精神障害は呼吸器感染症関連の医療利用リスクを高める

Mental Disabilities Increase the Risk of Respiratory Infection-related Healthcare Utilization.

• Chen-Hung Chiang
• Ming-Che Tsai
• Yee-Yung Ng
• Shiao-Chi Wu

抄録

慢性的な精神障害を有する患者は，慢性的な呼吸器感染症の脆弱性が高い．我々は，精神障害の有無にかかわらず，精神障害が呼吸器感染症関連利用リスクに及ぼす影響を検討した．集団ベースのレトロスペクティブなコホートデザインと 2 部構成モデルを用いて、MD を有する個人（MD 群）と対照群の呼吸器感染症関連利用率を解析した。1年間の呼吸器感染症関連利用率は、MD群（53.8％）の方が参考群（56.6％）よりも低かった。オッズ比（OR）は、共変量をコントロールした後、重症MD群（aOR = 1.10；95％CI 1.07～1.14）と虫歯の既往歴のある群（aOR = 1.16；95％CI 1.13～1.19）または歯周病の既往歴のある群（aOR = 1.22；95％CI 1.19～1.26）で有意に高かった。平均受診回数は、MD群（5.3回）の方が基準群（4.0回）よりも多かった。呼吸器感染症関連の利用率と平均受診回数は、歯周病歴のある軽度、中等度、重度の障害者群では、それぞれ基準群よりも有意に高かった。結論として、医療当局は、MDを有する個人の呼吸器感染症を予防するためのインセンティブプログラムを開発する必要がある。

Patients with chronic mental illness are highly vulnerable to chronic respiratory problems. We examined the influence of mental disability on respiratory infection-related utilization risk in individuals with and without mental disabilities. A population-based, retrospective cohort design and two-part model were used to analyze respiratory infection-related utilization in individuals with MDs (MD group) and a matched reference group. The respiratory infection-related utilization rate in one year was lower in the MD group (53.8%) than in the reference group (56.6%). The odds ratios (ORs) were significantly higher among individuals with profound MDs (aOR = 1.10; 95% CI 1.07-1.14) and those with a history of dental cavities (aOR = 1.16; 95% CI: 1.13-1.19) or periodontal disease (aOR = 1.22; 95% CI: 1.19-1.26) after controlling for covariables. The average number of visits was higher in the MD group (5.3) than in the reference group (4.0). The respiratory infection-related utilization rate and average number of visits were significantly higher in the mild, moderate and severe disabled groups with a history of periodontal disease, respectively, than that of the reference group. In conclusion, healthcare authorities must develop an incentive program to prevent respiratory infections among individuals with MDs.