【摘要】 目的 探讨社区在管精神分裂症患者全因和特定原因死亡的影响因素。方法 数据来自中国西部某地严重精神障碍的综合管理信息平台。采用Kaplan-Meier法和log-rank检验估计和比较患者死亡的累积发生率曲线。分别采用Cox比例风险回归模型和Fine-Gray竞争风险模型，探索全因死亡和不同死因的影响因素。结果 本研究共纳入207 638例精神分裂症患者，中位随访时间3.98年，最大随访时长为12.35年。随访期间共15 062例（7.3%）患者死亡，其中分别有8 758人（4.2%）因躯体疾病、563人（0.3%）因自杀、1 337人（0.6%）因意外、1 193人（0.6%）因精神疾病相关并发症、3 211人（1.6%）因其他原因死亡。多因素Cox回归分析结果显示，年龄[风险比（hazard ratio, HR）=3.65,95%置信区间（confidence interval,CI）:3.49～3.81]、性别（HR=0.78,95%CI:0.75～0.81）、民族（HR=0.78,95%CI:0.61～0.99）、婚姻状况（HR=1.24,95%CI:1.19～1.28）、经济水平（HR=1.67,95%CI:1.61～1.74）、文化程度（HR=0.69,95%CI:0.66～0.72）、精神疾病家族史（HR=0.90,95%CI:0.83～0.98）和病程[10～19年（HR=0.82,95%CI:0.79～0.85）、20～29年（HR=0.79,95%CI:0.76～0.83）]是患者发生全因死亡的影响因素。Fine-Gray模型结果显示，年龄较大、男性、文化程度低、贫困是患者因躯体疾病、意外、精神疾病相关并发症和其他原因死亡的共同危险因素。未婚/离异/丧偶、病程短是患者因躯体疾病、意外、其他原因死亡的共同危险因素。服药依从性不佳是精神疾病相关并发症和其他原因死亡的危险因素。除此之外，对于因躯体疾病死亡，汉族、无精神疾病家族史的患者死亡风险更高。而对于自杀死亡，文化程度高、贫困、病程短、服药依从性良好是其危险因素。结论 应对精神分裂症患者的不同死亡风险进行有针对性地管理和干预，以提高患者生存率。更多还原

【Abstract】 Objective To investigate the factors influencing all-cause and specific cause deaths in communitydwelling patients with schizophrenia. Methods The data analyzed in this study were obtained from the integrated management information platform for severe mental disorders in a region in western China. The Kaplan-Meier method and log-rank test were used to estimate and compare the cumulative incidence curves of patient deaths. Risk factors for all-cause and specific cause deaths were explored using the Cox proportional hazards regression model and Fine-Gray competing risk model, respectively. Results A total of 207 638 schizophrenia patients were included in the study, with a median follow-up period of 3.98 years and a maximum follow-up period of 12.35 years. A total of 15 062(7.3%) patients died during the follow-up period, including 8 758(4.2%) due to physical illnesses, 563(0.3%) due to suicide, 1 337(0.6%)due to accidents, 1 193(0.6%) due to mental illness-related complications, and 3 211(1.6%) due to other causes.Multivariate Cox regression analysis revealed that age(hazard ratio [HR] = 3.65, 95% CI: 3.49-3.81), sex(HR = 0.78, 95%CI: 0.75-0.81), ethnicity(HR = 0.78, 95% CI: 0.61-0.99), marital status(HR = 1.24, 95% CI: 1.19-1.28), economic status(HR = 1.67, 95% CI: 1.61-1.74), educational attainment(HR = 0.69, 95% CI: 0.66-0.72), family history of psychiatric illness(HR = 0.90, 95% CI: 0.83-0.98), and the duration of illness(10-19 years [HR = 0.82, 95% CI: 0.79-0.85] and 20-29 years [HR = 0.79, 95% CI: 0.76-0.83]) were influencing factors for all-cause deaths in patients with schizophrenia. The results of the Fine-Gray model indicated that older age, male sex, lower educational attainment, and poverty are common risk factors for patient deaths due to physical illnesses, accidents, mental illness-related complications, and other causes.Being single, divorced, or widowed and having a shorter duration of illness are common risk factors for mortality due to physical illnesses, accidents, and other causes. Poor medication adherence was a risk factor for patient deaths due to mental illness-related complications and other causes. Additionally, for deaths due to physical illnesses, Han ethnicity and the absence of a family history of psychiatric illness were associated with a higher mortality risk. Regarding suicide deaths,higher educational attainment, poverty, shorter duration of illness, and good medication adherence were identified as risk factors. Conclusion Targeted management and interventions should be implemented based on the different mortality risks in schizophrenia patients to improve their survival rates.更多还原