Background: Cardiovascular diseases are increasingly important in China, but the prevalence of risk factors for cardiovascular diseases in the indigent mentally ill are unknown.
Aim: Assess the prevalence of four key risk factors for cardiovascular disease -- hypertension, hyperglycemia, hyperlipidemia and smoking - among homeless patients with schizophrenia and identify factors associated with the presence of these risk factors.
Methods: We reviewed medical charts of 181 homeless and 181 non-homeless patients with schizophrenia or schizophreniform disorder admitted to the Shanghai Jiading Mental Health Center between May 2007 and April 2013. Demographic characteristics and risk factors of cardiovascular events were compared between the two groups. Logistic regression models identified the factors that were associated with the presence of one or more of the four risk factors.
Results: The prevalence of hypertension and hyperlipidemia were 19 to 20% in both males and females in the two groups; these rates are similar to those reported in the general population. The prevalence of hyperglycemia ranged from 11 to 15% among males and females in the two groups. Smoking was highly prevalent in male patients (82% in homeless males and 78% in non-homeless males) but, like in China generally, much less prevalent in female patients (7% in homeless females and 5% in non-homeless females). The logistic regression analysis found that male gender, older age, and urban (vs. rural) residence were independently associated with the presence of one or more of the four cardiovascular risk factors. Homelessness was not associated with the presence of cardiovascular risk factors.
Conclusion: This study is the first known report on cardiovascular risk factors among homeless mentally ill in China. The study did not assess several important factors (such as the type, dose and duration of use of antipsychotic medication) but it was, nevertheless, able to show that, unlike in high-income countries, homelessness is not related to elevated risk of cardiovascular disease in Chinese individuals with mental illnesses. Prospective studies with the growing number of homeless individuals in China will be needed to get a clearer picture of the best ways to provide them with the health care services they need.
背景: 心血管疾病在中国日益增长，但是贫困精神病患者心血管疾病的危险因素患病率尚不明确。
目标: 评估无家可归的精神分裂症患者中心血管疾病四个主要危险因素的患病率 - 高血压，高血糖，高血脂及吸烟 - 并确定与这些危险因素相关的因素。
方法: 我们回顾了从2007年5月到2013年4月期间，在上海嘉定精神卫生中心住院的精神分裂症以及分裂样精神病患者病历，包括181名无家可归的患者和181非无家可归的患者。比较了两组间人口学特征和心血管事件的危险因素。使用逻辑回归模型确定了与四个风险因素中一种或多种存在关联的因素。
结果: 两组患者的高血压和高血脂症的患病率范围为19%到20%（男性和女性的患病率范围相同）；这些比率和一般人群报道的相似。两组患者的高血糖患病率介于11%和15%之间（男性和女性的患病率范围相同）。在男性患者中吸烟是非常普遍的（无家可归男性吸烟率82%，非无家可归男性吸烟率78％），但是在中国女性患者吸烟远没有那么普遍（无家可归女性吸烟率7%，非无家可归女性吸烟率5%）。 Logistic回归分析发现，男性，年龄，城市（与农村相比）与四大心血管危险因素中的一种或多种独立相关。无家可归与心血管危险因素的患病率不相关。
结论: 本研究是对中国流浪精神病患者的心血管危险因素的第一个研究报告。这项研究有几个重要因素没有评估（如抗精神病药物的类型、剂量和使用时间），尽管如此，该研究还是能表明在中国，流浪与精神疾病患者心血管疾病风险增高无关，与高等收入国家不同。对于中国不断增多的流浪者而言，还需要进一步的前瞻性研究来探索他们所需的最佳医疗服务模式。
Keywords: China; cardiovascular risk factor; homeless; hyperglycemia; hyperlipidemia; hypertension; schizophrenia; smoking.