title: Prior psychiatric hospitalization is associated with excess mortality in patients hospitalized with non-cardiac chest pain: a data linkage study based on the full Scottish population (1991-2006).
abstract: OBJECTIVE
  Non-cardiac chest pain (NCCP) is considered a benign condition. We investigate case-fatality following an incident hospitalization for NCCP and determine whether previous psychiatric hospitalization is associated with short-term mortality.
  
  
  RESULTS
  This was a population-based retrospective cohort study of 159 888 patients discharged from hospital in Scotland (1991-2006) following a first NCCP hospitalization, using routinely collected morbidity and mortality data. All-cause and cardiovascular disease (CVD) mortality at 1 year following hospitalization was examined. A total of 3514 (4.4%) men and 3136 (3.9%) women with a first NCCP hospitalization had a psychiatric hospitalization in the 10 years preceding incident NCCP hospitalization. Those with a previous psychiatric hospitalization were younger and more socioeconomically deprived (SED). Overall, crude case fatality at 1 year was 4.4% in men and 3.7% in women. This was higher in patients with a previous psychiatric hospitalization compared with those without (overall: men 6.3 vs. 4.3%; women: 5.3 vs. 3.6%), in all age groups and all SED quintiles. Following adjustment (year of NCCP hospitalization, SED, co-morbid diabetes, and hypertension), the hazard of all-cause and CVD-specific death at 1 year was higher in men and women with a previous psychiatric hospitalization than without, with effect modification according to age group.
  
  
  CONCLUSIONS
  Non-cardiac chest pain is not an entirely benign condition. Individuals with a hospital discharge diagnosis of NCCP who have a previous psychiatric hospitalization have a greater risk of death, all-cause, and CVD-specific, at 1 year, than those without. A NCCP hospitalization is an opportunity to engage, and where appropriate, intervene to modify cardiovascular risk in this difficult-to-reach and high-risk group.
authors.affiliation: Department of Public Health and Health Policy, University of Glasgow, Glasgow, UK. michelle.gillies@glasgow.ac.uk
authors.forename: Michelle
authors.initials: M
authors.lastname: Gillies
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.forename: Karen
authors.initials: K
authors.lastname: MacTeague
authors.forename: Paul
authors.initials: P
authors.lastname: MacIntyre
authors.forename: Judith
authors.initials: J
authors.lastname: Allardyce
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.forename: Kate
authors.initials: K
authors.lastname: MacIntyre
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D002637:Chest Pain / Q000401:mortality* / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D017678:Sex Distribution