Trends in the diagnosis of diseases of despair in the United States, 2009-2018: a retrospective cohort study.
Trends in the diagnosis of diseases of despair in the United States, 2009-2018: a retrospective cohort study.
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DOI：
10.1136/bmjopen-2020-037679
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发表时间：
2020-11-09
期刊：
影响因子：
2.9
通讯作者：
Kraschnewski JL
中科院分区：
文献类型：
--
作者：
Brignone E;George DR;Sinoway L;Katz C;Sauder C;Murray A;Gladden R;Kraschnewski JL
在美国，死亡率上升和预期寿命下降在很大程度上归因于意外服药过量、与酒精相关的疾病和自杀。这些“绝望的死亡”通常是在发病多年之后发生的，然而，人们对临床上对“绝望疾病”的认识趋势知之甚少。这项研究的目的是描述过去十年中临床记录的绝望疾病的比率，并确定社会人口学风险因素。使用医疗索赔数据库进行的回溯性研究，并进行了10年的跟踪调查。参与者居住在全国范围内，但集中在受绝望死亡影响不成比例的美国各州，包括宾夕法尼亚州、西弗吉尼亚州和特拉华州。队列包括12,144,252名参与者，没有年龄或性别的限制。绝望疾病被定义为与酒精滥用、物质滥用和自杀意念/行为有关的诊断。回顾期间被用来识别事件诊断。计算了年度和所有时间的发病率/患病率估计值，以及当前诊断的风险和共病模式。515名 830名参与者接受了绝望疾病的诊断(58.5%男性，中位年龄36岁)。从2009年到2018年，与酒精相关、与物质相关和与自杀相关的诊断患病率分别增加了37%、94%和170%。55-74岁年龄段与酒精/物质相关的诊断增加最多(59%和172%)。与自杀有关的诊断增加最多的是18岁(287%)。总体而言，男性当年诊断的几率更高(调整后的OR(AOR)为1.49，95%CI为1.47至1.51)，以及那些拥有《平价医疗法案》或医疗保险的男性相对于商业保险(AOR为1.30，1.24至1.37；AOR为1.51，1.46至1.55)。绝望症诊断率的上升在很大程度上反映了更广泛的社会死亡率趋势。虽然阿片类药物危机仍然是公共卫生的首要任务，但与酒精有关的诊断和自杀人数的平行上升必须同时解决。研究结果表明，卫生保健系统和提供者有机会部署有针对性的预防措施，以减缓死亡率的发展。
Increasing mortality and decreasing life expectancy in the USA are largely attributable to accidental overdose, alcohol-related disease and suicide. These ‘deaths of despair’ often follow years of morbidity, yet little is known about trends in the clinical recognition of ‘diseases of despair’. The objective of this study is to characterise rates of clinically documented diseases of despair over the last decade and identify sociodemographic risk factors. Retrospective study using a healthcare claims database with 10 years of follow-up. Participants resided nationwide but were concentrated in US states disproportionately affected by deaths of despair, including Pennsylvania, West Virginia and Delaware. Cohort included 12 144 252 participants, with no restriction by age or gender. Diseases of despair were defined as diagnoses related to alcohol misuse, substance misuse and suicide ideation/behaviours. A lookback period was used to identify incident diagnoses. Annual and all-time incidence/prevalence estimates were computed, along with risk for current diagnosis and patterns of comorbidity. 515 830 participants received a disease of despair diagnosis (58.5% male, median 36 years). From 2009 to 2018, the prevalence of alcohol-related, substance-related and suicide-related diagnoses respectively increased by 37%, 94%, and 170%. Ages 55–74 had the largest increase in alcohol/substance-related diagnoses (59% and 172%). Ages <18 had the largest increase in suicide-related diagnoses (287%). Overall, odds for current-year diagnosis were higher among men (adjusted OR (AOR) 1.49, 95% CI 1.47 to 1.51), and among those with Affordable Care Act or Medicare coverage relative to commercial coverage (AOR 1.30, 1.24 to 1.37; AOR 1.51, 1.46 to 1.55). Increasing clinical rates of disease of despair diagnoses largely mirror broader societal trends in mortality. While the opioid crisis remains a top public health priority, parallel rises in alcohol-related diagnoses and suicidality must be concurrently addressed. Findings suggest opportunities for healthcare systems and providers to deploy targeted prevention to mitigate the progression of morbidities towards mortality.
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