Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis
Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis
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DOI：
10.1093/ije/dyu018
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发表时间：
2014-06-01
影响因子：
7.7
通讯作者：
Rehm, Juergen
中科院分区：
文献类型：
--
作者：
Roerecke, Michael;Rehm, Juergen
背景：酒精使用障碍（AUD）会造成高度致残。最近的研究报告称，与早期研究相比，AUD 患者全因死亡的相对风险要高得多。迄今为止，尚未获得有关 AUD 患者特定原因死亡率的系统证据。 方法：通过 MEDLINE、EMBASE 和 Web of Science 确定截至 2012 年 8 月的研究。遵循 MOOSE 指南，选择了评估 AUD 患者基线时与一般人群相比的特定原因死亡风险的前瞻性和历史队列研究。提取了多项研究特征的数据，包括 AUD 评估、随访期、背景、地点以及与一般人群相比的特定原因死亡风险。进行了随机效应荟萃分析。结果：总体而言，纳入了 17 项观察性研究，其中 28 087 名 AUD 患者中观察到 6420 例死亡。随访 10 年后，男性中肝硬化的汇总标准化死亡率 (SMR) 为 14.8（95% 置信区间：8.7-24.9），精神障碍为 18.0（11.2-30.3），受伤死亡为 6.6（5.0-8.8），癌症和心血管疾病约为 2。女性的 SMR 明显更高，但可用的研究较少。对于许多结果来说，风险随着时间的推移而大幅增加。结论：与一般人群相比，所有主要类别的 AUD 患者的原因特异性死亡率都很高。最近缺乏研究，未来的研究应重点关注合并症对 AUD 患者超额死亡风险的影响。鉴于成功的治疗可以大大降低相对常见的精神疾病的死亡风险，因此应优先考虑降低这些风险。
Background: Alcohol use disorders (AUD) are highly disabling. Recent studies reported much higher relative risks for all-cause mortality in AUD patients compared with earlier studies. Systematic evidence regarding cause-specific mortality among AUD patients has been unavailable to date.Methods: Studies were identified through MEDLINE, EMBASE and Web of Science up to August 2012. Following MOOSE guidelines, prospective and historical cohort studies assessing cause-specific mortality risk from AUD patients at baseline compared with the general population were selected. Data on several study characteristics, including AUD assessment, follow-up period, setting, location and cause-specific mortality risk compared with the general population were abstracted. Random-effect meta-analyses were conducted.Results: Overall, 17 observational studies with 6420 observed deaths among 28 087 AUD patients were included. Pooled standardized mortality ratios (SMRs) after 10 years of follow-up among men were 14.8 (95% confidence interval: 8.7-24.9) for liver cirrhosis, 18.0 (11.2-30.3) for mental disorders, 6.6 (5.0-8.8) for death by injury and around 2 for cancer and cardiovascular diseases. SMRs were substantially higher in women, with fewer studies available. For many outcomes the risk has been increasing substantially over time.Conclusions: Cause-specific mortality among AUD patients was high in all major categories compared with the general population. There has been a lack of recent research, and future studies should focus on the influence of comorbidities on excess mortality risk among AUD patients. Efforts to reduce these risks should be a priority, given that successful treatment reduces mortality risk substantially for a relatively common psychiatric disease.