Incidence and associations of hospital delirium diagnoses in 85,979 people with severe mental illness: A data linkage study.
Incidence and associations of hospital delirium diagnoses in 85,979 people with severe mental illness: A data linkage study.
复制标题
85,979 名严重精神疾病患者的医院谵妄诊断的发生率和关联：一项数据关联研究。
DOI：
10.1111/acps.13480
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发表时间：
2023
影响因子：
6.7
通讯作者：
Bauernfreund Y
中科院分区：
文献类型：
--
作者：
Bauernfreund Y
妄想症是一种由多种生理应激源引起的急性神经精神障碍，具有较高的发病率和死亡率。对其与严重精神疾病(SMI)的关系知之甚少。方法我们利用英国临床实践研究数据链(CPRD)和医院事件统计(HES)数据库的关联数据分析进行了一项回溯性队列研究。结果：队列中249,047例精神分裂症患者，CPRD平均随访时间为6.4 年。共有85,979名患者符合HES连锁的条件。精神错乱发病率从2000年的0.04(95%可信区间0.02-0.07)每100人年上升到2017年的每100人年1.05(95%可信区间0.93-1.17)，从2010年起增长最为显著。精神错乱与研究开始时年龄较大(OR1.05，95%CI 1.05-1.06)、SMI诊断为双相情感障碍(OR 1.66，95%CI 1.44-1.93)或与精神分裂症相关的其他精神病(OR 1.56，95%CI 1.35-1.80)以及更多的躯体并发症(Charlson共病指数每增加一次共病，OR 1.08，95%CI 1.02-1.14)有关。精神分裂症患者在随访期间接受了更多的抗精神病药物治疗(1-2个抗精神病药物OR为1.65，95%CI为1.44-1.90；>；2个抗精神病药物OR为2.49，95%CI为2.12-2.92)。老年人开的抗精神病药物越多，合并疾病越多，发病率就越高。链接的电子健康记录对于探索SMI中的精神错乱等医院诊断是可行的。
IntroductionDelirium is an acute neuro‐psychiatric disturbance precipitated by a range of physical stressors, with high morbidity and mortality. Little is known about its relationship with severe mental illness (SMI).MethodsWe conducted a retrospective cohort study using linked data analyses of the UK Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. We ascertained yearly hospital delirium incidence from 2000 to 2017 and used logistic regression to identify associations with delirium diagnosis in a population with SMI.ResultsThe cohort included 249,047 people with SMI with median follow‐up time in CPRD of 6.4 years. A total of 85,979 patients were eligible for linkage to HES. Delirium incidence increased from 0.04 (95% CI 0.02–0.07) delirium associated admissions per 100 person‐years in 2000 to 1.05 (95% CI 0.93–1.17) per 100 person‐years in 2017, increasing most notably from 2010 onwards. Delirium was associated with older age at study entry (OR 1.05 per year, 95% CI 1.05–1.06), SMI diagnosis of bipolar affective disorder (OR 1.66, 95% CI 1.44–1.93) or other psychosis (OR 1.56, 95% CI 1.35–1.80) relative to schizophrenia, and more physical comorbidities (OR 1.08 per additional comorbidity of the Charlson Comorbidity Index, 95% CI 1.02–1.14). Patients with delirium received more antipsychotic medication during follow‐up (1–2 antipsychotics OR 1.65, 95% CI 1.44–1.90; >2 antipsychotics OR 2.49, 95% CI 2.12–2.92).ConclusionsThe incidence of recorded delirium diagnoses in people with SMI has increased in recent years. Older people prescribed more antipsychotics and with more comorbidities have a higher incidence. Linked electronic health records are feasible for exploring hospital diagnoses such as delirium in SMI.