Prevalence and 5-year trend of incidence for medical illnesses after the diagnosis of bipolar disorder: A nationwide cohort study

Abstract

Objective: Medical comorbidities are prevalent in patients with bipolar disorder. Evaluating longitudinal trends of the incidence of medical illnesses enables implementation of early prevention strategies to reduce the high mortality rate in this at-risk population. However, the incidence risks of medical illnesses in the early stages of bipolar disorder remain unclear. This study investigated the incidence and 5-year trend of medical illnesses following bipolar disorder diagnosis. Methods: We identified 11,884 patients aged 13–40 years who were newly diagnosed as having bipolar disorder during 1996–2012 and 47,536 age- and sex-matched controls (1:4 ratio) who represented the general population from Taiwan’s National Health Insurance Research Database. We estimated the prevalence and incidence of individual medical illnesses yearly across the first 5 years after the index date. The adjusted incidence rate ratio was calculated to compare the occurrence of specific medical illnesses each year between the bipolar disorder group and control group using the Poisson regression model. Results: Apart from the prevalence, the adjusted incidence rate ratios of most medical illnesses were >1.00 across the first 5-year period after bipolar disorder diagnosis. Cerebrovascular diseases, ischaemic heart disease, congestive heart failure, other forms of heart disease, renal disease and human immunodeficiency virus infection exhibited the highest adjusted incidence rate ratios during the first year. Except for that of renal disease, the 5-year trends of the adjusted incidence rate ratios decreased for cerebrovascular diseases, cardiovascular diseases (e.g. ischaemic heart disease, other forms of heart disease, and vein and lymphatic disease), gastrointestinal diseases (e.g. chronic hepatic disease and ulcer disease) and communicable diseases (e.g. human immunodeficiency virus infection, upper respiratory tract infection and pneumonia). Conclusion: Incidence risks of medical illnesses are increased in the first year after bipolar disorder diagnosis. Clinicians must carefully evaluate medical illnesses during this period because the mortality rates from medical illnesses are particularly high in people with bipolar disorder.

Mood stabilizers and risk of all‐cause, natural, and suicide mortality in bipolar disorder: A nationwide cohort study

“…26,34,35 In addition, laboratory studies have indicated that lithium administered at therapeutic levels ameliorates pathological hypertrophy and cardiac fibrogenesis in cellular and rat models of myocardial infarction. 6,36 Lithium likely achieves cardioprotective effects by inhibiting inflammatory responses, reactive oxidative stress, and endothelial dysfunction 37,38 and involves numerous signaling pathways. 39 Similarly, mechanistic studies have discovered that valproic acid protects cardiomyocytes and neurons from ischemic injury by modulating histone deacetylase activity.…”

“…For instance, clinical studies have revealed that lithium treatment reduces the risk of cardiovascular disease in patients with bipolar disorder 26,34,35 . In addition, laboratory studies have indicated that lithium administered at therapeutic levels ameliorates pathological hypertrophy and cardiac fibrogenesis in cellular and rat models of myocardial infarction 6,36 . Lithium likely achieves cardioprotective effects by inhibiting inflammatory responses, reactive oxidative stress, and endothelial dysfunction 37,38 and involves numerous signaling pathways 39 .…”

“…In addition, the Taiwan Joint Commission on Hospital Accreditation oversees the accreditation of hospitals contracted with the NHI program; the accreditation standards of hospitals contracted with the NHI program require that diagnoses be made by board‐certified psychiatrists. The NHIRD has been used extensively for research purposes and has served as the basis for many epidemiological studies that were later published in multiple peer‐reviewed journals 6,26 . The Taipei City Hospital Research Ethics Committee approved this study (TCHIRB‐10803011‐E) and waived the need for informed consent after considering the deidentified and retrospective nature of the data.…”

“…The NHIRD has been used extensively for research purposes and has served as the basis for many epidemiological studies that were later published in multiple peer-reviewed journals. 6,26 The Taipei City Hospital Research Ethics Committee approved this study (TCHIRB-10803011-E) and waived the…”

“…1,2 In addition to mood symptoms and neurocognitive dysfunction, patients with bipolar disorder also have an elevated risk of multiple comorbidities. [3][4][5][6] National cohort studies and meta-analyses have demonstrated that patients with bipolar disorder have a mortality rate at least twice as high as that of the general population and a lower 10-year life expectancy than that of the general population. 4,[7][8][9][10][11][12] This high mortality is because of suicide as well as natural causes.…”