Increased mortality from somatic multimorbidity in patients with schizophrenia: a Danish nationwide cohort study. (7th August 2019)

• Record Type: Journal Article
• Authors: Kugathasan, P.; Stubbs, B.; Aagaard, J.; Jensen, S. E.; Munk Laursen, T.; Nielsen, R. E.
• Is Part Of: Acta psychiatrica Scandinavica. Volume 140:Number 4(2019)
• Page Start: 340
• Page End: 348
• Publication Date: 2019-08-07
• Subjects: physical health -- physical illness -- comorbidity -- mortality -- clinical aspects; Psychiatry -- Periodicals; 616.89
• DOI: 10.1111/acps.13076
• Languages: English
• ISSNs: 0001-690X

Abstract

Abstract : Objective: To investigate the association of single‐ and multimorbidity with mortality rates in patients with schizophrenia compared to the general population. Method: A nationwide cohort study including residents in Denmark between 1995 and 2015. The cohort was dichotomously divided by a diagnosis of schizophrenia. Somatic diseases included infections, cancer, endocrine, neurologic, cardiovascular, respiratory, digestive, skin, musculoskeletal, and urogenital diseases. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated. Results: The cohort included 30 210 patients with schizophrenia [mean age (SD) = 32.6 (11.4), males = 57.2%], and 5 402 611 from the general population [mean age (SD) = 33.0 (14.5), males = 50.4%]. All number of somatic diseases were associated with an increased mortality in schizophrenia [HR = 16.3 (95% CI = 15.4–17.3) for 1 disease to 21.0 (95% CI = 19.1–23.0) for ≥5 diseases], using the general population with no somatic disease as reference. Across all somatic diseases, patients with schizophrenia showed a HR > 2, compared to the general population, and respiratory (PAF = 9.3%), digestive (PAF = 8.2%), and cardiovascular (PAF = 7.9%) diseases showed largest contributions to death. Conclusions: Patients with schizophrenia showed higher mortality on all levels of multimorbidity, and a doubled mortality rate across all somatic diseases, compared to the general population. The findings suggest that the clusters and trajectories of symptoms associated with schizophrenia is the main driver of the excess mortality.