| 摘要: | [研究背景]
糖尿病患者已被證實有較高的風險罹患焦慮共病症。研究顯示糖尿病以及焦慮症分別與中風的發生有關聯。然而，至今仍沒有研究指出在糖尿病患者中合併衍生之焦慮症患者，是否有較高的中風風險。
[研究目的]
本研究目的為評估在糖尿病患者中，焦慮共病症是否與增加中風風險有相關性。
[研究方法]
本研究使用台灣全民健保資料庫之2010年百萬歸人抽樣檔。在符合糖尿病診斷患者中篩選出新診斷之焦慮共病症者，定義為實驗組；並且根據年齡以及性別與沒有焦慮共病症之糖尿病患者以一比四配對給實驗組的方式，定義為對照組。在五年的觀察期間裡，追縱兩組病患發生中風的情況。在統計分析的部分先使用傾向分數配對來平衡兩組的干擾因子，爾後再進行邏輯斯回歸分析以及存活分析來評估焦慮共病症與中風發生的相關性。
[研究結果]
在本研究的糖尿病族群中(N=31,223)，約有6.5%的患者同時具有焦慮共病症。在校正相關干擾因子後，實驗組相較於對照組，有較高的風險比以及勝算比(Hazard ratio= 1.35, 95% CI= 1.06-1.72; Odds ratio=1.36, 95% CI=1.06-1.75)。
[結論]
本篇研究發現，在糖尿病族群中,有焦慮共病症的患者，相較於沒有焦慮共病症的患者，有較高的中風風險。建議醫療保健人員能即早診斷出患有焦慮共病症之糖尿病患者，並及早預防治療。
[Background]
The presence of anxiety disorders in patients with diabetes is gaining increased attention. Previous studies have shown that comorbid anxiety is the most prevalent comorbid psychiatric condition among patients with diabetes. Both diabetes and anxiety disorders are independent risk factor of stroke. However, limited studies have investigated whether the risk of stroke is higher among diabetic patients with comorbid anxiety disorders than without comorbid anxiety disorders.
[Objective]
The purpose of this study is to investigate the association between comorbid anxiety disorders and the risk of stroke among patients with diabetes.
[Methods]
We conducted a retrospective cohort study using the 2001-2011 National Health Insurance Research Database (NHIRD) in Taiwan. The study population in this study is patients with diabetes, which they should be at least two outpatient visits or one inpatient visit diagnosed with diabetes mellitus between January 1, 2001, and December 31, 2006. All of those diabetic patients required at least one anti-hyperglycemic prescription.
After that, we defined the exposure group as patients with comorbid anxiety disorders among these study population. Those diabetic patients with at least two outpatient visits or one inpatient discharge visit diagnosed with anxiety disorders and at least one anxiolytic prescription between January 1, 2002, and December 31, 2006 were defined as patients with comorbid anxiety disorders and set as the exposure group. The index date was the date that anxiety disorders were firstly diagnosed. The comorbid anxiety group was matched to the non-comorbid anxiety group with age and gender by 1:4 ratios and assigned an index date.
Both groups were followed up to five year to evaluate the risk of stroke. We used propensity score, which were derived from patient characteristics and risk factors, to match and balance the observed confounders between two groups. The Cox proportional hazard regression models and logistic regression models were used to evaluate the association between comorbid anxiety disorders and the risk of stroke.
[Results]
Among patients with diabetes (N=31,223), an estimated 6.5% patients had comorbid anxiety disorders. After adjusting for covariates by using propensity score matching, the hazard of stroke and the odds of stroke were higher among diabetic patients with comorbid anxiety disorders than without comorbid anxiety disorders (Hazard ratio= 1.35, 95% CI= 1.06-1.72; Odds ratio=1.36, 95% CI=1.06-1.75).
[Conclusion]
Diabetic patients with comorbid anxiety disorders were found to be associated with an increased risk of stroke attack. Health providers need to routinely check mental health status for anxiety disorders among patients with diabetes to prevent a stroke attack. |
