Trends in standardized mortality among individuals with schizophrenia, 1993-2012: a population-based, repeated cross-sectional study
Trends in standardized mortality among individuals with schizophrenia, 1993-2012: a population-based, repeated cross-sectional study
复制标题
DOI：
10.1503/cmaj.161351
复制
发表时间：
2017-09-18
影响因子：
14.6
通讯作者：
Kurdyak, Paul A.
中科院分区：
文献类型：
--
作者：
Gatov, Evgenia;Rosella, Laura;Kurdyak, Paul A.
背景：我们研究了20年来精神分裂症患者和非精神分裂症患者的死亡时间趋势和过早死亡率。方法：在这项基于人群的重复横断面研究中，我们确定了安大略省1993至2012年间发生的所有15岁及以上人群的死亡病例。我们绘制了总体和特定原因的年龄和性别标准化死亡率(ASMR)，根据社会人口学特征对所有原因的ASMR趋势进行分层，并使用潜在寿命损失年数分析过早死亡率。此外，我们使用负二项回归计算死亡率比(MRR)，并对年龄、性别、收入、农村和死亡年份进行了调整。结果：我们发现精神分裂症患者中有31 349人死亡，非精神分裂症患者中有1 589 902人死亡。精神分裂症患者的死亡率是非精神分裂症患者的3倍(调整后的MRR3.12，95%可信区间3.06-3.17)。在研究期间，两组中所有原因的ASMR下降了约35%，男性、低收入者和农村居民的ASMR更高。在整个研究期间，ASMR的绝对差异也有所下降(从每1000人16.15人死亡下降到10.49人死亡)。在精神分裂症患者中，特定原因的ASMR更大，1993至2012年间，循环系统疾病占大多数死亡原因，而2005年后，肿瘤成为非精神分裂症患者的主要死亡原因。精神分裂症患者的平均死亡率也比非精神分裂症患者年轻8岁，失去了更多的潜在寿命。干预：尽管精神分裂症患者的死亡率在过去20年里有所下降，但可能需要专门的方法来缩小与普通人群持续的3倍的相对死亡率差距。
BACKGROUND: We examined mortality time trends and premature mortality among individuals with and without schizophrenia over a 20-year period.METHODS: In this population-based, repeated cross-sectional study, we identified all individual deaths that occurred in Ontario between 1993 and 2012 in persons aged 15 and over. We plotted overall and cause-specific age- and sex-standardized mortality rates (ASMRs), stratified all-cause ASMR trends by sociodemographic characteristics, and analyzed premature mortality using years of potential life lost. Additionally, we calculated mortality rate ratios (MRRs) using negative binomial regression with adjustment for age, sex, income, rurality and year of death.RESULTS: We identified 31 349 deaths among persons with schizophrenia, and 1 589 902 deaths among those without schizophrenia. Mortality rates among people with schizophrenia were 3 times higher than among those without schizophrenia (adjusted MRR 3.12, 95% confidence interval 3.06-3.17). All-cause ASMRs in both groups declined in parallel over the study period, by about 35%, and were higher for men, for those with low income and for rural dwellers. The absolute ASMR difference also declined throughout the study period (from 16.15 to 10.49 deaths per 1000 persons). Cause-specific ASMRs were greater among those with schizophrenia, with circulatory conditions accounting for most deaths between 1993 and 2012, whereas neoplasms became the leading cause of death for those without schizophrenia after 2005. Individuals with schizophrenia also died, on average, 8 years younger than those without schizophrenia, losing more potential years of life.INTERPRETATION: Although mortality rates among people with schizophrenia have declined over the past 2 decades, specialized approaches may be required to close the persistent 3-fold relative mortality gap with the general population.