PDF(Pubmed)
Abstract：
People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown.
We analysed reimbursement claims from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders.
We followed 1,070,183 beneficiaries for a median of three years, of whom 282,926 (26.4 %) received mental health diagnoses. Men with a mental health diagnosis lost 3.83 life years (95 % CI 3.58-4.10) compared to men without. Women with a mental health diagnosis lost 2.19 life years (1.97-2.41) compared to women without. Excess mortality varied by sex and diagnosis, from 11.50 LYL (95 % CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (men: 3.42, women: 1.94). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder.
Mental diagnoses are based on reimbursement claims.
Premature mortality among South African individuals with mental disorders is high. Our findings support interventions for the prevention, early detection, and treatment of physical comorbidities in this population. Targeted programs for suicide prevention and substance use treatment, particularly among men, can help reduce excess mortality from unnatural causes.
We analysed reimbursement claims from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders.
We followed 1,070,183 beneficiaries for a median of three years, of whom 282,926 (26.4 %) received mental health diagnoses. Men with a mental health diagnosis lost 3.83 life years (95 % CI 3.58-4.10) compared to men without. Women with a mental health diagnosis lost 2.19 life years (1.97-2.41) compared to women without. Excess mortality varied by sex and diagnosis, from 11.50 LYL (95 % CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (men: 3.42, women: 1.94). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder.
Mental diagnoses are based on reimbursement claims.
Premature mortality among South African individuals with mental disorders is high. Our findings support interventions for the prevention, early detection, and treatment of physical comorbidities in this population. Targeted programs for suicide prevention and substance use treatment, particularly among men, can help reduce excess mortality from unnatural causes.
摘要：
背景：患有精神疾病的人的预期寿命缩短，但南非精神疾病患者死亡率差距的程度以及自然和非自然原因对死亡率过高的贡献尚不清楚。
方法：我们分析了15-85岁南非医疗保险计划受益人的报销申请。我们估计与有机相关的剩余寿命年损失(LYL)，物质使用,精神病患者,心情,焦虑,吃,个性,发育或任何精神障碍。
结果：我们追踪了1,070,183名受益人，中位数为三年，其中282,926人(26.4%)接受了心理健康诊断。与没有精神健康诊断的男性相比，有精神健康诊断的男性损失了3.83岁（95％CI3.58-4.10）。与没有心理健康诊断的女性相比，有心理健康诊断的女性失去了2.19岁（1.97-2.41）。超额死亡率因性别和诊断而异，从患有酒精使用障碍的男性的11.50LYL(95%CI9.79-13.07)到患有广泛性焦虑症的女性的0.87LYL(0.40-1.43)。大多数LYL归因于自然原因（男性：3.42，女性：1.94）。在患有双相性（1.52）或物质使用（2.45）障碍的男性中，大量的LYL归因于非自然原因。
结论：精神诊断基于报销申请。
结论：南非精神障碍患者的过早死亡率很高。我们的发现支持预防干预措施，早期发现,和治疗该人群的身体合并症。有针对性的自杀预防和药物使用治疗计划，尤其是在男性中,可以帮助减少非自然原因造成的超额死亡率。
方法：我们分析了15-85岁南非医疗保险计划受益人的报销申请。我们估计与有机相关的剩余寿命年损失(LYL)，物质使用,精神病患者,心情,焦虑,吃,个性,发育或任何精神障碍。
结果：我们追踪了1,070,183名受益人，中位数为三年，其中282,926人(26.4%)接受了心理健康诊断。与没有精神健康诊断的男性相比，有精神健康诊断的男性损失了3.83岁（95％CI3.58-4.10）。与没有心理健康诊断的女性相比，有心理健康诊断的女性失去了2.19岁（1.97-2.41）。超额死亡率因性别和诊断而异，从患有酒精使用障碍的男性的11.50LYL(95%CI9.79-13.07)到患有广泛性焦虑症的女性的0.87LYL(0.40-1.43)。大多数LYL归因于自然原因（男性：3.42，女性：1.94）。在患有双相性（1.52）或物质使用（2.45）障碍的男性中，大量的LYL归因于非自然原因。
结论：精神诊断基于报销申请。
结论：南非精神障碍患者的过早死亡率很高。我们的发现支持预防干预措施，早期发现,和治疗该人群的身体合并症。有针对性的自杀预防和药物使用治疗计划，尤其是在男性中,可以帮助减少非自然原因造成的超额死亡率。
