hospital admissions (SMR: 2.9; 95% CI: 2.8-3.0) than from primary care (SMR: 2.2; 95% CI: 2.1-2.3) when compared to the general population. The SMR for the combined cohort was 2.6 (95% CI: 2.5-2.6). Cause specific SMRs in the combined cohort were particularly elevated in those with SMI relative to the general population for ill-defined and unknown causes, suicide, substance abuse, Parkinson's disease, accidents, dementia, infections and respiratory disorders (particularly pneumonia), and Alzheimer's disease. Solely hospital admission based studies, which have dominated the literature hitherto, somewhat over-estimate premature mortality in those with SMI. People with SMI are more likely to die by ill-defined and unknown causes, suicide and other less common and often under-reported causes. Comprehensive characterisation of mortality is important to inform policy and practice and to discriminate settings to allow for proportionate interventions to address this health injustice. (c) 2018 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).