| Summary: | 碩士 === 中山醫學大學 === 醫療產業科技管理學系碩士班 === 106 === Background:
Autoimmune diseases and psychiatric diseases are chronic diseases. Both of diseases have multiple comorbidity and more medical utilization. The complexity of the diseases made a challenge for the clinicians and health provider to manage it. The diseases makes burden to treatment and management. . We used a population-based retrospective cohort study to explore the questions on clarifying the correlation when the two diseases coexist; including the comorbidity, the medical utilization and the survival rate. The results may help the cli-nician to notice the special need for these patients and the health provider to design the better treatment strategy.
Method:
We identified subjects who were diagnosed with common autoimmune disease including rheumatoid arthritis, systemic lupus erythematous, Sjogren’s syndrome, ankylosing spon-dylitis and psoriasis between January 1, 2000, and December 31, 2012, in the Taiwan Na-tional Health Insurance (NHI) Research Database. A cross-sectional cohort study was con-ducted for patients with the diagnosis as mentioned above. Independent variation including common autoimmune diseases, psychiatric diseases, coomorbidity, and demographic characteristics; the independent variation were other comorbidity and medical utilization and mortality. There were patients 6,868 were included and 27,472 matched controls observed until diagnosed with psychiatric disorders or until death. This study was approved by the Institutional Review Board of Chung Shan Medical University in Taiwan (CS15134).
Results:
The collected data showed the prevalence of the selected autoimmune disease and psychi-atric diseases were 1.1% and 8.13%from 1997 to 2013. Under analysis of this retrospective cohort study, there was higher incidence of psychiatric disease for patients with autoim-mune disesase; the incident rate was 1.08 (95% confidential interval =0.99-1.18) and ad-justed hazard ratio was 1.42 (95% confidential interval=1.27-1.59). Systemic lupus ery-thematosus showed highest adjusted hazard ratio (aHR=1.66, 95% confidential ratio is 1.31(95% confidential incidence= 1.20-1.42). The mortality rate in patient with autoim-mune disease, the aHR=1.52(95% confidential incidence=1.38-1.67). Patients with system-ic lupus erythematosus showed the highest, aHR=3.17(95% confidential incidence=2.527-3.979).
Through this study, we conducted a nested cases (cases with or psychiatric disease) and control (without psychotic diesease). Patients with autoimmune disease had more physical comorbidity and more psychiatric comorbidity, especially comorbid with depression and anxiety. Autoimmune disease combined with psychiatric disorders had highest mortality risk (OR= 2.037). The medical utilization marked increased in hospitalization and outpa-tient followed-up.
Conclusion:
Patients with autoimmune disease comorbid with psychiatric disease have more comor-bidity, more medical utilization and more mortality rate. The results remind clinicians to pay more attention on identify the psychiatric disease while treating patients with autoim-mune disease. To determine if the combined care with psychiatrists leading to better out-come and better cost efficiency would need further investigation.
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