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Gender influence on the bipolar disorder inpatient length of stay in Sweden, 2005–2014 : A register-based study

Ragazan, Dragos C.; Eberhard, Jonas LU ; Ösby, Urban and Berge, Jonas LU (2019) In Journal of Affective Disorders 256. p.183-191
Abstract

Background: The influence of gender on bipolar disorder is controversial and it is unclear if inpatient care differs between men and women. Here, we investigate for gender differences in the inpatient length of stay for Swedes admitted for bipolar disorder and explore other factors that could explain any observed association. Methods: Admission data were extracted from the Swedish National Patient Register and included all patients first admitted to a psychiatric inpatient unit with a bipolar disorder diagnosis, circa 2005–2014. Patients were then retrospectively followed for subsequent hospitalizations. Diagnostic subtypes were categorized by ICD-10 clusters: depressive, depressive with psychotic features, manic, manic with psychotic... (More)

Background: The influence of gender on bipolar disorder is controversial and it is unclear if inpatient care differs between men and women. Here, we investigate for gender differences in the inpatient length of stay for Swedes admitted for bipolar disorder and explore other factors that could explain any observed association. Methods: Admission data were extracted from the Swedish National Patient Register and included all patients first admitted to a psychiatric inpatient unit with a bipolar disorder diagnosis, circa 2005–2014. Patients were then retrospectively followed for subsequent hospitalizations. Diagnostic subtypes were categorized by ICD-10 clusters: depressive, depressive with psychotic features, manic, manic with psychotic features, mixed, and other. Psychotropic therapies preceding the corresponding admissions were attained from the Prescribed Drug Register. Mixed-effects zero-truncated negative binomial regressions were employed to model the length of stay per admission. Results: Analysis included 39,653 admissions by 16,271 inpatients (60.0% women). Overall, when compared to men, women spent 7.5% (95% CI: 4.2–11.0%, p < 0.001) extra days hospitalized per admission. However, upon adjusting for candidate confounders, including the bipolar subtype, and selected comorbidities and psychotropics, the association weakened wherein women then spent 3.7% (95% CI: 0.1–6.9%, p = 0.028) extra days hospitalized per admission. Limitations: The integrity of register data can be variable and the adherence to outpatient dispensed psychotropics could not be validated. Conclusion: Although the influence of gender on the bipolar disorder inpatient length of stay is evident, other factors attenuate and better explain this crude observation.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bipolar disorder, Comorbidity, Gender, Length of stay, Psychotropic drug, Register
in
Journal of Affective Disorders
volume
256
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:85067064952
ISSN
0165-0327
DOI
10.1016/j.jad.2019.05.052
language
English
LU publication?
yes
id
c58d18b8-27e7-4996-916c-7d0e7c2cddb8
date added to LUP
2019-06-26 11:03:53
date last changed
2019-07-16 04:12:37
@article{c58d18b8-27e7-4996-916c-7d0e7c2cddb8,
  abstract     = {<p>Background: The influence of gender on bipolar disorder is controversial and it is unclear if inpatient care differs between men and women. Here, we investigate for gender differences in the inpatient length of stay for Swedes admitted for bipolar disorder and explore other factors that could explain any observed association. Methods: Admission data were extracted from the Swedish National Patient Register and included all patients first admitted to a psychiatric inpatient unit with a bipolar disorder diagnosis, circa 2005–2014. Patients were then retrospectively followed for subsequent hospitalizations. Diagnostic subtypes were categorized by ICD-10 clusters: depressive, depressive with psychotic features, manic, manic with psychotic features, mixed, and other. Psychotropic therapies preceding the corresponding admissions were attained from the Prescribed Drug Register. Mixed-effects zero-truncated negative binomial regressions were employed to model the length of stay per admission. Results: Analysis included 39,653 admissions by 16,271 inpatients (60.0% women). Overall, when compared to men, women spent 7.5% (95% CI: 4.2–11.0%, p &lt; 0.001) extra days hospitalized per admission. However, upon adjusting for candidate confounders, including the bipolar subtype, and selected comorbidities and psychotropics, the association weakened wherein women then spent 3.7% (95% CI: 0.1–6.9%, p = 0.028) extra days hospitalized per admission. Limitations: The integrity of register data can be variable and the adherence to outpatient dispensed psychotropics could not be validated. Conclusion: Although the influence of gender on the bipolar disorder inpatient length of stay is evident, other factors attenuate and better explain this crude observation.</p>},
  author       = {Ragazan, Dragos C. and Eberhard, Jonas and Ösby, Urban and Berge, Jonas},
  issn         = {0165-0327},
  keyword      = {Bipolar disorder,Comorbidity,Gender,Length of stay,Psychotropic drug,Register},
  language     = {eng},
  pages        = {183--191},
  publisher    = {Elsevier},
  series       = {Journal of Affective Disorders},
  title        = {Gender influence on the bipolar disorder inpatient length of stay in Sweden, 2005–2014 : A register-based study},
  url          = {http://dx.doi.org/10.1016/j.jad.2019.05.052},
  volume       = {256},
  year         = {2019},
}