Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries

Abstract

ObjectiveExcess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method.ResultsThe SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter.ConclusionOur data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years.

Causes of Mortality in Schizophrenia: An Updated Review of European Studies

“…SMR for both sexes was higher in patients admitted in 1998-2006 versus those admitted in 1980-1988 (Høye et al 2011). In another Scandinavian study results from observations in 2000-2007 were unambiguous: SMR was 3.3, 3.0, and 2.9 for men, and 3.9, 2.7 and 2.9 for women in Finland, Denmark and Sweden, respectively (Laursen et al 2013). …”

“…Scandinavian studies showed that in Finland and Denmark in schizophrenia patients, SMR associated with cardiovascular diseases was lower than all causes of death in total. However, when ischaemic heart disease, cerebrovascular disease and other cardiovascular diseases (including rheumatic heart disease, hypertension, arterial or venous diseases) were considered separately, no significant SMR deviations were demonstrated in Denmark and Sweden, while in Finland that rate was higher for other cardiovascular diseases (Laursen et al 2013). …”

“…During 15 years of observations, a mean age at death was 62.6 years for patients without substance use disorders and 49.2 for patients with dual diagnosis (Schmidt et al 2011). In Denmark, Finland and Sweden, a difference in life expectancy (LE) for schizophrenia patients versus a general population in these countries was 20.0, 17.1, 18.9 years for men and 16.5, 15.6, 16.9 years for women, respectively (Laursen et al 2013).…”

“…One of the studies was conducted in three Nordic countries: Denmark, Finland and Sweden, using common data register (Laursen et al 2013). Two international studies were sponsored by pharmacological companies (Fleischhacker et al 2014, Mittoux et al 2013.…”

Physical activity and metabolic disease among people with affective disorders: Prevention, management and implementation

“…The vast majority (in excess of 70%) of the premature mortality observed in people with affective disorders is due to physical comorbidities, predominantly cardio-metabolic diseases (Wulsin et al, 1999, Laursen et al, 2013. People with affective disorders are at greatly increased risk of metabolic syndrome (Vancampfort et al, 2013a;Vancampfort et al, 2014) and type 2 diabetes mellitus (T2DM) (Vancampfort et al, 2015a & b).…”