Premature mortality among people with severe mental illness — New evidence from linked primary care data

Abstract

Studies assessing premature mortality in people with severe mental illness (SMI) are usually based in one setting, hospital (secondary care inpatients and/or outpatients) or community (primary care). This may lead to ascertainment bias. This study aimed to estimate standardised mortality ratios (SMRs) for all-cause and cause-specific mortality in people with SMI drawn from linked primary and secondary care populations compared to the general population. SMRs were calculated using the indirect method for a United Kingdom population of almost four million between 2004 and 2013. The all-cause SMR was higher in the cohort identified from secondary care hospital admissions (SMR: 2.9; 95% CI: 2.8-3.0) than from primary care (SMR: 2.2; 95% CI: 2.1-2.3) when compared to the general population. The SMR for the combined cohort was 2.6 (95% CI: 2.5-2.6). Cause specific SMRs in the combined cohort were particularly elevated in those with SMI relative to the general population for ill-defined and unknown causes, suicide, substance abuse, Parkinson's disease, accidents, dementia, infections and respiratory disorders (particularly pneumonia), and Alzheimer's disease. Solely hospital admission based studies, which have dominated the literature hitherto, somewhat over-estimate premature mortality in those with SMI. People with SMI are more likely to die by ill-defined and unknown causes, suicide and other less common and often under-reported causes. Comprehensive characterisation of mortality is important to inform policy and practice and to discriminate settings to allow for proportionate interventions to address this health injustice.

Suicide, fatal injuries and drowning among the crews of United Kingdom and Bermuda registered cruise and passenger ships from 1976 to 2018

“…Because of the limitations of the available data it is not possible to calculate mortality rates using the at-risk populations employed and so the number of ships registered has been used as a less than ideal surrogate for this. As in other studies [23], some deaths from other unnatural and unexplained causes may also have been due to suicide.…”

“…It is based on two large defined populations serving UK and Bermuda registered passenger ships and covers a long 43-year study period to assess trends in mortality. It is also based on reliable information sources that have been used in previous investigations of mortality in the maritime industries [16,22,23]. The major study limitation is that the numbers of crew employed in UK, Bermuda and almost all other passenger fleets world-wide are not known.…”

Cardiovascular and metabolic side effects of second-generation antipsychotics - narrative review

“…Severely mentally ill patients have a substantially shorter lifespan (10-20 years) than the general population. Despite the advances in research and health care, this life-expectancy reduction is actually increasing [19]. Among schizophrenia patients, the coexistence of diabetes is significantly more frequent than in the general population, while the increased risk of cardiovascular diseases contributes significantly to the pre-mature mortality of these patients [16,20].…”

Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

“…associated with an increased risk of death from speci c causes such as suicide, as well as deaths from natural causes (39), (26), (40), (41), (17), (23), (32).…”