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精神疾病相关死亡健康指标的综合分析
作者:小柯机器人 发布时间:2019/10/28 15:54:04

丹麦奥胡斯大学John McGrath研究组取得一项新突破。他们综合分析了精神疾病相关死亡的健康指标:一项全国性的、基于注册表的队列研究。10月24日,《柳叶刀》在线发表了这项成果。

在这项基于人群的队列研究中,研究组分析了1995年1月1日至2015年12月31日在丹麦生活的所有95岁以下的人。有关精神障碍的信息从丹麦精神病中心研究登记处获得,死亡日期和死因从丹麦死亡原因登记处获得。

研究组共分析了7369926人的数据,结果发现患有精神障碍的人群死亡率为每1000人年28.70例,显著高于丹麦普通人群(12.95例)。另外,所有类型的精神疾病均与较高的死亡率有关,死亡率比率从情绪障碍的1.92增加至物质使用障碍的3.91。

所有类型的精神障碍还与较短的预期寿命相关,寿命损失年从女性器质性疾病的5.42年增加至男性物质使用障碍的14.84年。当研究特定的死亡原因时,与普通人群相比,患有任何类型精神障碍的男性因肿瘤相关死亡的寿命损失年有所减少,尽管他们的癌症死亡率更高。

总之,精神障碍与早死有关。通过对早死的准确估计,研究组揭示了与竞争风险和特定死因相关、但在此前却被低估的一些特征。

附:英文原文

Title: A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Author: Oleguer Plana-Ripoll, Carsten Bcker Pedersen, Esben Agerbo, Yan Holtz, Annette Erlangsen, Vladimir Canudas-Romo, Per Kragh Andersen, Fiona J Charlson, Maria K Christensen, Holly E Erskine, Alize J Ferrari, Kim Moesgaard Iburg, Natalie Momen, Preben Bo Mortensen, Merete Nordentoft, Damian F Santomauro, James G Scott, Harvey A Whiteford, Nanna Weye, John J McGrath, Thomas M Laursen

Issue&Volume: 2019/10/24

Abstract: 

Background

Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.

Methods

In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.

Findings

7?369?926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57–28·82] vs 12·95 deaths [12·93–12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91–1·94) for mood disorders to 3·91 (3·87–3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36–5·48) for organic disorders in females to 14·84 years (14·70–14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.

Interpretation

Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.

DOI: 10.1016/S0140-6736(19)32316-5

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32316-5/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet