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

Wang, Jong-Yi; Chang, Cheng-Chen; Lee, Meng-Chen; Li, Yi-Jhen

doi:10.1186/s12913-020-05089-6

Table 4 Association between the category of mental disorders, mortality, and total medical expenditures per capita, controlling for all other variables (Cox proportional hazard model and GLM, N = 285,125)

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

Variables	Death per 1000 person-days	Death		P-value	Mean of total medical expenditures (USD)	P-value
Variables	Death per 1000 person-days	Adjusted HR	95% CI	P-value	Mean of total medical expenditures (USD)	P-value
Health and Medication Conditions
Category of mental disorders						< 0.0001*
Affective disorders	0.0617	1.246	1.180–1.316	< 0.0001*	15,791.06
Anxiety disorders	0.0335	–	–	–	12,618.92
Substance use disorders	0.0500	1.064	1.009–1.122	0.0231*	13,307.55
Schizophrenia	0.0685	1.072	0.923–1.245	0.3646	29,748.05
Other disorders	0.0546	1.233	1.195–1.271	< 0.0001*	13,016.03
Multiple diagnoses						< 0.0001*
Present	0.0488	–	–	–	17,275.36
Absent	0.0421	1.095	1.062–1.130	< 0.0001*	16,517.29
Involuntary hospitalization						< 0.0001*
Present	0.0892	–	–	–	28,345.00
Absent	0.0443	1.417	0.988–2.032	0.0579	5447.64
Comorbidity (CCI)						0.4944
0	0.0212	–	–	–	16,887.48
1	0.0744	1.004	0.970–1.040	0.8134	16,869.13
≥ 2	0.1825	1.178	1.126–1.233	< 0.0001*	16,932.35
Use of psychiatric medication						< 0.0001*
Mood stabilizer	0.0503	1.061	1.025–1.098	0.0007*	16,743.08
Antidepressants	0.0365	1.057	0.968–1.153	0.2169	16,357.20
Antipsychotics	0.0579	1.237	1.152–1.330	< 0.0001*	16,591.78
Multiple categories	0.0763	–	–	–	18,354.09
None	0.0274	1.213	1.166–1.261	< 0.0001*	16,435.46
Demographics
Gender						< 0.0001*
Male	0.0578	1.039	1.009–1.069	0.0104*	17,058.96
Female	0.0333	–	–	–	16,733.68
Age (years)						< 0.0001*
< 19	0.0035	–	–	–	16,905.26
20–34	0.0105	1.760	1.460–2.122	< 0.0001*	16,768.65
35–49	0.0187	2.143	1.789–2.567	< 0.0001*	16,892.76
50–64	0.0238	1.915	1.598–2.294	< 0.0001*	16,847.92
≥ 65	0.1458	1.809	1.514–2.162	< 0.0001*	17,067.00
Occupation^a						< 0.0001*
First category	0.0327	1.073	1.021–1.127	0.0053*	16,757.76
Second category	0.0318	–	–	–	16,719.60
Third category	0.0847	1.066	1.011–1.124	0.0180*	16,749.59
Fourth category	0.0338	1.058	0.817–1.371	0.6670	16,464.26
Fifth category	0.1031	1.193	1.029–1.382	0.0190*	17,809.09
Sixth category	0.0814	1.065	1.003–1.130	0.0400*	16,877.63
Premium-based monthly salary (USD)						< 0.0001*
≤ 576	0.0407	1.095	0.987–1.214	0.0857	17,166.44
576–760	0.0622	1.079	0.967–1.205	0.1755	17,050.43
760–960	0.0277	1.185	1.038–1.352	0.0119*	16,888.68
960–1210	0.0322	1.064	0.938–1.208	0.3322	16,879.77
1210–1526	0.0264	1.024	0.895–1.171	0.7319	16,713.87
> 1526	0.0198	–	–	–	16,678.74
Provider Features
Level of hospital						< 0.0001*
Medical center	0.0478	1.123	1.068–1.181	< 0.0001*	17,468.25
Regional hospital	0.0550	1.200	1.146–1.256	< 0.0001*	17,110.40
District hospital	0.0644	1.101	1.056–1.148	< 0.0001*	16,871.55
Clinic	0.0295	–	–	–	16,135.08
Ownership of Hospital						< 0.0001*
Public	0.0625	1.013	0.972–1.056	0.5297	17,341.45
Private	0.0359	–	–	–	16,581.21
Consortium	0.0464	1.012	0.968–1.058	0.6082	16,605.31
Association	0.0669	1.139	1.044–1.243	0.0035*	17,057.32
Psychiatrist’s year of practice						< 0.0001*
≤ 5	0.0484	1.709	1.629–1.793	< 0.0001*	16,838.19
6–10	0.0436	1.237	1.193–1.283	< 0.0001*	16,843.31
11–15	0.0445	1.020	0.980–1.062	0.3206	16,938.61
≥ 16	0.0423	–	–	–	16,965.18
Geographic Characteristics
Region						0.1356
Taipei	0.0388	–	–	–	16,906.41
Northern	0.0455	1.009	0.959–1.062	0.7265	16,897.61
Central	0.0433	1.028	0.982–1.076	0.2401	16,819.57
Southern	0.0516	1.087	1.036–1.142	0.0008*	16,891.88
Southeast	0.0480	1.014	0.970–1.061	0.5367	16,878.81
Eastern	0.0617	1.141	1.043–1.247	0.0038*	16,983.65
Urbanization level						0.7318
Level 1 (Highest)	0.0361	1.063	0.976–1.158	0.1597	16,906.04
Level 2	0.0405	1.080	0.996–1.171	0.0636	16,912.38
Level 3	0.0435	1.069	0.984–1.161	0.1131	16,921.85
Level 4	0.0541	1.050	0.970–1.136	0.2301	16,851.65
Level 5	0.0688	–	–	–	16,928.21
Level 6	0.0730	1.081	0.989–1.182	0.0855	16,872.15
Level 7 (Lowest)	0.0645	1.114	1.013–1.224	0.0264*	16,881.97

* P < 0.05
HR hazard ratio
^a First category includes private employees and public servants; Second category includes labor union members; Third category includes farmers and fishermen; Fourth category includes soldiers; Fifth category includes social security insureds; Sixth category includes veterans and religious group members

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ISSN: 1472-6963

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