合并重性精神病对2型糖尿病患者就医和健康结局的影响：一项在英国开展的纵向观察性研究

2021

07/13

中国全科医学

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摘要：

背景

重性精神病患者的预期寿命短于普通人群。重性精神病患者糖尿病患病率更高,预后更差, 糖尿病可能是导致该人群与普通人群的预期寿命差异的一个因素。

目的

探讨合并重性精神病对2型糖尿病患者就医和健康结局的影响。

设计和开展地点

本项回顾性、观察性、配对、巢式病例对照研究在英国开展。数据来源于与英国临床研究数据库相链接的医院患者统计数据库。

方法

将2 192例合并重性精神病的2型糖尿病患者作为病例组, 7 773例单纯2型糖尿病患者作为对照组, 对两组患者的一系列就医数据（初级医疗机构咨询情况、体检数据和测量代谢参数）和健康结局（心血管病患病率、心血管病住院率及死亡风险）进行了比较。将患者社会人口统计学资料、共病情况和药物治疗情况作为协变量纳入回归模型进行分析。

结果

与对照组相比，病例组的全因死亡风险[HR=1.919, 95%CI(1.602, 2.300)]和心血管病死亡的风险更高[HR=2.242, 95%CI(1.547, 3.250)]。病例组的基层就诊率 [IRR =1.149, 95%CI(1.111,1.188)]、血压测量频率[IRR =1.024, 95%CI(1.003, 1.046)]和胆固醇检测频率[IRR =1.038, 95%CI(1.019,1.058)]更高。此外，虽然病例组心绞痛患病率低于对照组[OR=0.671, 95%CI(0.450,1.001)], 但是因心绞痛急诊住院次数多于对照组[IRR =1.532, 95% CI (1.069, 2.195)]。病例组缺血性心脏病择期住院次数少于对照组[IRR =0.682, 95% CI(0.508, 0.915)]。

结论

单纯2型糖尿病患者与合并重性精神病的2型糖尿病患者的代谢数据具有可比性。心血管疾病漏诊和延误治疗可能是导致合并重性精神病的2型糖尿病患者死亡率增加的因素。

原文网址：

https://doi.org/10.3399/BJGP.2020.0884

原文摘要如下：

Impact of severe mental illness on healthcare use and health outcomes for people with type 2 diabetes: a longitudinal observational study in England

Abstract

Background People with severe mental illnesses (SMIs) have reduced life expectancy compared with the general population. Diabetes is a contributor to this disparity, with higher prevalence and poorer outcomes in people with SMI.

Aim To determine the impact of SMI on healthcare processes and outcomes for people with type 2 diabetes (T2DM).

Design and setting Retrospective, observational, matched, nested, case–control study conducted in England using patient records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics.

Method A range of healthcare processes (primary care consultations, physical health checks, and metabolic measurements) and outcomes (prevalence and hospitalisation for cardiovascular disease [CVD], and mortality risk) were compared for 2192 people with SMI and T2DM (cases) with 7773 people who had diabetes alone (controls). Sociodemographics, comorbidity, and medication prescription were covariates in regression models.

Results When compared with results for participants with T2DM only, SMI was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.919, 95% confidence interval [CI] = 1.602 to 2.300) and CVD-specific mortality (HR 2.242, 95% CI = 1.547 to 3.250), higher primary care physician consultation rates (incidence rate ratio [IRR] 1.149, 95% CI = 1.111 to 1.188), more-frequent checks of blood pressure (IRR 1.024, 95% CI = 1.003 to 1.046) and cholesterol (IRR 1.038, 95% CI = 1.019 to 1.058), lower prevalence of angina (odds ratio 0.671, 95% CI = 0.450 to 1.001), more emergency admissions for angina (IRR 1.532, 95% CI = 1.069 to 2.195), and fewer elective admissions for ischaemic heart disease (IRR 0.682, 95% CI = 0.508 to 0.915).

Conclusion Monitoring of metabolic measurements was comparable for people with T2DM who did, and did not, have SMI. Increased mortality rates observed in people with SMI may be attributable to underdiagnosis of CVD and delays in treatment.