Posttraumatic Stress Disorder and Incident Infections A Nationwide Cohort Study
Posttraumatic Stress Disorder and Incident Infections A Nationwide Cohort Study
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DOI：
10.1097/ede.0000000000001071
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发表时间：
2019-11-01
期刊：
影响因子：
5.4
通讯作者：
Gradus, Jaimie L.
中科院分区：
文献类型：
--
作者：
Jiang, Tammy;Farkas, Dora Kormendine;Gradus, Jaimie L.
背景：目前尚不清楚创伤后应激障碍（PTSD）是否与偶发感染有关。本研究的目的是检查（1）PTSD诊断与28种感染之间的关联，以及（2）PTSD诊断与性别之间的相互作用对感染率的影响。研究方法：研究人群包括1995年至2011年期间接受PTSD诊断的丹麦所有居民的纵向全国队列，以及年龄和性别匹配的一般人群比较队列。我们拟合了考克斯比例风险回归模型来检验创伤后应激障碍诊断与感染之间的关联。为了解释多重估计，我们使用半贝叶斯收缩调整了风险比（HR）。我们计算了交互对比，以评估PTSD诊断和性别之间的相互作用。结果如下：半贝叶斯收缩后，任何类型感染的HR为1.8（95%置信区间：1.6，2.0），调整婚姻状况，非精神病合并症，物质滥用，物质依赖和抑郁症的诊断。PTSD诊断与一些感染之间的关联（例如，尿路感染）在女性中更强，而其他相关性在男性中更强（例如，皮肤感染）。结论：这项研究的结果表明，创伤后应激障碍诊断是许多感染类型的风险因素，创伤后应激障碍诊断和感染之间的关联是由性别修改。
Background: It is unknown whether posttraumatic stress disorder (PTSD) is associated with incident infections. This study's objectives were to examine (1) the association between PTSD diagnosis and 28 types of infections and (2) the interaction between PTSD diagnosis and sex on the rate of infections. Methods: The study population consisted of a longitudinal nationwide cohort of all residents of Denmark who received a PTSD diagnosis between 1995 and 2011, and an age- and sex-matched general population comparison cohort. We fit Cox proportional hazards regression models to examine associations between PTSD diagnosis and infections. To account for multiple estimation, we adjusted the hazard ratios (HRs) using semi-Bayes shrinkage. We calculated interaction contrasts to assess the presence of interaction between PTSD diagnosis and sex. Results: After semi-Bayes shrinkage, the HR for any type of infection was 1.8 (95% confidence interval: 1.6, 2.0), adjusting for marital status, non-psychiatric comorbidity, and diagnoses of substance abuse, substance dependence, and depression. The association between PTSD diagnosis and some infections (e.g., urinary tract infections) were stronger among women, whereas other associations were stronger among men (e.g., skin infections). Conclusions: This study's findings suggest that PTSD diagnosis is a risk factor for numerous infection types and that the associations between PTSD diagnosis and infections are modified by sex.