老年焦慮症併身體疾患之致死風險

Risks of Mortality in the Elderly with Anxiety Comorbid with Physical Illness

目的：焦慮症可能會增加老年人的身體共病風險，但致死率的結果並不一致。我們的研 究探討是否 (A) 焦慮症會增加老年人致死率 (B) 不同身體疾病的致死率差別。方法：使用全 民健康保險研究資料庫，追蹤 2000 至 2008 共 8 年，分析了共 247 位 60 歲以上有焦慮症的 老年人，以及987 位沒有焦慮症的控制組，和焦慮症有關的部份身體疾患也一併分析，以比 較兩組間的致死率風險比值。結果：有焦慮症老人的致死率會顯著增加 (HR = 2.05, 95% CI = 1.32 - 3.21, p < 0.01)。除此之外，逐步迴歸模型顯示對老年人來說鬱血性心衰竭是最重要 的致死率預測因子 (p < 0.001)。中風 (p < 0.01)、心律不整 (p < 0.05)、和胃潰瘍 (p < 0.05) 也 會顯著影響致死率。對有焦慮症的老年人來說，鬱血性心衰竭更是唯一的致死率預測因子 (p < 0.001)。結論：許多身體疾患會增加老年人病人的致死率。除此之外，心血管相關疾病可 能為老年焦慮症致死率的危險因子。

Objectives: Anxiety disorders may increase the risks of physical comorbidities in the elderly, but the results of mortality rates are inconsistent. In this study, we intended to explore (A) whether anxiety disorders increase the risks of mortality in the elderly, and (B) whether the mortality risks could be different in different physical illnesses. Methods: We included subjects aged over 60 years using the National Health Insurance Research Database (NHIRD). We included 247 subjects with anxiety disorders (generalized anxiety disorders, panic disorders, phobic disorders) and 987 control subjects without anxiety disorders in an eight-year longitudinal follow-up using the database analysis from 2000 to 2008. Certain specifi c physical illnesses related to anxiety disorders were analyzed. The hazard ratios (HRs) were calculated for the mortality risks between two groups. Results: The mortality risks of subjects with anxiety disorders and with physical comorbidities increased signifi cantly (HR = 3.29, 95% confi dence interval = 1.92 - 5.62, p < 0.001). Furthermore, congestive heart failure (CHF) (HR = 2.84, 95% CI =1.73 - 4.66, p < 0.001) was the most signifi cant predictive factor for mortality risks. Cerebrovascular disease (HR = 1.86, 95% CI = 1.19 - 2.93, p < 0.01), cardiac arrhythmia (HR = 1.7, 95% CI = 1.01 - 2.86, p < 0.05), and peptic ulcers (HR = 1.56, 95% CI = 1.07 - 2.28, p < 0.01) also signifi cantly infl uenced the mortality risks. Additionally, CHF (HR = 6.63, 95% CI = 22.97 - 14.79, p < 0.001) was the only predictive factor for mortality risks in the elderly with anxiety disorders. Conclusions: Several physical illnesses could enhance mortality risks in the elderly. Cardiovascular related illnesses could be the mediators of anxiety disorders in the elderly to increase mortality risks.