Premature Mortality Among Adults With Schizophrenia in the United States

Abstract

IMPORTANCE Although adults with schizophrenia have a significantly increased risk of premature mortality, sample size limitations of previous research have hindered the identification of the underlying causes. OBJECTIVE To describe overall and cause-specific mortality rates and standardized mortality ratios (SMRs) for adults with schizophrenia compared with the US general population. DESIGN, SETTING, AND PARTICIPANTS We identified a national retrospective longitudinal cohort of patients with schizophrenia 20 to 64 years old in the Medicaid program (January 1, 2001, to December 31, 2007). The cohort included 1 138 853 individuals, 4 807 121 years of follow-up, and 74 003 deaths, of which 65 553 had a known cause. MAIN OUTCOMES AND MEASURES Mortality ratios for the schizophrenia cohort standardized to the general population with respect to age, sex, race/ethnicity, and geographic region were estimated for all-cause and cause-specific mortality. Mortality rates per 100 000 person-years and the mean years of potential life lost per death were also determined. Death record information was obtained from the National Death Index. RESULTS Adults with schizophrenia were more than 3.5 times (all-cause SMR, 3.7; 95% CI, 3.7-3.7) as likely to die in the follow-up period as were adults in the general population. Cardiovascular disease had the highest mortality rate (403.2 per 100 000 person-years) and an SMR of 3.6 (95% CI, 3.5-3.6). Among 6 selected cancers, lung cancer had the highest mortality rate (74.8 per 100 000 person-years) and an SMR of 2.4 (95% CI, 2.4-2.5). Particularly elevated SMRs were observed for chronic obstructive pulmonary disease (9.9; 95% CI, 9.6-10.2) and influenza and pneumonia (7.0; 95% CI, 6.7-7.4). Accidental deaths (119.7 per 100 000 person-years) accounted for more than twice as many deaths as suicide (52.0 per 100 000 person-years). Nonsuicidal substance-induced death, mostly from alcohol or other drugs, was also a leading cause of death (95.2 per 100 000 person-years). CONCLUSIONS AND RELEVANCE In a US national cohort of adults with schizophrenia, excess deaths from cardiovascular and respiratory diseases implicate modifiable cardiovascular risk factors, including especially tobacco use. Excess deaths directly attributable to alcohol or other drugs highlight threats posed by substance abuse. More aggressive identification and management of cardiovascular risk factors, as well as reducing tobacco use and substance abuse, should be leading priorities in the medical care of adults with schizophrenia.

Leukocyte telomere length: Effects of schizophrenia, age, and gender

“…While the reasons for the gender difference in LTL in schizophrenia vs. HCs remain unclear, this might help explain the greater standardized mortality ratio seen in women, compared to men with schizophrenia (Olfson et al, 2015). There may be several consequences of prematurely shortened LTL in women with schizophrenia.…”

“…Schizophrenia is associated with major medical co-morbidity, a 3-to 5-fold increase in premature death, and an estimated 15e20 years of shortened life span (Dickerson et al, 2014;Kilbourne et al, 2009;Kirkpatrick et al, 2008;Olfson et al, 2015). This has led to a suggestion that schizophrenia is associated with accelerated biological aging (Anthes, 2014;Dawes et al, 2011;Kirkpatrick et al, 2008;Kochunov et al, 2013;Koutsouleris et al, 2014;Lindqvist et al, 2015;Okusaga, 2014;Schnack et al, 2016;Shivakumar et al, 2014).…”

“…This has led to a suggestion that schizophrenia is associated with accelerated biological aging (Anthes, 2014;Dawes et al, 2011;Kirkpatrick et al, 2008;Kochunov et al, 2013;Koutsouleris et al, 2014;Lindqvist et al, 2015;Okusaga, 2014;Schnack et al, 2016;Shivakumar et al, 2014). Whereas men have overall higher death rates than women, mortality ratios in schizophrenia (standardized to the general population with respect to age, race/ethnicity and geographic region) are higher in women than in men with schizophrenia, with cardiovascular disease being a leading cause of premature death in both genders (Olfson et al, 2015). The causes of medical co-morbidity and premature mortality in schizophrenia are not fully understood but are likely multifactorial, including lifestyle factors (Chwastiak et al, 2011;Robson and Gray, 2007), antipsychotic drugs, and poor access to health care (McCabe and Leas, 2008) as well as intrinsic biological differences (Ringen et al, 2014).…”

Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial

“…People with schizophrenia have a lifespan that is shortened by an average 28.5 years, 4 and the elevated rate of smoking is a major contributing factor to this decreased life expectancy. 5,6 Moreover, smoking is a considerable financial burden to patients with schizophrenia 7 and interferes with maintenance of stable levels of some antipsychotic medications.…”

Do adverse perinatal events predict mortality in schizophrenia during midlife?

“…Individuals with psychotic disorders have over a 2-to 4-fold higher all-cause mortality risk than the general population (Crump et al 2013b;Høye et al 2011;Kiviniemi et al 2010;Lumme et al 2016;Olfson et al 2015;Saha et al 2007;Termorshuizen et al 2013) and their life expectancy is 10-25 years lower (Crump et al 2013b;Tiihonen et al 2009). Furthermore, those differences are continuing into old age (Talaslahti et al 2014).…”