Transformation of excess mortality in people with schizophrenia and bipolar disorder in Taiwan

Pan, Yi‐Ju; Yeh, Ling‐Ling; Chan, Hung‐Yu; Chang, Chin‐Kuo

doi:10.1017/s0033291717001040

Cited by 16 publications

(17 citation statements)

References 37 publications

(48 reference statements)

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“…Our finding of a time trend showing a significant increase in all‐cause SMR over the study period of patients diagnosed with bipolar disorder is in agreement with prior results from England, Sweden and Taiwan, even though these studies were based on smaller sample sizes and shorter study periods. A widening gap in mortality between bipolar patients and the general population can be due to either an absolute increase in the number of deaths among patients or be the result of a decrease in number of deaths in the regional general population.…”

Section: Discussionsupporting

confidence: 92%

Increasing mortality gap for patients diagnosed with bipolar disorder—A nationwide study with 20 years of follow‐up

et al. 2018

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Section: Discussionsupporting

confidence: 92%

Increasing mortality gap for patients diagnosed with bipolar disorder—A nationwide study with 20 years of follow‐up

et al. 2018

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“…Excess deaths associated with bipolar disorder are mainly attributed to natural causes, particularly cardiovascular diseases, respiratory diseases and cancers (Crump et al ., 2013 ; Hayes et al ., 2015 ). Accumulating evidence indicates that such mortality gap has persisted (Ajetunmobi et al ., 2013 ; Crump et al ., 2013 ) or widened (Hayes et al ., 2017 ; Pan et al ., 2017 ; Hansen et al ., 2019 ; Lomholt et al ., 2019 ) in recent decades despite overall improvement in life expectancy in the general population due to enhanced healthcare. Physical health inequalities experienced by people with bipolar disorder thus represent a serious public health challenge that warrants urgent attention.…”

Section: Introductionmentioning

confidence: 99%

Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

Chan

Wong

Yung

et al. 2021

Epidemiol Psychiatr Sci

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Aims Bipolar disorder is associated with premature mortality, but evidence is mostly derived from Western countries. There has been no research evaluating shortened lifespan in bipolar disorder using life-years lost (LYLs), which is a recently developed mortality metric taking into account illness onset for life expectancy estimation. The current study aimed to examine the extent of premature mortality in bipolar disorder patients relative to the general population in Hong Kong (HK) in terms of standardised mortality ratio (SMR) and excess LYLs, and changes of mortality rate over time. Methods This population-based cohort study investigated excess mortality in 12 556 bipolar disorder patients between 2008 and 2018, by estimating all-cause and cause-specific SMRs, and LYLs. Trends in annual SMRs over the 11-year study period were assessed. Study data were retrieved from a territory-wide medical-record database of HK public healthcare services. Results Patients had higher all-cause [SMR: 2.60 (95% CI: 2.45–2.76)], natural-cause [SMR: 1.90 (95% CI: 1.76–2.05)] and unnatural-cause [SMR: 8.63 (95% CI: 7.34–10.03)] mortality rates than the general population. Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Men and women with bipolar disorder had 6.78 (95% CI: 6.00–7.84) years and 7.35 (95% CI: 6.75–8.06) years of excess LYLs, respectively. The overall mortality gap remained similar over time, albeit slightly improved in men with bipolar disorder. Conclusions Bipolar disorder is associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to natural causes. Persistent mortality gap underscores an urgent need for targeted interventions to improve physical health of patients with bipolar disorder.

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“…Our previous study in Taiwan revealed that, from 2003 through 2011, the differential in mortality for people with schizophrenia slightly decreased, whereas the differential in mortality for bipolar disorder individuals remained relatively stable (Pan et al ., 2017 ). The discrepant findings on excess mortality, defined as the number of deaths which occurred for a given condition or disease above what we would have expected to see under normal situations, of schizophrenia and bipolar disorder urged further research across various major mental illnesses, including unipolar depression.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, we presented the changes of excess mortality and life expectancy at birth in people with schizophrenia, bipolar disorder and depressive disorder, using nationwide cohorts who were diagnosed and treated in 2005 and 2010 in Taiwan, respectively. In our previous analysis (Pan et al ., 2017 ), we applied the time frames of observation to define these cohorts for the reason that, earlier than 2005, national health insurance data linking to national mortality registry was lack of basic demographic information and the most updated data available was only given until the end of 2013. For the purposes of consistency, we defined the study cohorts in exact the same way.…”

Section: Introductionmentioning

confidence: 99%

Excess mortality and shortened life expectancy in people with major mental illnesses in Taiwan

Pan

Yeh

Chan

et al. 2020

Epidemiol Psychiatr Sci

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Aims Given the concerns of health inequality associated with mental illnesses, we aimed to reveal the extent of which general mortality and life expectancy at birth in people with schizophrenia, bipolar disorder and depressive disorder varied in the 2005 and 2010 nationally representative cohorts in Taiwan. Methods Two nationally representative samples of individuals with schizophrenia, bipolar disorder and depressive disorder were identified from Taiwan's national health insurance database in 2005 and 2010, respectively, and followed-up for consecutive 3 years. The database was linked to nationwide mortality registry to identify causes and date of death. Age-, gender- and cause-specific mortality rates were generated, with the average follow-up period of each age- and gender-band applied as ‘weighting’ for the calculation of expected number of deaths. Age- and gender-standardised mortality ratios (SMRs) were calculated for these 3-year observation periods with Taiwanese general population in 2011/2012 as the standard population. The SMR calculations were then stratified by natural/unnatural causes and major groups of death. Corresponding life expectancies at birth were also calculated by gender, diagnosis of mental disorders and year of cohorts for further elucidation. Results The general differential in mortality rates for people with schizophrenia and bipolar disorder remained wide, revealing an SMR of 3.65 (95% confidence interval (CI): 3.55–3.76) for cohort 2005 and 3.27 (3.18-3.36) for cohort 2010 in schizophrenia, and 2.65 (95% CI: 2.55–2.76) for cohort 2005 and 2.39 (2.31-2.48) for cohort 2010 in bipolar disorder, respectively. The SMRs in people with depression were 1.83 (95% CI: 1.81–1.86) for cohort 2005 and 1.59 (1.57-1.61) for cohort 2010. SMRs due to unnatural causes tended to decrease in people with major mental illnesses over the years, but those due to natural causes remained relatively stable. The life expectancies at birth for schizophrenia, bipolar disorder and depression were all significantly lower than the national norms, specifically showing 14.97–15.50 years of life lost for men and 15.15–15.48 years for women in people with schizophrenia. Conclusions Compared to general population, the differential in mortality rates for people with major mental illnesses persisted substantial. The differential in mortality for unnatural causes of death seemed decreasing over the years, but that due to natural causes remained relatively steady. Regardless of gender, people with schizophrenia, bipolar disorder and depression were shown to have shortened life expectancies compared to general population.

show abstract

Transformation of excess mortality in people with schizophrenia and bipolar disorder in Taiwan

Cited by 16 publications

References 37 publications

Increasing mortality gap for patients diagnosed with bipolar disorder—A nationwide study with 20 years of follow‐up

Increasing mortality gap for patients diagnosed with bipolar disorder—A nationwide study with 20 years of follow‐up

Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

Excess mortality and shortened life expectancy in people with major mental illnesses in Taiwan

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