利用健保資料庫分析常見自體免疫疾病患者新發精神疾病之相關性分析

目的：自體免疫疾病往往需長期治療，影響多重器官，罹患精神疾病比例較高。然整體就醫及健康狀況，過去未有充份的研究。本研究使用全民健保資料庫分析，以了解病人樣態，供未來擬定治療策略之參考。方法：本研究使用國家衛生研究院『健保研究資料庫』中的2000年承保人100萬隨機抽樣歸人資料檔，於1997-2012年間，依ICD-9確診的患者進行統計分析。研究變項為常見的五種自體免疫疾病、六種精神疾病，且納入社會人口特質及其他生理共病。分析中進行控制調整或分層分析，以卡方檢定檢視同質性。使用存活分析觀察至精神疾病的發生，並以Cox比例風險回歸模型估計自體免疫疾病患者（暴露組）的精神疾病校正風險對比值（aHR）。結果：研究期間，免疫風濕疾病患者共10,923名（盛行率1.10%）。暴露組有較高的精神疾病發生率（1.08, 95% C.I.=0.99-1.18每千人月），且在新發生精神疾病的aHR為1.421（95%, C.I.=1.268-1.593）。類風濕性關節炎與失智症有顯著相關。合併兩種以上自體免疫疾病者其罹患情感性精神病及焦慮症aHR最高。結論：自體免疫疾病患者，生理及精神疾病共病風險均增加。從醫療及健康管理的角度來看，需考慮此疾病的複雜性，以利協助提供醫療整合照顧。

關鍵字

自體免疫疾病；精神疾病；共病；健保資料庫；存活分析

並列摘要

Objectives: Patients with autoimmune diseases (AIDs) often require long-term treatment because of the effects on multiple organs and high ratio of existing psychiatric disorders. However, studies on the overall medical treatments and health status of these patients are inadequate. To address this gap, this study used the National Health Insurance Research Database (NHIRD) to analyze the health status of patients with AIDs to establish further treatment. Methods: Data from the Longitudinal Health Insurance Database, 2000 (LHID2000) provided by the National Health Research Institutes for the period from 1997 to 2012 were used in this study. The LHID 2000 contains all original claims data for the 1 million randomly sampled individuals from the NHIRD. The data of patients with AIDs identified using International Classification of Diseases, Ninth Revision were included in this study. The research variables included five common AIDs and six psychiatric diseases, social demographic characteristics, and physical comorbidities. We used covariance analysis, stratification, and the χ^2 test for homogeneity. The occurrence of psychiatric disorders was observed using survival analysis, and the adjusted hazard ratio (aHR) for patients with AIDs (exposed group) was estimated using a Cox regression model. Results: During the study period, the prevalence of AIDs was 1.10%. The exposed group had a higher incidence of physical disease (incidence per 1000 person-months = 1.08, 95% confidence interval (CI) = 0.99- 1.18), and the aHR for newly diagnosed psychiatric disorders was 1.421 (95% CI = 1.27-1.59). Rheumatoid arthritis was significantly associated with dementia. Patients with more than two AIDs had the highest risk of having comorbidity with bipolar disorders or with anxiety disorders. Conclusions: Patients with AIDs had more physical and psychiatric comorbidities. Considering the complexity of AIDs, integrated medical care is necessary to provide better care.

並列關鍵字

Autoimmune diseases ； psychiatric disorder ； comorbidity ； health insurance database ； survival analysis

參考文獻

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利用健保資料庫分析常見自體免疫疾病患者新發精神疾病之相關性分析

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