Understanding Excess Mortality in Persons With Mental Illness 17-Year Follow Up of a Nationally Representative US Survey
Understanding Excess Mortality in Persons With Mental Illness 17-Year Follow Up of a Nationally Representative US Survey
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DOI：
10.1097/mlr.0b013e31820bf86e
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发表时间：
2011-06-01
期刊：
影响因子：
3
通讯作者：
Marcus, Steven C.
中科院分区：
文献类型：
--
作者：
Druss, Benjamin G.;Zhao, Liping;Marcus, Steven C.
背景资料：尽管人们越来越关注精神疾病患者的过早医疗死亡问题，但使用基于人口的全国代表性样本来量化这一问题的程度和相关性的数据有限。方法：该研究使用了1989年全国健康访谈调查精神健康补充资料的数据，2006年的死亡率数据通过国家死亡指数联系起来（80，850名参与者，16，435人死亡）。调整人口统计学因素的多变量模型评估了增加的死亡风险，增加了社会经济状况，医疗保健变量，临床因素，首先单独，然后together.Results：精神障碍患者的平均死亡年龄为8.2岁，比其他人群（P < 0.001）。调整人口统计学因素后，精神疾病的存在与死亡率过高的显著风险相关（风险比= 2.06，95%置信区间= 1.71-2.40），95.4%的死亡是由于医疗原因而不是非自然原因。在模型中加入社会经济因素的风险比为1.77（P < 0.001），加入卫生系统因素的风险比为1.80（P < 0.001），加入基线临床特征的风险比为1.32（P < 0.001）。同时添加所有3组变量后，该协会从基线减少了82%，并成为统计学上不显着（风险比= 1.19，P = 0.053）。结论：研究结果强调了复杂的原因和高负担的医疗死亡率在美国精神障碍的人。解决这一公共卫生问题的努力需要解决其背后的社会经济、医疗保健和临床风险因素。
Background: Although growing concern has been expressed about premature medical mortality in persons with mental illness, limited data are available quantifying the extent and correlates of this problem using population-based, nationally representative samples.Methods: The study used data from the 1989 National Health Interview Survey mental health supplement, with mortality data through 2006 linked through the National Death Index (80,850 participants, 16,435 deaths). Multivariable models adjusting for demographic factors assessed the increased hazard of mortality adding socioeconomic status, healthcare variables, clinical factors first separately, and then together.Results: Persons with mental disorders died an average of 8.2 years younger than the rest of the population (P < 0.001). Adjusting for demographic factors, presence of a mental illness was associated with a significant risk of excess mortality, (hazard ratio = 2.06, 95% confidence interval = 1.71-2.40), with 95.4% of deaths owing to medical rather than unnatural causes. Adding socioeconomic variables to the model, the hazard ratio was 1.77 (P < 0.001); adding health system factors, it was 1.80 (P < 0.001)); adding baseline clinical characteristics, the hazard ratio was 1.32 (P < 0.001). After adding all the 3 groups of variables simultaneously, the association was reduced by 82% from baseline and became statistically nonsignificant (hazard ratio = 1.19, P = 0.053).Conclusions: The results of the study underscore the complex causes and high burden of medical mortality among persons with mental disorders in the United States. Efforts to address this public health problem will need to address the socioeconomic, healthcare, and clinical risk factors that underlie it.