Somatic Hospital Contacts, Invasive Cardiac Procedures, and Mortality From Heart Disease in Patients With Severe Mental Disorder
Somatic Hospital Contacts, Invasive Cardiac Procedures, and Mortality From Heart Disease in Patients With Severe Mental Disorder
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DOI：
10.1001/archgenpsychiatry.2009.61
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发表时间：
2009-07-01
影响因子：
--
通讯作者：
Mortensen, Preben Bo
中科院分区：
文献类型：
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作者：
Laursen, Thomas Munk;Munk-Olsen, Trine;Mortensen, Preben Bo
背景：在患有严重精神障碍的患者中，可以观察到心脏病的超额死亡率。这种过高的死亡率可能源于药物或精神药物治疗的不良影响、生活方式因素或不适当的躯体护理。目的：检查严重精神障碍患者(定义为患有双相情感障碍、分裂情感障碍或精神分裂症的精神病院住院患者)是否与医院接触并接受与非精神疾病普通人群相同程度的心脏疾病侵入性手术，并确定他们是否有更高的心脏病死亡率。设计、背景和参与者：1994年至2007年对丹麦出生的460万人进行了基于人群的队列跟踪调查。主要观察指标：心脏病入院的发生率、心脏病死亡率以及发生侵入性心脏手术的概率。结果：与非精神科普通人群相比，重度精神障碍患者的心脏病接触发生率仅略有增加，为1.11(95%可信区间，1.08-1.14)。相比之下，他们的心脏病超额死亡率比为2.90(95%可信区间，2.71-3.10)。首次接触躯体心脏病五年后，患有严重精神障碍(老年人)的人死于心脏病的风险为8.26%
Context: Excess mortality from heart disease is observed in patients with severe mental disorder. This excess mortality may be rooted in adverse effects of pharmacological or psychotropic treatment, lifestyle factors, or inadequate somatic care.Objectives: To examine whether persons with severe mental disorder, defined as persons admitted to a psychiatric hospital with bipolar affective disorder, schizoaffective disorder, or schizophrenia, are in contact with hospitals and undergoing invasive procedures for heart disease to the same degree as the nonpsychiatric general population, and to determine whether they have higher mortality rates of heart disease.Design, Setting, and Participants: A population-based cohort of 4.6 million persons born in Denmark was followed up from 1994 to 2007. Rates of mortality, somatic contacts, and invasive procedures were estimated by survival analysis.Main Outcome Measures: Incidence rate ratios of heart disease admissions and heart disease mortality as well as probability of invasive cardiac procedures.Results: The incidence rate ratio of heart disease contacts in persons with severe mental disorder compared with the rate for the nonpsychiatric general population was only slightly increased, at 1.11 (95% confidence interval, 1.08-1.14). In contrast, their excess mortality rate ratio from heart disease was 2.90( 95% confidence interval, 2.71-3.10). Five years after the first contact for somatic heart disease, the risk of dying of heart disease was 8.26% for persons with severe mental disorder (aged