Increased rates of respiratory disease in schizophrenia: A systematic review and meta-analysis including 619,214 individuals with schizophrenia and 52,159,551 controls

Suetani, Shuichi; Honarparvar, Faraz; Siskind, Dan; Hindley, Guy; Veronese, Nicola; Vancampfort, Davy; Allen, Lauren; Solmi, Marco; Lally, John; Gaughran, Fiona; Stubbs, Brendon; Pillinger, Toby

doi:10.1016/j.schres.2021.08.022

Cited by 43 publications

(20 citation statements)

References 52 publications

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“…Disparities between individuals with schizophrenia and the general population with respect to the implementation of screening procedures (e.g., for cardiovascular risk factors and disorders, and for cancer) and the quality of medical care, including a lack of advice for lifestyle changes such as smoking cessation and physical activity, have been repeatedly reported 2,27,28,43,174,175 . Addressing smoking is of particular importance, given the 70‐162% increased risk of asthma, chronic obstructive pulmonary disease and pneumonia in subjects with schizophrenia 176 , and considering our finding that pneumonia confers the highest risk of death among natural causes. Thus, to close the mortality gap in individuals with schizophrenia, smoking cessation interventions, cardiovascular and cancer screening and monitoring, consistent healthy lifestyle instructions, as well as early interventions for detected physical diseases, should be regarded as imperative.…”

Section: Discussionmentioning

confidence: 99%

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Correll

Solmi

Croatto³

et al. 2022

World Psychiatry

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297

169

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People with schizophrenia die 15‐20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random‐effects meta‐analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all‐cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific‐cause mortality. Publication bias, subgroup and meta‐regression analyses, and quality assessment (Newcastle‐Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all‐cause mortality was increased in people with schizophrenia versus any non‐schizophrenia control group (RR=2.52, 95% CI: 2.38‐2.68, n=79), with the largest risk in first‐episode (RR=7.43, 95% CI: 4.02‐13.75, n=2) and incident (i.e., earlier‐phase) schizophrenia (RR=3.52, 95% CI: 3.09‐4.00, n=7) versus the general population. Specific‐cause mortality was highest for suicide or injury‐poisoning or undetermined non‐natural cause (RR=9.76‐8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79‐7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio‐cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All‐cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001‐0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all‐cause and suicide‐related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide‐related mortality risk in incident schizophrenia samples. All‐cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all‐cause mortality (RR=1.62, 95% CI: 1.47‐1.80, n=3). Antipsychotics were protective against all‐cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59‐0.84, n=11), with largest effects for second‐generation long‐acting injectable antipsychotics (SGA‐LAIs) (RR=0.39, 95% CI: 0.27‐0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34‐0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39‐0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44‐0.63, n=4). Antipsychotics were also protective against natural cause‐related mortality, yet first‐generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust ...

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Section: Discussionmentioning

confidence: 99%

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Correll

Solmi

Croatto³

et al. 2022

World Psychiatry

Self Cite

297

169

View full text Add to dashboard Cite

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“…Interestingly, some authors reported the presence of a similar cytokine (Interleukin-6 ) in both patients with sarcopenia and schizophrenia (9). In addition, pneumonia was reported to be significantly higher in patients with schizophrenia than in the general population (10). Combining the above studies, we consider that pneumonia in schizophrenia may be associated with sarcopenia.…”

Section: Introductionmentioning

confidence: 68%

Association between the mid-upper arm circumference (MUAC) and calf circumference (CC) screening indicators of sarcopenia with the risk of pneumonia in stable patients diagnosed with schizophrenia

Ren

Huang

Chen³

et al. 2022

Front. Psychiatry

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AimHere, we investigate the relationship between mid-upper arm circumference (MUAC) and calf circumference (CC) screening indicators of sarcopenia and the risk of pneumonia in stable patients diagnosed with schizophrenia.MethodThe study is prospective and includes inpatients with schizophrenia from two mental health centers in Western China. The studied screening indicators, MUAC and CC were assessed in standing patients. The relationship between MUAC and CC as sarcopenia screening indicators with the risk of pneumonia in patients with schizophrenia was analyzed by performing a statistical logistic regression analysis.ResultFor this study, 339 patients with schizophrenia, aged 50 years and over were recruited. Moreover, four patients with pneumonia that occurred within 1 week of the relapse of schizophrenia were excluded. As a result, only 335 patients were included in the analysis. Pneumonia has been reported in 82 (24.5%) of all included patients with schizophrenia. Our data analysis confirmed that in the male patients, the higher CC was associated with a lower risk of pneumonia (odds ratio [OR] = 0.751, 95% CI: 0.635–0.889). We have divided men into two cohorts following the values of CC. Our analysis further showed that the patients with CC ≥ 34 cm had a lower risk of pneumonia in men (OR = 0.36, 95% CI: 0.163–0.795).ConclusionWe demonstrate that CC is associated with pneumonia risk in stable men with schizophrenia.

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“…This large proportion of unexplained burden points to the contribution of other causes of death. Respiratory diseases are highly prevalent in people with schizophrenia; a recent meta-analysis reported an adjusted prevalence of almost 20% for chronic obstructive pulmonary disease (COPD), the third leading cause of death in the world in 2019 (GBD Collaborative Network, 2020b ; Suetani et al ., 2021 ). People with schizophrenia are over four times as likely to die of respiratory diseases as defined by ICD-10, which includes both infections and chronic diseases (Ali et al ., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Schizophrenia as a risk factor for cardiovascular and metabolic health outcomes: a comparative risk assessment

Ali

Santomauro

Ferrari

et al. 2023

Epidemiol Psychiatr Sci

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Aims Cardiometabolic diseases are responsible for the majority of premature deaths in people with schizophrenia. This study aimed to quantify the fatal burden of ischaemic heart disease (IHD), stroke and diabetes attributable to schizophrenia. Methods Comparative Risk Assessment methodology from the Global Burden of Disease (GBD) study was used to calculate attributable burden; pooled relative risks (RRs) for IHD, stroke and diabetes were estimated via meta-regression, which were combined with GBD schizophrenia prevalence estimates to calculate the deaths and years of life lost (YLLs) caused by these health outcomes that were attributable to schizophrenia. The proportion of explained all-cause fatal burden and corresponding unexplained burden was also calculated. Results The pooled RRs for IHD, stroke and diabetes mortality were 2.36 [95% uncertainty interval (UI) 1.77 to 3.14], 1.86 (95% UI 1.36 to 2.54) and 4.08 (95% UI 3.80 to 4.38) respectively. Schizophrenia was responsible for around 50 000 deaths and almost 1.5 million YLLs globally in 2019 from these health outcomes combined. IHD, stroke and diabetes together explained around 13% of all deaths and almost 11% of all YLLs attributable to schizophrenia, resulting in 320 660 (95% UI 288 299 to 356 517) unexplained deaths and 12 258 690 (95% UI 10 925 426 to 13 713 646) unexplained YLLs. Conclusions Quantifying the physical disease burden attributable to schizophrenia provides a means of capturing the substantial excess mortality associated with this disorder within the GBD framework, contributing to an important evidence base for healthcare planning and practice.

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Increased rates of respiratory disease in schizophrenia: A systematic review and meta-analysis including 619,214 individuals with schizophrenia and 52,159,551 controls

Cited by 43 publications

References 52 publications

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Association between the mid-upper arm circumference (MUAC) and calf circumference (CC) screening indicators of sarcopenia with the risk of pneumonia in stable patients diagnosed with schizophrenia

Schizophrenia as a risk factor for cardiovascular and metabolic health outcomes: a comparative risk assessment

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