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Incidence and associations of hospital delirium diagnoses in 85979 people with severe mental illness: a data linkage study



Bauernfreund, Yehudit;

Launders, Naomi;

Favarato, Graziella;

Hayes, Joseph F;

Osborn, David;

Sampson, Elizabeth L;

(2022)

Incidence and associations of hospital delirium diagnoses in 85979 people with severe mental illness: a data linkage study.

Acta Psychiatrica Scandinavica


10.1111/acps.13480.

(In press).

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Acta Psychiatr Scand – 2022 – Bauernfreund – Incidence and associations of hospital delirium diagnoses in 85979 people with.pdf
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Abstract

INTRODUCTION: Delirium is an acute neuro-psychiatric disturbance precipitated by a range of physical stressors, with high morbidity and mortality. Little is known about its relationship with severe mental illness (SMI). METHODS: We conducted a retrospective cohort study using linked data analyses of the UK Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. We ascertained yearly hospital delirium incidence from 2000 – 2017 and used logistic regression to identify associations with delirium diagnosis in a population with severe mental illness. RESULTS: The cohort included 249,047 people with severe mental illness with median follow-up time in CPRD of 6.4 years. 85,979 patients were eligible for linkage to HES. Delirium incidence increased from 0.04 (95% CI 0.02 – 0.07) delirium associated admissions per 100 person-years in 2000 to 1.05 (95% CI 0.93 – 1.17) per 100 person-years in 2017, increasing most notably from 2010 onwards. Delirium was associated with older age at study entry (OR 1.05 per year, 95% CI 1.05-1.06), SMI diagnosis of bipolar affective disorder (OR 1.66, 95% CI 1.44 – 1.93) or other psychosis (OR 1.56, 95% CI 1.35 – 1.80) relative to schizophrenia, and more physical comorbidities (OR 1.08 per additional comorbidity of the Charlson Comorbidity Index, 95% CI 1.02 – 1.14). Patients with delirium received more antipsychotic medication during follow-up (1-2 antipsychotics OR 1.65, 95% CI 1.44 – 1.90; >2 antipsychotics OR 2.49, 95% CI 2.12 – 2.92). CONCLUSIONS: The incidence of recorded delirium diagnoses in people with severe mental illness has increased in recent years. Older people prescribed more antipsychotics and with more comorbidities have a higher incidence. Linked electronic health records are feasible for exploring hospital diagnoses such as delirium in SMI.

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