背景:过早死亡,经常复发,容易导致住院,和不连续就业是精神分裂症治疗的关键挑战。我们评估了重要临床结局的危险因素(死亡,住院治疗,辞职,和病假)在日本的精神分裂症患者。
方法:对日本索赔数据库中确定的精神分裂症患者进行了巢式病例对照研究。对于每个结果,该病例与多达四个相同年龄的对照相匹配,性别,指数年,和登记状态(雇员或受抚养家庭)。潜在的危险因素由事件发生前3个月内或事件发生前3个月内的处方或诊断来定义。使用多变量条件逻辑回归分析和逐步变量选择评估潜在危险因素与每个结果之间的关联。
结果:每个结果的病例和合格患者数量分别为144和38,451(死亡),1,520和35,225(住院),811和18,770(辞职),和4,590和18,770(病假),分别。抑郁是死亡的危险因素(比值比[OR]:1.92;95%置信区间[CI]:1.12,3.29),住院(OR:1.22;95%CI:1.05,1.42),和病假(OR:1.46;95%CI:1.36,1.57)。死亡的其他危险因素是住院史,Charlson合并症指数(CCI)评分,和泻药的处方。催眠药的处方,泻药,和抗胆碱能药物是住院的危险因素。催眠药和抗胆碱能药物的处方是辞职的危险因素。CCI得分,催眠药的处方,泻药,抗糖尿病药物是病假的危险因素。
结论:我们的研究结果表明,抑郁症和一些身体症状,如便秘和锥体外系症状,是精神分裂症患者重要临床结局的危险因素。精神分裂症的治疗应同时注意抑郁症和身体症状。
Premature mortality, frequent relapse that easily leads to hospitalization, and discontinuous employment are key challenges for the treatment of schizophrenia. We evaluated risk factors for important clinical outcomes (death, hospitalization, resignation, and sick leave from work) in patients with schizophrenia in Japan.
A nested
case-control study was conducted for patients with schizophrenia identified in a Japanese claims database. For each outcome, the
case was matched with up to four controls of the same age, sex, index year, and enrollment status (employee or dependent family). Potential risk factors were defined by prescriptions or diagnoses within 3 months prior to or in the month of the event. The association among potential risk factors and each outcome was evaluated using multivariable conditional logistic regression analysis with stepwise variable selection.
The number of cases and eligible patients for each outcome were 144 and 38,451 (death), 1,520 and 35,225 (hospitalization), 811 and 18,770 (resignation), and 4,590 and 18,770 (sick leave), respectively. Depression was a risk factor for death (odds ratio [OR]: 1.92; 95% confidence interval [CI]: 1.12, 3.29), hospitalization (OR: 1.22; 95% CI: 1.05, 1.42), and sick leave from work (OR: 1.46; 95% CI: 1.36, 1.57). Other risk factors for death were hospitalization history, Charlson Comorbidity Index (CCI) score, and prescription for laxatives. Prescriptions for hypnotics, laxatives, and anticholinergics were risk factors for hospitalization. Prescriptions for hypnotics and anticholinergics were risk factors for resignation. CCI score, prescription for hypnotics, laxatives, and antidiabetics were risk factors for sick leave from work.
Our findings suggest that depression and some physical symptoms, such as constipation and extrapyramidal symptoms, are risk factors for important clinical outcomes in patients with schizophrenia. Attention should be paid to both depression and physical symptoms for the treatment of schizophrenia.