Xueyan Han1, Feng Jiang2, Jack Needleman3, Huixuan Zhou4, Chen Yao5, Yi-Lang Tang6. 1. Peking University First Hospital, 8 Xishiku Road, Xicheng District, Beijing, China. Electronic address: hanxueyan611@163.com. 2. Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, 1954 Huashan Road, Xuhui District, Shanghai, China. Electronic address: fengjiang@sjtu.edu.cn. 3. Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA, USA. Electronic address: needlema@ucla.edu. 4. School of Sport Science, Beijing Sport University, 48 Xinxi Road, Haidian District, Beijing, China. Electronic address: chouhuixuan@live.cn. 5. Peking University First Hospital, 8 Xishiku Road, Xicheng District, Beijing, China; Peking University Clinical Research Institute, 38 Xueyuan Road, Haidian District Beijing, China. Electronic address: yaochen.pucri@foxmail.com. 6. Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite 150, Atlanta, GA, USA; Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, USA. Electronic address: ytang5@emory.edu.
Abstract
BACKGROUND: Comorbidities are common among patients with schizophrenia yet the prevalence of comorbidity combinations and their associations with inpatient service utilization and readmission have been scarcely explored. METHODS: Data were extracted from discharge summaries of patients whose primary diagnosis was schizophrenia spectrum disorders (ICD-10: F20-F29). We identified 30 most frequent comorbidities in patients' secondary diagnoses and then used the association rule mining (ARM) method to derive comorbidity combinations associated with length of stay (LOS), daily expense and one-year readmission. RESULTS: The study included data from 8252 patients. The top five most common comorbidities were extrapyramidal syndrome (EPS, 44.58%), constipation (31.63%), common cold (21.80%), hyperlipidemia (20.99%) and tachycardia (19.13%). Most comorbidity combinations identified by ARM were significantly associated with longer LOS (≥70 days), few were associated with higher daily expenses, and fewer with readmission. The 3-way combination of common cold, hyperlipidemia and fatty liver had the strongest association with longer LOS (adjusted OR (aOR): 3.38, 95% CI: 2.12-5.38). The combination of EPS and mild cognitive disorder was associated with higher daily expense (≥700 RMB) (aOR: 1.67, 95% CI: 1.20-2.31). The combination of constipation, tachycardia and fatty liver were associated with higher 1-year readmission (aOR: 2.05, 95% CI: 1.03-4.09). CONCLUSION: EPS, constipation, and tachycardia were among the most commonly reported comorbidities in schizophrenia patients in Beijing, China. Specific groups of comorbidities may contribute to higher inpatient psychiatric service utilization and readmission. The mechanism behind the associations and potential interventions to optimize service use warrant further investigation.
BACKGROUND: Comorbidities are common among patients with schizophrenia yet the prevalence of comorbidity combinations and their associations with inpatient service utilization and readmission have been scarcely explored. METHODS: Data were extracted from discharge summaries of patients whose primary diagnosis was schizophrenia spectrum disorders (ICD-10: F20-F29). We identified 30 most frequent comorbidities in patients' secondary diagnoses and then used the association rule mining (ARM) method to derive comorbidity combinations associated with length of stay (LOS), daily expense and one-year readmission. RESULTS: The study included data from 8252 patients. The top five most common comorbidities were extrapyramidal syndrome (EPS, 44.58%), constipation (31.63%), common cold (21.80%), hyperlipidemia (20.99%) and tachycardia (19.13%). Most comorbidity combinations identified by ARM were significantly associated with longer LOS (≥70 days), few were associated with higher daily expenses, and fewer with readmission. The 3-way combination of common cold, hyperlipidemia and fatty liver had the strongest association with longer LOS (adjusted OR (aOR): 3.38, 95% CI: 2.12-5.38). The combination of EPS and mild cognitive disorder was associated with higher daily expense (≥700 RMB) (aOR: 1.67, 95% CI: 1.20-2.31). The combination of constipation, tachycardia and fatty liver were associated with higher 1-year readmission (aOR: 2.05, 95% CI: 1.03-4.09). CONCLUSION: EPS, constipation, and tachycardia were among the most commonly reported comorbidities in schizophrenia patients in Beijing, China. Specific groups of comorbidities may contribute to higher inpatient psychiatric service utilization and readmission. The mechanism behind the associations and potential interventions to optimize service use warrant further investigation.