Comparison of mean residual life between mental disease patients and healthy population in a national survey 公开

Chen, Xu (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/2v23vv03q?locale=zh
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Abstract

The prevalence of mental illness across the globe and in the United States has become a heavy public health burden. Studies have shown that people with mental illness are at high risk of mortality and morbidities. Understanding the magnitude of premature mortality and underlying risk factors among patients with mental disease has important implications for decreasing the burden of mental disease.

To quantify the social and economic impact of mortality caused by mental disease in a society, researchers and health policymakers need an index that is easy to understand for most people. One of the most commonly used methods measuring premature mortality is years of potential life lost (YPLL). YPLL is an estimate of the years a person would have lived if he or she had not died. Despite its nice interpretation, the estimate of YPLL is a biased estimate because censored data are not included. Another method to measure the risk of premature death is Cox proportional hazard model. But the estimated risk is not enough to portray the actual degree of year gap between people with and without mental illness. We demonstrate an alternative method to examine the premature mortality of mental illness patients in terms of mean or median residual life. The objective of the thesis is to illustrate the use of mean or median residual life methods in describing the two populations: individuals with and without mental disease. We show that how policymakers can use the method of mean or median residual life to summarize the data with censoring and to give meaningful and straightforward interpretation.

Data were obtained from the 1989 National Health Interview Survey mental health supplement, with mortality data through 2006. There were 80,850 participants in total, of which 16,435 were dead during the follow-up time. Mean residual lifetimes and median residual lifetimes were estimated and compared over the age range 24 to 100 between the populations with and without mental disease, using the empirical likelihood test. We found that persons with mental disease have shorter remaining life expectancy (p=0.044) compared to those without mental disease.

Table of Contents

Table of Contents

1. Introduction............................................................................... 1

1.1 Burden and Causes of Mental Illness................................................1

1.2 Problem Statement...................................................................... 3

1.3 Purpose Statement...................................................................... 6

1.4 Objectives.................................................................................. 7

2. Methods..................................................................................... 8

2.1 Study Setting............................................................................. 8

2.2 Mean Residual Life...................................................................... 9

2.3 Median Residual Life................................................................... 10

2.4 Empirical Likelihood Ratio Test..................................................... 11

2.5 Two-Sample Mean Residual Life Comparison................................... 13

2.6 Cox Proportional Hazards Model................................................... 14

2.7 Potential Risk Factors................................................................. 15

2.8 Statistical Analysis..................................................................... 15

3. Results..................................................................................... 16

4. Discussion................................................................................ 20

5. Conclusions ............................................................................... 23

Reference.....................................................................................25

Appendix A. Tables ........................................................................ 28

Appendix B. Figures ....................................................................... 32

Appendix C. R Code Samples.......................................................... 34

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