Clinical management and mortality risk in those with eating disorders and self-harm: e-cohort study using the SAIL databank.
Clinical management and mortality risk in those with eating disorders and self-harm: e-cohort study using the SAIL databank.
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DOI：
10.1192/bjo.2021.23
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发表时间：
2021-03-19
期刊：
影响因子：
5.4
通讯作者：
DelPozo-Banos M
中科院分区：
文献类型：
--
作者：
John A;Marchant A;Demmler J;Tan J;DelPozo-Banos M
自我伤害的饮食失调患者是一个弱势群体，其特点是更严重的病理和更差的结果。探讨有自残记录者的医疗保健利用和死亡率：仅限饮食失调；两者同时发生。我们对2003年至2016年10-64岁的个体进行了回顾性全人群电子队列研究。个体分为：仅有自残记录者；仅限饮食失调；自残和饮食失调；也没有自残或饮食失调的记录。我们使用从初级保健、急诊科、住院和门诊预约收集的相关常规医疗数据来检查医疗接触和死亡率。我们确定了82627个人：n = 75 165只自残；N = 5786只伴有饮食失调；N = 1676，两者相加。在所有群体和环境中，明显有更多的人参加，接触的人明显多于其他人群。联合组的人均接触人数最高（全科医生，发生率比IRR = 3.3, 95% CI 3.1-3.5；急诊科，IRR = 5.2, 95% CI 4.7-5.8；住院，IRR = 5.2, 95% CI 4.5-6.0；门诊，IRR = 3.9, 95% CI 3.5-4.4）。标准化死亡率显示，仅自残组的总体超额死亡率最高（SMR = 3.2, 95% CI 3.1-3.3），特别是非自然原因死亡（SMR = 17.1, 95% CI 16.3-17.9）。在联合用药组中，较年轻年龄组的smr和寿命损失年数显示死亡风险增加。调整后的风险比显示，所有组的死亡率都有所增加（仅自残，HR = 5.3, 95% CI 5.2-5.5；仅饮食失调，HR = 4.1, 95% CI 3.4-4.9；联合组，HR = 6.8, 95% CI 5.4-8.6）。所有群体中的个人都比一般人群有更高的医疗保健服务利用率。有饮食失调和自残记录的年轻人死亡风险增加，这凸显了早期专家干预和加强支持的必要性。
Individuals with eating disorders who self-harm are a vulnerable group characterised by greater pathology and poorer outcomes. To explore healthcare utilisation and mortality in those with a record of: self-harm only; eating disorders only; and both co-occurring. We conducted a retrospective whole population e-cohort study of individuals aged 10–64 years from 2003 to 2016. Individuals were divided into: record of self-harm only; eating disorders only; both self-harm and eating disorders; and no record of self-harm or eating disorders. We used linked routinely collected healthcare data across primary care, emergency departments, hospital admissions and out-patient appointments to examine healthcare contacts and mortality. We identified 82 627 individuals: n = 75 165 with self-harm only; n = 5786 with eating disorders only; n = 1676 with both combined. Across all groups and settings significantly more individuals attended with significantly more contacts than the rest of the population. The combined group had the highest number of contacts per person (general practitioner, incident rate ratio IRR = 3.3, 95% CI 3.1–3.5; emergency department, IRR = 5.2, 95% CI 4.7–5.8; hospital admission, IRR = 5.2, 95% CI 4.5–6.0; out-patients, IRR = 3.9, 95% CI 3.5–4.4). Standardised mortality ratios showed the highest excess mortality overall in the self-harm only group (SMR = 3.2, 95% CI 3.1–3.3), particularly for unnatural causes of death (SMR = 17.1, 95% CI 16.3–17.9). SMRs and years of life lost showed an increased risk of mortality in younger age groups in the combined group. Adjusted hazard ratios showed increased mortality across all groups (self-harm only, HR = 5.3, 95% CI 5.2–5.5; eating disorders only, HR = 4.1, 95% CI 3.4–4.9; combined group, HR = 6.8, 95% CI 5.4–8.6). Individuals in all groups had higher healthcare service utilisation than the general population. The increased mortality risk in young people with a record of both eating disorders and self-harm highlights the need for early specialist intervention and enhanced support.
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DOI：
10.1192/bjp.2019.153
发表时间：
2020-02
期刊：
The British journal of psychiatry : the journal of mental science
影响因子：
--
作者：
Demmler JC;Brophy ST;Marchant A;John A;Tan JOA
通讯作者：
Tan JOA
影响因子：
3.5
作者：
Lyons RA;Jones KH;John G;Brooks CJ;Verplancke JP;Ford DV;Brown G;Leake K
通讯作者：
Leake K
影响因子：
8.9
作者：
Chen, Laura P.;Murad, M. Hassan;Zirakzadeh, Ali
通讯作者：
Zirakzadeh, Ali
影响因子：
6.6
作者：
John, A.;Marchant, A. L.;Lloyd, K.
通讯作者：
Lloyd, K.
影响因子：
3.3
作者：
Castellini, Giovanni;Lo Sauro, Carolina;Ricca, Valdo
通讯作者：
Ricca, Valdo