Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK.
Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK.
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DOI：
10.1136/bmjopen-2015-009010
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发表时间：
2015-12-15
期刊：
影响因子：
2.9
通讯作者：
Kontopantelis E
中科院分区：
文献类型：
--
作者：
Reilly S;Olier I;Planner C;Doran T;Reeves D;Ashcroft DM;Gask L;Kontopantelis E
在英国初级保健中，对严重精神疾病（SMI）患者的合并症患病率知之甚少。我们计算了英国国家、英国地区和剥夺五分位数的SMI患病率，SMI患者的抗精神病和抗抑郁药物处方率，以及SMI患者与无SMI患者相比常见合并症的患病率。2000 - 2012年回顾性队列研究。627个全科实践为英国初级保健数据库临床实践研究数据链做出了贡献。每个确定的病例（346 551）在年龄、性别和一般实践方面与5例随机选择的对照病例（1 732 755）相匹配，这些病例在每个年度时间点均未诊断为SMI。 计算了16种疾病的患病率。在苏格兰和更贫困的地区，重度精神病感染率最高。随着时间的推移，英格兰、威尔士和北方爱尔兰的失业率有所上升，北方爱尔兰的增幅最大（2000/2001年为0.48%，2011/2012年为0.69%）。与无重度精神病患者相比，重度精神病患者所有疾病的年患病率均较高。在大多数情况下，随着时间的推移，有和没有SMI的患病率之间的差异增加。在研究期间，与无SMI人群（2000/2001年为0.5，2011/2012年为0.6）相比，在SMI人群中观察到额外疾病的平均数量增加更大（2000/2001年为0.6，2011/2012年为1.0）。对于这两个群体来说，大多数疾病在更贫困的地区更为普遍，而对于重度精神障碍者群体来说，甲状腺功能减退症、慢性肾病和癌症等疾病在更富裕的地区更为普遍。我们的研究结果强调了SMI患者面临的健康不平等。需要提供适当的、及时的健康预防、促进和监测活动，以减少这些健康不平等现象，特别是在贫困地区。
Little is known about the prevalence of comorbidity rates in people with severe mental illness (SMI) in UK primary care. We calculated the prevalence of SMI by UK country, English region and deprivation quintile, antipsychotic and antidepressant medication prescription rates for people with SMI, and prevalence rates of common comorbidities in people with SMI compared with people without SMI. Retrospective cohort study from 2000 to 2012. 627 general practices contributing to the Clinical Practice Research Datalink, a UK primary care database. Each identified case (346 551) was matched for age, sex and general practice with 5 randomly selected control cases (1 732 755) with no diagnosis of SMI in each yearly time point. Prevalence rates were calculated for 16 conditions. SMI rates were highest in Scotland and in more deprived areas. Rates increased in England, Wales and Northern Ireland over time, with the largest increase in Northern Ireland (0.48% in 2000/2001 to 0.69% in 2011/2012). Annual prevalence rates of all conditions were higher in people with SMI compared with those without SMI. The discrepancy between the prevalence of those with and without SMI increased over time for most conditions. A greater increase in the mean number of additional conditions was observed in the SMI population over the study period (0.6 in 2000/2001 to 1.0 in 2011/2012) compared with those without SMI (0.5 in 2000/2001 to 0.6 in 2011/2012). For both groups, most conditions were more prevalent in more deprived areas, whereas for the SMI group conditions such as hypothyroidism, chronic kidney disease and cancer were more prevalent in more affluent areas. Our findings highlight the health inequalities faced by people with SMI. The provision of appropriate timely health prevention, promotion and monitoring activities to reduce these health inequalities are needed, especially in deprived areas.