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The temporal relationship between severe mental illness diagnosis and chronic physical comorbidity: a UK primary care cohort study of disease burden over 10 years
The Lancet Psychiatry ( IF 64.3 ) Pub Date : 2022-07-21 , DOI: 10.1016/s2215-0366(22)00225-5
Naomi Launders 1 , Leiah Kirsh 1 , David P J Osborn 2 , Joseph F Hayes 2
Affiliation  

Background

Despite increased rates of physical health problems in people with schizophrenia, bipolar disorder, and other psychotic illnesses, the temporal relationship between physical disease acquisition and diagnosis of a severe mental illness remains unclear. We aimed to determine the cumulative prevalence of 24 chronic physical conditions in people with severe mental illness from 5 years before to 5 years after their diagnosis.

Methods

In this cohort study, we used the UK Clinical Practice Research Datalink (CPRD) to identify patients aged 18–100 years who were diagnosed with severe mental illness between Jan 1, 2000, and Dec 31, 2018. Each patient with severe mental illness was matched with up to four individuals in the CPRD without severe mental illness by sex, 5-year age band, primary care practice, and year of primary care practice registration. Individuals in the matched cohort were assigned an index date equal to the date of severe mental illness diagnosis in the patient with severe mental illness to whom they were matched. Our primary outcome was the cumulative prevalence of 24 physical health conditions, based on the Charlson and Elixhauser comorbidity indices, at 5 years, 3 years, and 1 year before and after severe mental illness diagnosis and at the time of diagnosis. We used logistic regression to compare people with severe mental illness with the matched cohort, adjusting for key variables such as age, sex, and ethnicity.

Findings

We identified 68 789 patients diagnosed with a severe mental illness between Jan 1, 2000, and Dec 31, 2018, and we matched them to 274 827 patients without a severe mental illness diagnosis. In both cohorts taken together, the median age was 40·90 years (IQR 29·46–56·00), 175 138 (50·97%) people were male, and 168 478 (49·03%) were female. The majority of patients were of White ethnicity (59 867 [87·03%] patients with a severe mental illness and 244 566 [88·99%] people in the matched cohort). The most prevalent conditions at the time of diagnosis in people with severe mental illness were asthma (10 581 [15·38%] of 68 789 patients), hypertension (8696 [12·64%]), diabetes (4897 [7·12%]), neurological disease (3484 [5·06%]), and hypothyroidism (2871 [4·17%]). At diagnosis, people with schizophrenia had increased odds of five of 24 chronic physical conditions compared with matched controls, and nine of 24 conditions were diagnosed less frequently than in matched controls. Individuals with bipolar disorder and other psychoses had increased odds of 15 conditions at diagnosis. At 5 years after severe mental illness diagnosis, these numbers had increased to 13 conditions for schizophrenia, 19 for bipolar disorder, and 16 for other psychoses.

Interpretation

Elevated odds of multiple conditions at the point of severe mental illness diagnosis suggest that early intervention on physical health parameters is necessary to reduce morbidity and premature mortality. Some physical conditions might be under-recorded in patients with schizophrenia relative to patients with other severe mental illness subtypes.

Funding

UK Office For Health Improvement and Disparities.



中文翻译:

严重精神疾病诊断与慢性躯体合并症之间的时间关系:英国 10 年疾病负担的初级保健队列研究

背景

尽管精神分裂症、双相情感障碍和其他精神病患者的身体健康问题发生率增加,但身体疾病获得与严重精神疾病诊断之间的时间关系仍不清楚。我们的目的是确定患有严重精神疾病的人从诊断前 5 年到诊断后 5 年的 24 种慢性身体状况的累积患病率。

方法

在这项队列研究中,我们使用英国临床实践研究数据链 (CPRD) 来确定 2000 年 1 月 1 日至 2018 年 12 月 31 日期间被诊断患有严重精神疾病的 18-100 岁患者。按性别、5 岁年龄段、初级保健实践和初级保健实践注册年份与 CPRD 中最多四名没有严重精神疾病的人匹配。匹配队列中的个体被分配一个索引日期,该索引日期等于与他们匹配的患有严重精神疾病的患者的严重精神疾病诊断日期。我们的主要结果是根据 Charlson 和 Elixhauser 合并症指数,在严重精神疾病诊断前后 5 年、3 年和 1 年以及诊断时的 24 种身体健康状况的累积患病率。

发现

我们在 2000 年 1 月 1 日至 2018 年 12 月 31 日期间确定了 68 789 名被诊断患有严重精神疾病的患者,并将他们与没有被诊断为严重精神疾病的 274 827 名患者进行匹配。在两个队列中,中位年龄为 40·90 岁(IQR 29·46–56·00),男性 175 138 人(50·97%),女性 168 478 人(49·03%)。大多数患者是白人(59 867 [87·03%] 名患有严重精神疾病的患者和匹配队列中的 244 566 [88·99%] 人)。严重精神疾病患者诊断时最常见的疾病是哮喘(68 789 名患者中的 10 581 [15·38%])、高血压(8696 [12·64%])、糖尿病(4897 [7·12 %])、神经系统疾病 (3484 [5·06%]) 和甲状腺功能减退 (2871 [4·17%])。诊断时,与匹配的对照组相比,精神分裂症患者的 24 种慢性身体状况中有 5 种的几率增加,24 种疾病中有 9 种的诊断频率低于匹配的对照组。双相情感障碍和其他精神病患者在诊断时出现 15 种疾病的几率增加。在诊断出严重精神疾病 5 年后,这些数字增加到 13 种精神分裂症、19 种双相情感障碍和 16 种其他精神病。

解释

在严重精神疾病诊断时出现多种疾病的几率升高表明,早期干预身体健康参数对于降低发病率和过早死亡是必要的。与其他严重精神疾病亚型患者相比,精神分裂症患者的某些身体状况可能记录不足。

资金

英国健康改善和差异办公室。

更新日期:2022-07-21
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