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

Kugathasan, Pirathiv; Stubbs, Brendon; Aagaard, Jørgen; Jensen, Svend Eggert; Laursen, Thomas Munk; Nielsen, René Ernst

doi:10.1111/acps.13076

Cited by 46 publications

(40 citation statements)

References 36 publications

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“…The large sample size of this study, and representativeness of data from CPRD(34, 35), suggests the results of this study are generalisable to the UK population. The prevalence of multimorbidity in the SMI cohort was similar to previous studies(16, 18, 56), however prevalence of multimorbidity depends on the conditions studied and therefore other studies have found substantially different(15, 17) estimates. As with all studies using electronic health records, a limitation of this study is potential biases in recording variables.…”

Section: Discussionsupporting

confidence: 86%

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Launders¹,

Hayes

Price

et al. 2021

Preprint

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Objective: To investigate the clustering of physical health multimorbidity in people with severe mental illness (SMI) compared to matched comparators. Design: A cohort-nested analysis of lifetime diagnoses of physical health conditions. Setting: Over 1,800 UK general practices (GP) contributing to Clinical Practice Research DataLink (CPRD) Gold or Aurum databases. Participants: 68,392 adult patients with a diagnosis of SMI between 2000 and 2018, with at least one year of follow up data, matched 1:4 to patients without an SMI diagnosis, on age, sex, GP, and year of GP registration. Main outcome measures: Odds ratios for 24 physical health conditions derived using Elixhauser and Charlson comorbidity indices. We controlled for age, sex, region, and ethnicity; and then additionally for smoking status, alcohol and drug misuse and body mass index. We defined multimorbidity clusters using Multiple Correspondence Analysis and K-Means cluster analysis and described them based on the observed/expected ratio. Results: Patients with a diagnosis of SMI had an increased odds of 19 of 24 physical health conditions and had a higher prevalence of multimorbidity at a younger age compared to comparators (aOR: 2.47; 95%CI: 2.25 to 2.72 in patients aged 20-29). Smoking, obesity, alcohol, and drug misuse were more prevalent in the SMI group and adjusting for these reduced the odds ratio of all comorbid conditions. In patients with multimorbidity (SMI cohort: n=22,843, comparators: n=68,856), we identified six multimorbidity clusters in the SMI cohort, and five in the comparator cohort. Five profiles were common to both. The "hypertension and varied multimorbidity" cluster was most common: 49.8% in the SMI cohort, and 56.7% in comparators. 41.5% of the SMI cohort were in a "respiratory and neurological disease" cluster, compared to 28.7% of comparators. Conclusions: Physical health multimorbidity clusters similarly in people with and without SMI, though patients with SMI develop multimorbidity earlier and a greater proportion fall into a "respiratory and neurological disease" cluster. There is a need for interventions aimed at younger-age multimorbidity in those with SMI.

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Section: Discussionsupporting

confidence: 86%

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Launders¹,

Hayes

Price

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Also, diagnostic overshadowing is an issue: a process by which physical symptoms are misattributed to mental illness and not diagnosed as a medical entity [ 23 ]. The combination of schizophrenia with a physical disorder leads to worse outcomes in both conditions [ 24 ], and those with schizophrenia show higher mortality compared to the general population [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Physical-mental health comorbidity: A population-based cross-sectional study

et al. 2021

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Background Multimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population. Methods In this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex. Results Half of the individuals (49.1% (95% CI 49.0–49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1–8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1–6.2) of the study population, and 13.1% (13.0–13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse. Conclusions The burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.

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“…3 Excess deaths associated with psychotic disorders are mainly attributed to natural causes, particularly cardiovascular disease, respiratory disease, and cancers. [4][5][6][7] Evidence shows that such mortality gap has persisted 2,3,[8][9][10] or widened 1,[11][12][13] in recent decades despite the overall increase in life expectancy in the general population due to healthcare improvement. Physical health disparities experienced by people with psychotic disorders thus constitute a serious public health concern that warrants urgent attention.…”

Section: Introductionmentioning

confidence: 99%

Excess Mortality and Life-Years Lost in People With Schizophrenia and Other Non-affective Psychoses: An 11-Year Population-Based Cohort Study

Yung

Wong

Chan

et al. 2020

Schizophrenia Bulletin

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Psychotic disorders are associated with premature mortality, but research was primarily based on Western countries and rarely examined non-affective psychoses other than schizophrenia (ONAP). This population-based cohort study investigated excess mortality in 46 896 schizophrenia and 20 651 ONAP patients between January 2006 and December 2016 in Hong Kong (HK), by estimating all-cause and cause-specific standardized mortality ratios (SMRs), and life-years lost (LYLs), a recently developed, more precise reduced life expectancy measure taking into account the illness onset (age at first-recorded diagnosis). Changes in mortality metrics over the study period were assessed. Study data were retrieved from a territory-wide medical-record database of public healthcare services to 7.5 million HK residents. Results showed that schizophrenia and ONAP patients had higher all-cause (schizophrenia: SMR: 2.49 [95% CI: 2.43–2.55]; ONAP: 2.00 [1.92–2.09]), natural-cause (1.80 [1.74–1.85]; 1.47 [1.40–1.54]), and unnatural-cause (6.97 [6.47–7.49]; 8.53 [7.61–9.52]) mortality rates than general population. Respiratory diseases, cardiovascular diseases, and cancers accounted for the majority of deaths in patient cohorts. Men and women with schizophrenia had 9.53 years and 8.07 years of excess LYLs, respectively. For ONAP, excess LYLs was 8.18 years for men and 5.44 years for women. The overall mortality gap remained similar for both patient groups over time despite their improved longevity and declined unnatural-cause mortality rates. Taken together, schizophrenia and ONAP are associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to a natural cause. Persistent mortality gap highlights an urgent need for targeted interventions to improve the physical health of patients with psychotic disorders.

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

Cited by 46 publications

References 36 publications

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Physical-mental health comorbidity: A population-based cross-sectional study

Excess Mortality and Life-Years Lost in People With Schizophrenia and Other Non-affective Psychoses: An 11-Year Population-Based Cohort Study

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