Abstract：
BACKGROUND: The burden of psychiatric morbidity, level of education, and work participation is currently unknown in patients with congenital ventricular septal defects (VSD).
METHODS: In a Danish population-based cohort study using nationwide medical registries the burden of psychiatric disorders, use of psychotropic agents, level of education, and work participation were examined in patients with isolated congenital VSD and controls from the general population matched by age and sex. Subjects with known chromosomal abnormalities were excluded. To compute estimates, Cox proportional regression model, Fine and Gray\'s competing risk regression, and Kaplan-Meier failure function were used.
RESULTS: We included 8 006 patients and 79 568 controls born before 2018. Median follow-up was 23 years. Compared with controls, patients with VSD displayed a HR of 1.24 (95% CI: 1.17-1.32) for any psychiatric disorder where the hazard for intellectual disabilities was most pronounced [HR of 3.66 (95% CI: 2.98-4.50)]. The use of psychotropic agents was higher in patients compared with controls [HR 1.14 (95% CI: 1.09-1.20)]. The work participation was lower in patients with VSD compared with controls (P < 0.001) and was lower in patients with VSD with a psychiatric disorder compared with those without (P < 0.001). The 40-year cumulative incidence of permanent social security benefits was 29% in patients with psychiatric disorders (versus 21% in controls with psychiatric disorders) and 8% in patients without psychiatric disorders (versus 4% in controls).
CONCLUSIONS: Patients with isolated VSD suffer from a higher burden of psychiatric disorders and display lower work participation compared with matched controls from the general Danish population. It is important to consider longer-term impacts on mental health, education, and subsequent employment in patients with VSD, in addition to cardiovascular effects, as these factors severely affect quality of life and have direct socioeconomic implications on an individual and societal level.
METHODS: In a Danish population-based cohort study using nationwide medical registries the burden of psychiatric disorders, use of psychotropic agents, level of education, and work participation were examined in patients with isolated congenital VSD and controls from the general population matched by age and sex. Subjects with known chromosomal abnormalities were excluded. To compute estimates, Cox proportional regression model, Fine and Gray\'s competing risk regression, and Kaplan-Meier failure function were used.
RESULTS: We included 8 006 patients and 79 568 controls born before 2018. Median follow-up was 23 years. Compared with controls, patients with VSD displayed a HR of 1.24 (95% CI: 1.17-1.32) for any psychiatric disorder where the hazard for intellectual disabilities was most pronounced [HR of 3.66 (95% CI: 2.98-4.50)]. The use of psychotropic agents was higher in patients compared with controls [HR 1.14 (95% CI: 1.09-1.20)]. The work participation was lower in patients with VSD compared with controls (P < 0.001) and was lower in patients with VSD with a psychiatric disorder compared with those without (P < 0.001). The 40-year cumulative incidence of permanent social security benefits was 29% in patients with psychiatric disorders (versus 21% in controls with psychiatric disorders) and 8% in patients without psychiatric disorders (versus 4% in controls).
CONCLUSIONS: Patients with isolated VSD suffer from a higher burden of psychiatric disorders and display lower work participation compared with matched controls from the general Danish population. It is important to consider longer-term impacts on mental health, education, and subsequent employment in patients with VSD, in addition to cardiovascular effects, as these factors severely affect quality of life and have direct socioeconomic implications on an individual and societal level.
摘要：
背景：精神病发病率的负担，教育水平,先天性室间隔缺损（VSD）患者的工作参与目前未知。
方法：在一项基于丹麦人群的队列研究中，该研究使用了全国性的医疗登记处来评估精神疾病的负担，使用精神药物，教育水平,对孤立的先天性VSD患者和对照组的工作参与率进行了检查，这些患者来自年龄和性别匹配的普通人群。排除具有已知染色体异常的受试者。要计算估计值，Cox比例回归模型，精细和灰色的竞争风险回归，使用Kaplan-Meier失效函数。
结果：我们纳入了2018年前出生的8.006例患者和79.568例对照。中位随访时间为23年。与对照组相比，对于智力障碍危险最明显的任何精神疾病,VSD患者的HR为1.24(95%CI:1.17~1.32)[HR为3.66(95%CI:2.98~4.50)].与对照组相比，患者使用精神药物的比例更高[HR1.14（95％CI：1.09-1.20）]。与对照组相比，VSD患者的工作参与率较低（P<0.001），而与精神病患者相比，VSD患者的工作参与率较低（P<0.001）。在患有精神疾病的患者中，永久性社会保障福利的40年累积发生率为29％（在患有精神疾病的对照组中为21％），在没有精神疾病的患者中为8％（在对照组中为4％）。
结论：与丹麦普通人群中的匹配对照组相比，孤立性VSD患者的精神疾病负担更高，工作参与率较低。重要的是要考虑对心理健康的长期影响，教育,以及随后雇用VSD患者，除了心血管的影响，因为这些因素严重影响生活质量，对个人和社会层面有直接的社会经济影响。
方法：在一项基于丹麦人群的队列研究中，该研究使用了全国性的医疗登记处来评估精神疾病的负担，使用精神药物，教育水平,对孤立的先天性VSD患者和对照组的工作参与率进行了检查，这些患者来自年龄和性别匹配的普通人群。排除具有已知染色体异常的受试者。要计算估计值，Cox比例回归模型，精细和灰色的竞争风险回归，使用Kaplan-Meier失效函数。
结果：我们纳入了2018年前出生的8.006例患者和79.568例对照。中位随访时间为23年。与对照组相比，对于智力障碍危险最明显的任何精神疾病,VSD患者的HR为1.24(95%CI:1.17~1.32)[HR为3.66(95%CI:2.98~4.50)].与对照组相比，患者使用精神药物的比例更高[HR1.14（95％CI：1.09-1.20）]。与对照组相比，VSD患者的工作参与率较低（P<0.001），而与精神病患者相比，VSD患者的工作参与率较低（P<0.001）。在患有精神疾病的患者中，永久性社会保障福利的40年累积发生率为29％（在患有精神疾病的对照组中为21％），在没有精神疾病的患者中为8％（在对照组中为4％）。
结论：与丹麦普通人群中的匹配对照组相比，孤立性VSD患者的精神疾病负担更高，工作参与率较低。重要的是要考虑对心理健康的长期影响，教育,以及随后雇用VSD患者，除了心血管的影响，因为这些因素严重影响生活质量，对个人和社会层面有直接的社会经济影响。
