Mortality and the relationship of somatic comorbidities to mortality in schizophrenia. A nationwide matched-cohort study

Bitter, István; Czobor, Pál; Borsi, András; Fehér, László; Bz, Nagy; Bacskai, M; Rakonczai, P.; Hegyi, R.; Németh, T.; Varga, Péter Pál; Gimesi-Országh, Judit; Fadgyas-Freyler, Petra; Sermon, Jan; Takács, Péter

doi:10.1016/j.eurpsy.2017.05.022

Cited by 69 publications

(64 citation statements)

References 10 publications

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“…Earlier studies have reported an excess mortality of somatic diseases in patients with schizophrenia . Our results indicate that the largest difference in mortality rates between patients with schizophrenia and the general population is observed before the development of somatic multimorbidity.…”

Section: Discussionsupporting

confidence: 50%

“…The main causes of death are somatic diseases, such as cardiovascular, respiratory, and cancer diseases . These causes of death are similar to the main causes of death observed in the general population, although the developments within somatic treatments have resulted in an improved survival following these and other somatic diseases , but data do not support similar improved survival following somatic diseases in patients diagnosed with schizophrenia .…”

Section: Introductionmentioning

confidence: 98%

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Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study

Kugathasan

Stubbs

Aagaard

et al. 2019

Acta Psychiatr Scand

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Nielsen RE. Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study.Objective: To investigate the association of single-and multimorbidity with mortality rates in patients with schizophrenia compared to the general population. Method: A nationwide cohort study including residents in Denmark between 1995 and 2015. The cohort was dichotomously divided by a diagnosis of schizophrenia. Somatic diseases included infections, cancer, endocrine, neurologic, cardiovascular, respiratory, digestive, skin, musculoskeletal, and urogenital diseases. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated. Results: The cohort included 30 210 patients with schizophrenia [mean age (SD) = 32.6 (11.4), males = 57.2%], and 5 402 611 from the general population [mean age (SD) = 33.0 (14.5), males = 50.4%]. All number of somatic diseases were associated with an increased mortality in schizophrenia [HR = 16.3 (95% CI = 15.4-17.3) for 1 disease to 21.0 (95% CI = 19.1-23.0) for ≥5 diseases], using the general population with no somatic disease as reference. Across all somatic diseases, patients with schizophrenia showed a HR > 2, compared to the general population, and respiratory (PAF = 9.3%), digestive (PAF = 8.2%), and cardiovascular (PAF = 7.9%) diseases showed largest contributions to death. Conclusions: Patients with schizophrenia showed higher mortality on all levels of multimorbidity, and a doubled mortality rate across all somatic diseases, compared to the general population. The findings suggest that the clusters and trajectories of symptoms associated with schizophrenia is the main driver of the excess mortality. Significant outcomes• In this nationwide cohort study, we found an increased mortality rate across all levels of somatic multimorbidity in patients with schizophrenia, compared to the general population.• Different somatic disease systems contribute to the increased mortality in patients with schizophrenia; however, the results point toward the signs and symptoms associated with schizophrenia as the main driver of the excess mortality. Limitations• We were not able to adjust for important confounders, such as cigarette smoking, diet habits, and physical activity, as these variables are not available in the Danish registers.• Information on the severity of the somatic condition was lacking.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 98%

Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study

Kugathasan

Stubbs

Aagaard

et al. 2019

Acta Psychiatr Scand

View full text Add to dashboard Cite

show abstract

“…Clozapine is recommended for use after two other antipsychotics have been ineffective and, therefore, is generally initiated later in the illness course than other antipsychotics. Since mortality may be particularly high in the early phase of the illness, the later use of clozapine could introduce a survival bias. Therefore, we conducted sensitivity analyses by excluding the first ten years of follow‐up.…”

Section: Discussionmentioning

confidence: 99%

20‐year follow‐up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20)

Taipale

Tanskanen

Mehtälä³

et al. 2020

World Psychiatry

285

204

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Antipsychotics are effective in preventing relapses of schizophrenia, but it is generally believed that their long‐term use is harmful for patients’ physical well‐being. However, there are no long‐term studies which have verified this view. This nationwide, register‐based cohort study aimed to assess the risk of hospitalization due to physical health problems, as a marker for severe physical morbidity, and the risk of all‐cause mortality, as well as of cardiovascular and suicidal death, associated with antipsychotic use in all patients treated for schizophrenia in inpatient care between 1972 and 2014 in Finland (N=62,250), with up to 20 years of follow‐up (median: 14.1 years). The use of antipsychotic drugs (i.e., use of any antipsychotic compared with non‐use) and the use of specific antipsychotics were investigated, and outcomes were somatic and cardiovascular hospitalization, and all‐cause, cardiovascular and suicide death. Hospitalization‐based outcomes were analyzed by a within‐individual design to eliminate selection bias, comparing use and non‐use periods in the same individual by stratified Cox model. Mortality outcomes were assessed by traditional between‐individual Cox multivariate models. The adjusted hazard ratios (aHRs) for any somatic hospitalization and cardiovascular hospitalization were 1.00 (95% CI: 0.98‐1.03) and 1.00 (95% CI: 0.92‐1.07) during use of any antipsychotic compared to non‐exposure periods within the same individual. The aHRs were 0.48 (95% CI: 0.46‐0.51) for all‐cause mortality, 0.62 (95% CI: 0.57‐0.67) for cardiovascular mortality, and 0.52 (95% CI: 0.43‐0.62) for suicide mortality during use vs. non‐use of any antipsychotic. The most beneficial mortality outcome was associated with use of clozapine in terms of all‐cause (aHR=0.39, 95% CI: 0.36‐0.43), cardiovascular (aHR=0.55, 95% CI: 0.47‐0.64) and suicide mortality (aHR=0.21, 95% CI: 0.15‐0.29). The cumulative mortality rates during maximum follow‐up of 20 years were 46.2% for no antipsychotic use, 25.7% for any antipsychotic use, and 15.6% for clozapine use. These data suggest that long‐term antipsychotic use does not increase severe physical morbidity leading to hospitalization, and is associated with substantially decreased mortality, especially among patients treated with clozapine.

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“…A recent study by Bitter et al (11) highlighted the reduction in life expectancy among patients with schizophrenia. Of note is the fact that, compared with the controls, 20-year-old males with schizophrenia had their life expectancy reduced by 11.5 years and females by 13.7 years; the analogous numbers for 45-yearold schizophrenics were 8.1 and 9.6 years, respectively.…”

Section: Mortality In Schizophrenia and Pharmacological Treatmentmentioning

confidence: 99%

Adding Suicide Prevention to the Triple Advantages of Injectable Long-Acting Second-Generation Antipsychotics

Pompili

2020

Front. Psychiatry

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Mortality and the relationship of somatic comorbidities to mortality in schizophrenia. A nationwide matched-cohort study

Cited by 69 publications

References 10 publications

Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study

Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study

20‐year follow‐up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20)

Adding Suicide Prevention to the Triple Advantages of Injectable Long-Acting Second-Generation Antipsychotics

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