Mortality in schizophrenia: 30‐year nationwide follow‐up study

Tanskanen, Antti; Tiihonen, Jari; Taipale, Heidi

doi:10.1111/acps.12913

Cited by 112 publications

(66 citation statements)

References 24 publications

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“…According to a meta‐analysis based on studies from various countries, persons with schizophrenia have a 14.5 years shorter average life expectancy compared with the general population. Our recent findings from a large, nationwide cohort study showed that the gap in longevity has remained the same during the last 30 years. This unchanged excess mortality compared with the general population was explained by a simultaneous decrease in suicides and increase in cancer and cardiovascular deaths among persons with schizophrenia.…”

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confidence: 94%

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

274

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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mentioning

confidence: 94%

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

274

204

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“…SMI patients die about 10-20 years earlier than the general population (1)(2)(3)(4)(5). Most systematic reviews showed that all-cause mortality in SMI patients is 2 to 3.5 times higher than in the general population (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). There is also evidence that this mortality gap has been increasing over time (4,19,6).…”

Section: Introductionmentioning

confidence: 99%

Dying Too Soon: Excess Mortality in Severe Mental Illness

et al. 2019

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Aims:We aimed to identify baseline predictors of mortality in patients with a severe mental illness (SMI) over a 6-year period and to describe mortality rates as standardised mortality ratios (SMRs). We hypothesised that cardiovascular diseases, older age, cigarette smoking, more severe psychiatric symptoms and more severe psychotropic side effects, and alcohol or drug use were independent risk factors for mortality.Method: Medical examinations were conducted at baseline in a cohort of 322 SMI patients. SMRs were estimated after 6 years and an evaluation was made of the impact of a wide range of variables on survival time.Results: Almost 11% of the SMI patients had died at the end of the study period. Allcause SMRs were 4.51 (95% CI 3.07-5.95) for all SMI patients (4.89, 95% CI 2.97-6.80 for men, and 3.94, 95% CI 1.78-6.10 for women). Natural causes accounted for 86% of excess mortality and unnatural causes for 14%. Cardiovascular disease was a major contributor to this excess mortality. Multivariate Cox regression analyses showed that premature death was associated with a longer history of tobacco use (HR: 1.03, 95% CI 1.02-1.03) and more severe symptoms of disorganisation (HR: 2.36, 95% CI 2.21-2.52). Conclusions:The high SMR and the incidence of cardiovascular disease-related death in SMI patients in our study justify concern. This study underscores the urgent need for interventions to reduce excess mortality in patients with SMI.

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“…comorbidities, specifically CVD and T2D (Hjorthøj et al, 2017;Tanskanen et al, 2018, Vancampfort et al, 2015. Addressing sleep abnormalities could play major role in the prevention and treatment of cardio-metabolic disease in this high risk population.…”

Section: Introductionmentioning

confidence: 99%

Does exercise improve sleep quality in individuals with mental illness? A systematic review and meta-analysis

Lederman

Ward

Firth

et al. 2019

Journal of Psychiatric Research

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Mortality in schizophrenia: 30‐year nationwide follow‐up study

Abstract: The longevity of persons with schizophrenia is improving at approximately the same rate as the general population but suicide rates have declined substantially. However, there is still a major disparity in mortality compared with general population.

Cited by 112 publications

References 24 publications

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)

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)

Dying Too Soon: Excess Mortality in Severe Mental Illness

Does exercise improve sleep quality in individuals with mental illness? A systematic review and meta-analysis

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