| Summary: | 碩士 === 中國醫藥大學 === 醫務管理學系碩士在職專班 === 104 === Objectives: The health condition of patients with chronic psychiatric disorder is generally worse than that of the general public. In 2013, WHO reported that patients with severe psychiatric disorder have a lifespan 10–25 years shorter than that of the general public. This study correlated the risk of death in patients with chronic psychiatric disorder and related factors contributing to their deaths.
Methods: This research is a retrospective and longitudinal cohort study of 82,114 people with chronic psychiatric disorder who were enrolled during 2002-2008 and were registered in National Disability Registration Database. The relevant medical data and cause of death data were taken from the National Health Insurance Research Database. Their incidence of death from that time was noted up until 2012 - a total of 11 years of the study period. First, univariate Poisson regression analysis was undertaken to understand the relationships between variables and mortality, and the log rank test was used to examine the difference among variables in patients with chronic psychiatric disorders leading to death. A Cox proportional hazard model was adopted to analyze the relative risks and related factors for the mortality of patients. These patients were matched 1: 1 with the general public by propensity score matching, and Cox proportional hazard model was used to compare the difference of mortality risk and related factors.
Results：The mortality rate of patients with chronic psychiatric disorders was 19.55 per 1000 person-years and increases with the severity level of the disorder. In addition, their average age at death was 53.45. The mortality rate of patients with mild psychiatric disorders was 13.29 per 1000 person-years, and that of patients with severe mental disorder increased to 38.68. The mortality rate of male patients with psychiatric disorders was 22 per 1000 person-years, which was significantly higher than that of female patients (16.74). The most crucial factor influencing patient death was age (i.e., those aged 65 years or older were 6.39 times more likely to die than those aged 35 years or older), followed by the Charlson Comorbidity Index (CCI; i.e., those who scored greater than 3 in CCI were 4.21 times more likely to die than those who scored 0). Other less crucial factors also affected the patient mortality rate: Specifically, patients who had a higher education or higher income, live in highly urbanized areas, are married or divorced, are nonindigenous origin, or visit medical centers as their primary medical institutions exhibited a higher mortality rate. When all other variables were controlled, the risk of death in patients with chronic psychiatric disorder was 3.12 times higher than that of the general public; and the risk of death in patients with mild, moderate, severe, and very severe psychiatric disorder was 2.47, 2.93, 3.73, and 4.08 than that of the general public, respectively.
Conclusions：This study found that patients with chronic psychiatric disorders have the higher risk of death than those of general public. The most associated factors were age, severity level of the disorder, and comorbidity. The study results can be applied to government agencies while practicing preventive health care or formulating relevant policy. By adapting the appropriate policy, the risk of mortality could be lower and the society could be benefited as well.
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