Identification of psychiatric patients with high mortality and low medical utilization: a population-based propensity score-matched analysis

Abstract

Background: The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization. Methods: A total of 570,250 individuals identified from the 2002-2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4. Results: PSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05). Conclusion: Substance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.

Effects of Social Participation by Middle-Aged and Elderly Residents on the Utilization of Medical Services: Evidence From China

“…The results show that older adults who reported internet use have lower depression levels than did those who did not use the internet, with adjustments made for Confounding factors ( 15 ). Jong-Yi Wang found that mortality and total medical expenditures per capita were significantly higher in psychiatric patients than in non-psychiatric patients by 1:1 dual propensity score matching ( 16 ).…”

Physical health attitude scale among mental health nurses in Taiwan: Validation and a cross-sectional study

“…The mortality rate in people with serious mental illness has been reported to be higher than that in people without such illness [ 3 , 4 ]; moreover, the life expectancy of people with serious mental illness is approximately 15 years shorter than that of individuals without such illness [ 5 ]. In Taiwan, individuals with serious mental illness were reported to experience higher mortality rates and healthcare expenditure than do individuals without such illness [ 6 ], and this gap appears to be increasing [ 7 ]. People with a diagnosis of serious mental illness do not appear to be benefiting from advances made in health care.…”