Clinical predictors of mortality in dual diagnosis patients receiving integrated in-patient treatment—A cohort study with 21 years follow-up

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-07-29 DOI:10.1111/add.70125

Signe Wegmann Düring, Lei Blandin Jobe, Magnus R. Balleby, Solvej Mårtensson

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Abstract

Aims

To examine mortality, and identify predictors of mortality, in a cohort of dual diagnosis (co-existing psychiatric disorder and substance use disorder) patients.

Design

Cohort study based on national register and electronic health record data.

Setting and participants

Between 2002 and 2017, 2359 dual-diagnosis patients received treatment at a specialized Danish department and were followed until death, migration or a maximum of 21 years.

Measurements

Data on diagnosis, substance use, demographics, medication use and mortality were linked to national registers. Kaplan–Meier plots illustrated mortality differences across diagnostic groups, while the Cox model identified factors associated with mortality.

Findings

In this study, 23.5% of dual diagnosis patients died within ten years of discharge and 33.7% at end of follow-up. The highest mortality risk was among those with a primary substance use disorder (SUD) and no psychiatric diagnosis, with 45.9% dying. Alcohol [adjusted hazard ratio (aHR) = 1.42; 95% confidence interval (CI) = 1.18–1.71], opioids (aHR = 1.26; 95% CI = 1.03–1.54), as well as Charlson Comorbidity Index: 1 (aHR = 1.70; 95% CI = 1.41–2.04) and 2 + (aHR = 2.56; 95% CI = 1.94–3.36), increased mortality risk. In contrast, cannabis use disorder (aHR = 0.77; 95% CI = 0.65–0.93) and being female (aHR = 0.83; 95% CI = 0.71–0.97) reduced it. Psychiatric diagnoses F30–39 (aHR = 0.70; 95% CI = 0.56–0.87) and F40–49 (aHR = 0.76; 95% CI = 0.59–0.97) were associated with lower mortality risk compared with F20–29. Of 733 deaths with mortality cause data, nearly two-thirds were from natural causes, 8% from suicide and 20% from accidents or violence.

Conclusion

The observed high mortality rates among clinically confirmed dual diagnosis patients (co-existing psychiatric disorder and substance use disorder) in Denmark highlight the urgent need for comprehensive treatment for this population. The risk of death appears to be related to type of substance use, with alcohol and opioids associated with higher mortality rates than other substances.

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接受综合住院治疗的双重诊断患者死亡率的临床预测因素——一项21年随访的队列研究

目的：在双重诊断（共存精神障碍和物质使用障碍）患者队列中检查死亡率，并确定死亡率的预测因素。设计：基于国家登记和电子健康记录数据的队列研究。背景和参与者：2002年至2017年期间，2359名双重诊断患者在丹麦的一个专门部门接受了治疗，并被随访至死亡、迁移或最多21年。测量方法：关于诊断、药物使用、人口统计、药物使用和死亡率的数据与国家登记册相关联。Kaplan-Meier图显示了诊断组之间的死亡率差异，而Cox模型则确定了与死亡率相关的因素。研究结果：在本研究中，23.5%的双重诊断患者在出院后10年内死亡，33.7%在随访结束时死亡。死亡风险最高的是那些患有原发性物质使用障碍（SUD）但没有精神诊断的人，死亡率为45.9%。酒精[校正风险比(aHR) = 1.42；95%可信区间(CI) = 1.18-1.71]，阿片类药物(aHR = 1.26；95% CI = 1.03-1.54)， Charlson合并症指数为1 (aHR = 1.70；95% CI = 1.41-2.04)和2 + (aHR = 2.56；95% CI = 1.94-3.36)，死亡风险增加。相比之下，大麻使用障碍(aHR = 0.77；95% CI = 0.65-0.93)和女性(aHR = 0.83；95% CI = 0.71-0.97)。精神科诊断F30-39 (aHR = 0.70；95% CI = 0.56-0.87)和F40-49 (aHR = 0.76；95% CI = 0.59-0.97)与F20-29相比，死亡风险较低。在有死亡原因数据的733例死亡中，近三分之二是自然死亡，8%是自杀，20%是事故或暴力。结论：在丹麦临床确诊的双重诊断患者（共存的精神障碍和物质使用障碍）中观察到的高死亡率突出了对这一人群进行综合治疗的迫切需要。死亡风险似乎与物质使用类型有关，酒精和阿片类药物的死亡率高于其他物质。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.