Potential gains in life expectancy from reducing amenable mortality among people diagnosed with serious mental illness in the United Kingdom
Potential gains in life expectancy from reducing amenable mortality among people diagnosed with serious mental illness in the United Kingdom
复制标题
DOI：
10.1371/journal.pone.0230674
复制
发表时间：
2020-03-27
期刊：
影响因子：
3.7
通讯作者：
Hotopf, Matthew
中科院分区：
文献类型：
--
作者：
Dregan, Alex;McNeill, Ann;Hotopf, Matthew
背景在西方人群中，通过解决特定的严重精神疾病(SMI)亚组，即精神分裂症、分裂情感障碍和双相情感障碍，解决全原因死亡率(不包括自杀和意外或暴力死亡)的可变危险因素，估计预期寿命的潜在增长。方法我们使用最近荟萃分析的相对风险来估计由于特定的可修改危险因素而导致的人群归因分数(PAF)，这些危险因素已知与SMI内的全原因死亡率相关。通过估计不同背景水平(行为、医疗保健、社会)的可修改风险因素的综合影响，并考虑应对这些因素的现有干预措施的有效性，评估了出生时、50岁和65岁时预期寿命的潜在增长。使用年度百分比变化(APC)公式估计了20年内出生时预期寿命的年增长预测。根据针对这些可改变的危险因素的现有干预措施的有效性，我们估计了出生时4人(双相情感障碍)、6人(分裂情感障碍)或7岁(精神分裂症)的潜在预期寿命增加。50岁时的预期寿命增加了三年(双相情感障碍)或五年(精神分裂症和分裂情感障碍)。65岁时预期寿命增加三年(双相情感障碍)或四年(精神分裂症和分裂情感障碍)。结论针对可改变的危险因素的现有干预措施的实施可以将普通人群和重度精神障碍人群之间目前的死亡率差距缩小24%(男性)至28%(女性)。这些预测代表了理想的情况，没有经常伴随着PAF而来的高估的限制。
BackgroundTo estimate the potential gain in life expectancy from addressing modifiable risk factors for all-cause mortality (excluding suicide and deaths from accidents or violence) across specific serious mental illness (SMI) subgroups, namely schizophrenia, schizoaffective disorders, and bipolar disorders in a Western population.MethodsWe have used relative risks from recent meta-analyses to estimate the population attribution fraction (PAF) due to specific modifiable risk factors known to be associated with all-cause mortality within SMI. The potential gain in life expectancy at birth, age 50 and age 65 years were assessed by estimating the combined effect of modifiable risk factors from different contextual levels (behavioural, healthcare, social) and accounting for the effectiveness of existing interventions tackling these factors. Projections for annual gain in life expectancy at birth during a two-decade was estimated using the Annual Percentage Change (APC) formula. The predicted estimates were based on mortality rates for year 2014-2015.ResultsBased on the effectiveness of existing interventions targeting these modifiable risk factors, we estimated potential gain in life expectancy at birth of four (bipolar disorders), six (schizoaffective disorders), or seven years (schizophrenia). The gain in life expectancy at age 50 years was three (bipolar disorders) or five (schizophrenia and schizoaffective disorders) years. The projected gain in life expectancy at age 65 years was three (bipolar disorders) or four (schizophrenia and schizoaffective disorders) years.ConclusionsThe implementation of existing interventions targeting modifiable risk factors could narrow the current mortality gap between the general and the SMI populations by 24% (men) to 28% (women). These projections represent ideal circumstances and without the limitation of overestimation which often comes with PAFs.