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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (3): 99-109.doi: 10.6040/j.issn.1671-7554.0.2024.1054

• 公共卫生与预防医学 • 上一篇    

精神障碍患者住院时长与再入院率的因果关联分析

袁莹1,2,3,仉率杰1,2,3,孙爽爽1,2,3,张伯韬1,2,3,徐朝珂2,4,胡锡峰1,2,3,于媛媛2,5,薛付忠1,2,3   

  1. 1. 山东大学齐鲁医学院公共卫生学院生物统计学系, 山东 济南 250012;2. 山东大学齐鲁医学院公共卫生学院国家健康医疗大数据研究院, 山东 济南 250003;3. 山东大学齐鲁医学院齐鲁医院, 山东 济南 250012;4. 山东师范大学信息科学与工程学院, 山东 济南 250039;5. 山东大学数据科学研究院, 山东 济南 250100
  • 发布日期:2025-04-08
  • 通讯作者: 薛付忠. E-mail:xuefzh@sdu.edu.cn于媛媛. E-mail:yu_yy_1993@163.com
  • 基金资助:
    国家自然科学基金重点项目(82330108);国家自然科学基金(82173625);山东省重点研发计划(科技示范工程)(2021SFGC0504);中国博士后科学基金(2022M721921);山东省青年基金(ZR2023QH236)

Causal associations between length of stay and readmission rates in patients with mental disorders

YUAN Ying1,2,3, ZHANG Shuaijie1,2,3, SUN Shuangshuang1,2,3, ZHANG Botao1,2,3, XU Zhaoke2,4, HU Xifeng1,2,3, YU Yuanyuan2,5, XUE Fuzhong1,2,3   

  1. 1. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Healthcare Big Data Research Institute, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250003, Shandong, China;
    3. Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    4. School of Information Science and Engineering, Shandong Normal University, Jinan 250039, Shandong, China;
    5. Data Science Institute, Shandong University, Jinan 250100, Shandong, China
  • Published:2025-04-08

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摘要： 目的 探讨精神障碍患者住院时长与再入院率的因果关联,为改善患者预后和优化住院管理提供依据。 方法 依托齐鲁全生命周期电子健康研究型数据库构建真实世界新使用者队列。根据住院时长将精神障碍患者分为5组,以15~30 d为对照组,其他4组(1~7、8~14、31~60、61~90 d)为处理组。采用L1正则化进行高维变量选择,并基于选定的协变量计算倾向性评分。采用卡尺距离内1∶1最近邻匹配方法匹配处理组与对照组,借助可比性诊断和平衡性诊断评价匹配效果。采用经典Cox比例风险回归模型评估精神障碍患者的住院时长与1年再入院率(包括精神障碍再入院和全因再入院)之间的因果关联。 结果 共纳入22 437例因精神障碍住院的患者。基线信息包括人口统计学、住院、合并症、药物和手术信息等1 794个协变量。L1正则化分别筛选出374、293、293、255个变量用于匹配。平衡性诊断结果表明协变量均已平衡。相比对照组,1~7 d组住院患者1年精神障碍再入院率(HR=0.54; 95%CI: 0.46~0.65)与全因再入院率(HR=0.75; 95%CI: 0.67~0.84)均显著降低;8~14 d组住院患者1年精神障碍再入院率(HR=0.85; 95%CI: 0.74~0.99)显著降低;61~90 d组住院患者1年精神障碍再入院率(HR=1.37; 95%CI: 1.15~1.63)显著增加。 结论 精神障碍患者的1年精神障碍再入院率随住院时间延长呈一定上升趋势,但这一趋势在31~60 d组与对照组间不明显;全因再入院率仅在1~7 d显著降低。住院时长对精神障碍患者的再入院率有显著影响,缩短住院时长不会增加再入院风险;过长的住院时长可能增加再入院率。这一发现为临床制定更有效的住院管理决策提供了依据。

关键词: 精神障碍, 住院时长, 高维变量选择, 再入院率, 真实世界研究

Abstract: Objective To explore the causal associations between length of stay(LOS)and readmission rates among patients with mental disorders, so as to provide evidence for improving patient prognosis and refining clinical management. Methods A real-world, new-user cohort was constructed using the Cheeloo Lifespan Electronic-Health Research Data-library. Patients were categorized into five groups based on LOS, with the middle group(15-30 days)as the control and the other four groups(1-7, 8-14, 31-60, 61-90 days)as treatment groups. L1 regularization was used for high-dimensional variable selection, followed by propensity score matching using 1∶1 nearest-neighbor match with a defined caliper. The matching quality was assessed via comparability and balance diagnostics. The proportional hazards models were applied to evaluate the causal associations between LOS and 1-year readmission rates, including both mental disorder-related and all-cause readmissions. Results A total of 22,437 mental disorder inpatients were included, with baseline data comprising 1,794 covariates, covering demographics, hospitalization, disease, medication, and procedure information. L1 regularization selected 374, 293, 293 and 255 variables for matching. Balance diagnostics indicated all covariates were well-balanced. Compared with patients hospitalized for 15 to 30 days, patients with a LOS of 1 to 7 days had significantly reduced 1-year mental disorder-related readmission rate(HR=0.54; 95%CI: 0.46-0.65)and all-cause readmission rate(HR=0.75; 95%CI: 0.67-0.84); patients with a LOS of 8 to 14 days had a significantly lower rate of 1-year mental disorder-related readmission(HR=0.85; 95%CI: 0.74-0.99); patients with a LOS of 61 to 90 days had a significantly increased rate of 1-year mental disorder-related readmission(HR=1.37; 95%CI: 1.15-1.63). Conclusion The 1-year mental disorder-related readmission rate among patients with mental disorders showed an increasing trend with longer LOS, but this trend was not significant between the longer stay group(31-60 days)and the control group. All-cause readmission rates were significantly lower only in the very short stay group(1-7 days). These results indicate that LOS significantly affects the readmission rates of patients with mental disorders. Shortening LOS does not increase the risk of readmission, whereas excessively prolonged LOS predicts higher readmission rates. This finding provides evidence to inform more effective hospital management decisions in clinical practice.

Key words: Mental disorder, Length of stay, High-dimensional variable selection, Readmission, Real-word study

中图分类号: 

  • R197
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