Type 2 diabetes mellitus in people with severe mental illness: inequalities by ethnicity and age. Cross-sectional analysis of 588 408 records from the UK.
Type 2 diabetes mellitus in people with severe mental illness: inequalities by ethnicity and age. Cross-sectional analysis of 588 408 records from the UK.
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DOI：
10.1111/dme.13298
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发表时间：
2017-07
期刊：
影响因子：
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通讯作者：
Prince MJ
中科院分区：
文献类型：
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作者：
Das-Munshi J;Ashworth M;Dewey ME;Gaughran F;Hull S;Morgan C;Nazroo J;Petersen I;Schofield P;Stewart R;Thornicroft G;Prince MJ
调查严重精神疾病与2型糖尿病的关联是否因种族和年龄而异。我们对来自588408名年龄≥18岁的不同种族样本的数据进行了横断面分析，这些样本在英国伦敦98%的全科诊所（初级保健）注册。关注的结局为2型糖尿病患病率。相对于没有严重精神疾病的人，患有严重精神疾病的人患2型糖尿病的相对风险在最年轻的年龄组中最大。在英国白色人群中，18-34岁人群的相对风险为9.99（95% CI 5.34，18.69），35-54岁人群为2.89（95% CI 2.43，3.45），≥55岁人群为1.16（95% CI 1.04，1.30），所有少数民族人群的趋势相似。抗精神病药物处方的额外调整仅略微减弱了相关性。按种族对严重精神疾病中2型糖尿病的估计患病率进行评估（绝对效应测量）表明，少数民族严重精神疾病与2型糖尿病之间的关联比英国白色严重精神疾病组更为显著，尤其是印度、巴基斯坦和孟加拉国严重精神疾病患者。2型糖尿病的相对风险在年轻人群中升高。尽管调整了抗精神病药物处方，但大多数相关性仍然存在。少数民族群体在存在严重精神疾病的情况下患2型糖尿病的患病率较高。未来的研究和政策，特别是在严重精神疾病人群中2型糖尿病的筛查和临床护理方面，应该考虑这些发现。少数民族中严重精神疾病与2型糖尿病相关的证据有限。使用来自> 50万人的数据，我们确定：（1）与没有严重精神疾病的人群相比，患有严重精神疾病的人患2型糖尿病的风险增加了10倍，无论种族如何，并且在最年轻的年龄组中最大;（2）2型糖尿病的患病率在患有严重精神疾病的孟加拉人中最高，但在所有其他南亚，非洲黑人和加勒比黑人群体中也很高;（3）尽管调整了抗精神病药物处方，但大多数相关性仍然存在。
To investigate whether the association of severe mental illness with Type 2 diabetes varies by ethnicity and age. We conducted a cross‐sectional analysis of data from an ethnically diverse sample of 588 408 individuals aged ≥18 years, registered to 98% of general practices (primary care) in London, UK. The outcome of interest was prevalent Type 2 diabetes. Relative to people without severe mental illness, the relative risk of Type 2 diabetes in people with severe mental illness was greatest in the youngest age groups. In the white British group the relative risks were 9.99 (95% CI 5.34, 18.69) in those aged 18–34 years, 2.89 (95% CI 2.43, 3.45) in those aged 35–54 years and 1.16 (95% CI 1.04, 1.30) in those aged ≥55 years, with similar trends across all ethnic minority groups. Additional adjustment for anti‐psychotic prescriptions only marginally attenuated the associations. Assessment of estimated prevalence of Type 2 diabetes in severe mental illness by ethnicity (absolute measures of effect) indicated that the association between severe mental illness and Type 2 diabetes was more marked in ethnic minorities than in the white British group with severe mental illness, especially for Indian, Pakistani and Bangladeshi individuals with severe mental illness. The relative risk of Type 2 diabetes is elevated in younger populations. Most associations persisted despite adjustment for anti‐psychotic prescriptions. Ethnic minority groups had a higher prevalence of Type 2 diabetes in the presence of severe mental illness. Future research and policy, particularly with respect to screening and clinical care for Type 2 diabetes in populations with severe mental illness, should take these findings into account. There is limited evidence of the association of severe mental illness with Type 2 diabetes mellitus in ethnic minorities. Using data from >500 000 people, we established that: (1) risk of Type 2 diabetes was increased up to 10‐fold in people with severe mental illness compared with groups without severe mental illness, irrespective of ethnicity, and was greatest in the youngest age groups; (2) prevalence of Type 2 diabetes was highest in Bangladeshi people with severe mental illness but was also high in all other South Asian, black African and black Caribbean groups; and (3) most associations persisted despite adjustment for anti‐psychotic prescriptions.