Multimorbidity clusters among people with serious mental illness: a representative primary and secondary data linkage cohort study.
Multimorbidity clusters among people with serious mental illness: a representative primary and secondary data linkage cohort study.
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DOI：
10.1017/s003329172200109x
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发表时间：
2023-07
影响因子：
6.9
通讯作者：
Stubbs, Brendon
中科院分区：
文献类型：
--
作者：
Ma, Ruimin;Romano, Eugenia;Ashworth, Mark;Yadegarfar, Mohammad E.;Dregan, Alexandru;Ronaldson, Amy;de Oliveira, Claire;Jacobs, Rowena;Stewart, Robert;Stubbs, Brendon
严重精神疾病（SMI）患者的死亡率较高，部分原因是长期疾病（LTC）患病率较高。然而，很少有人知道多个LTC（MLTC）聚集在这个人群中。来自南伦敦的患有SMI和两个或两个以上诊断时年龄在18岁以上的现有LTC的人被纳入2012 - 2020年的相关初级和精神卫生保健记录。潜在类别分析（LCA）确定MLTC类别和多项逻辑回归研究人口统计学/临床特征和潜在类别成员之间的关联。样本包括1924例患者（平均值（s.d.）年龄48.2（17.3）岁）。五个潜在的类：“物质相关”（24.9%），“特应性”（24.2%），“纯粹的情感”（30.4%），“心血管”（14.1%），和“复杂的多morphine”（6.4%）。患者在每个簇中平均有7 - 9个LTC。与“纯情感”相比，男性在所有四个集群中的MLTC几率都有所增加。与最大的集群相比，（“纯粹情感”）、“物质相关”和“特应性”集群更年轻[比值比（OR）每年增加0.99（95% CI 0.98 - 1.00）和0.96（0.95 - 0.97）]，而"心血管"和"复杂性多发性硬化症"组年龄较大（OR分别为1.09（1.07 - 1.10）和1.16（1.14 - 1.18））。"物质相关"聚类更可能是白色，"心血管"聚类更可能是黑人（与白色相比; OR 1.75，95% CI 1.10 - 2.79），与其他聚类相比，两者更可能患有精神分裂症。目前的研究确定了五个潜在类MLTC集群与SMI患者。建议在这一人群中采用综合护理模式治疗MLTC，以改善多发性硬化症的护理。
People with serious mental illness (SMI) experience higher mortality partially attributable to higher long-term condition (LTC) prevalence. However, little is known about multiple LTCs (MLTCs) clustering in this population. People from South London with SMI and two or more existing LTCs aged 18+ at diagnosis were included using linked primary and mental healthcare records, 2012–2020. Latent class analysis (LCA) determined MLTC classes and multinominal logistic regression examined associations between demographic/clinical characteristics and latent class membership. The sample included 1924 patients (mean (s.d.) age 48.2 (17.3) years). Five latent classes were identified: ‘substance related’ (24.9%), ‘atopic’ (24.2%), ‘pure affective’ (30.4%), ‘cardiovascular’ (14.1%), and ‘complex multimorbidity’ (6.4%). Patients had on average 7–9 LTCs in each cluster. Males were at increased odds of MLTCs in all four clusters, compared to the ‘pure affective’. Compared to the largest cluster (‘pure affective’), the ‘substance related’ and the ‘atopic’ clusters were younger [odds ratios (OR) per year increase 0.99 (95% CI 0.98–1.00) and 0.96 (0.95–0.97) respectively], and the ‘cardiovascular’ and ‘complex multimorbidity’ clusters were older (ORs 1.09 (1.07–1.10) and 1.16 (1.14–1.18) respectively). The ‘substance related’ cluster was more likely to be White, the ‘cardiovascular’ cluster more likely to be Black (compared to White; OR 1.75, 95% CI 1.10–2.79), and both more likely to have schizophrenia, compared to other clusters. The current study identified five latent class MLTC clusters among patients with SMI. An integrated care model for treating MLTCs in this population is recommended to improve multimorbidity care.