Cigarette Smoking and Mortality Risk in People With Schizophrenia

Abstract

This study examined effects of cigarette smoking on mortality risk in 1213 persons aged 19-69 years with schizophrenia-related psychotic disorders admitted to State of Maryland Hospitals between 1994 and 2000. Inpatient medical records from 7 hospitals were reviewed to obtain demographic information, diagnosis, medication use, as well as smoking and other substance use. Social Security Death Index data were used to identify deaths in the study group between 1994 and 2004. Death records were reviewed to obtain manner of death and underlying disorders. Of the 1213, 55% were smokers and 71% abused substances. There was an age × smoking interaction (χ(2) = 14.6, df = 1, P = .0001) for mortality, with estimated hazard ratios (HRs) for smokers vs nonsmokers of 2.1 among 35- to 54-year olds and HR of 0.7 among those aged 55-69 years. Five- and 10-year mortality rates for smokers aged 35-54 years were 7.0% and 14.2%, compared with 3.3% and 10.0% for nonsmokers, respectively (χ(2) = 5.53, df = 1, P = .019). Cardiac causes were identified in 43% of deaths in smokers but only 19% of deaths in nonsmokers (P < .006). For those aged 35-54 years, the odds of cardiac related death was increased by 12 fold in smokers relative to nonsmokers (HR = 12.4, χ(2) = 12.0, df = 1, P = .0005). Among people aged 35-54 years, those smoking greater than one pack daily have a significantly increased total mortality risk (HR = 2.7) vs nonsmokers. Cigarette smoking, particularly in people aged 35-54 years, contributes to an increased risk of death. Greater smoking severity significantly increases this risk. Smoking cessation in people with schizophrenia deserves significant attention.

Do Older People Benefit from Having a Confidant? An Oklahoma Physicians Resource/Research Network (OKPRN) Study

“…14,16, and 17 ) and is both less expensive and easier to access and use than the National Death Index. 18 The SSDI is less complete for younger and foreignborn people, neither of whom was part of our target study population.…”

Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”?

“…Such patients have a 20% shorter life expectancy; most of it is attributable to smoking [37,38]. For 35-54-year-old patients with schizophrenia, the hazard ratio for mortality for smokers versus non-smokers is 2.0 [39].…”

Varenicline for smoking cessation and reduction in people with severe mental illnesses: systematic review and meta-analysis

“…Smoking reduction yields substantial benefits by reducing the toxic intake from smoking, reducing the relative risk of smoking- Smoking-related medical illness is the one of the primary causes of morbidity and mortality in SMI patients. Smoking-related comorbidities are associated with higher proportions of heavy smoking [4], and the greater the number of cigarettes smoked daily, the higher the risk of smoking-related diseases and mortality [13,15,54]. Therefore, smoking reduction is expected to generate health benefits for these smokers, even if they are not ready to, or cannot, quit smoking in the short term.…”

“…High levels of nicotine dependence put smokers with SMI at increased risk of smoking-related mortality and morbidity [4,13,14]. A recent study reported that adult smokers with schizophrenia had a 145% higher risk of mortality from smoking-related diseases, such as lung cancer, cardiovascular diseases and chronic obstructive pulmonary disease (COPD), than non-smokers [15].…”