Risk for premature death higher with comorbid cardiometabolic, psychiatric disorders
Adults with CVD, diabetes or chronic respiratory diseases and comorbid psychiatric conditions are at “substantially” increased risk for premature death or death by suicide compared with adults without psychiatric comorbidities, data show.
In a longitudinal study of more than 1 million Swedish adults with chronic health diseases, researchers found mortality rates ranged from 15% to 21% in adults with chronic respiratory diseases, CVD or diabetes who had a comorbid psychiatric disorder.
“The equivalent risks ranged between 6% to 9% in patients without such comorbidities, representing an absolute risk difference of at least 9%,” Amir Sariaslan, PhD, senior research fellow in psychiatric epidemiology at the University of Oxford, U.K., and colleagues wrote.
Sariaslan and colleagues analyzed registry data for all people born in Sweden from 1932 to 1995 with inpatient and outpatient diagnoses of chronic respiratory diseases (n = 249,825), CVD (n = 568,818) and diabetes (n = 255,579), followed for an average of 8.1 years. Researchers assessed risks for premature mortality, defined as death before age 65 years, and suicide through December 2013 and compared patients diagnosed with chronic respiratory diseases, CVD or diabetes with age- and sex-matched population controls (n = 10,345,758) and unaffected biological full siblings (n = 1,119,543). Researchers also assessed comorbidity with any psychiatric disorder by major psychiatric categories, using diagnoses from patient registers.
Within the cohort, 32% of patients with chronic respiratory diseases, 25% of patients with CVD and 28.2% of people with diabetes had a lifetime diagnosis of a comorbid psychiatric disorder compared with approximately 16% of population controls.
Researchers found more patients with noncommunicable diseases and comorbid psychiatric disorders died during the first 5 years of follow-up than patients without psychiatric comorbidities. The cumulative mortality risk range was 15.4% to 21.2% for all-cause mortality for those with comorbid psychiatric disorders compared with 5.5% to 9.1% for those without comorbid psychiatric disorders. Similarly, the cumulative mortality risk range was 1.2% to 1.5% for suicide for those with comorbid psychiatric disorders compared with 0.1% to 0.1% for those without comorbid psychiatric conditions.
When the researchers compared each patient with an unaffected sibling to account for familial risk factors, patients with any comorbid psychiatric disorder had elevated risks for premature mortality, with adjusted HRs ranging from 7.2 to 8.9, and suicide, with adjusted HRs ranging from 10.6 to 12.3. relative to patients without psychiatric comorbidities.
“This pattern of associations was similar across specific psychiatric disorders, but with smaller effect sizes for depression than substance use disorders,” the researchers wrote.
The researchers noted that residual genetic confounding is a limiting factor; however, the reported associations remained large even after adjustment for shared and unmeasured familial confounders.
“By examining mortality risks in more than 1 million adults, we have found substantial effects of psychiatric comorbidities in patients with cardiac, respiratory and diabetic conditions,” the researchers wrote. “Screening and treatment for co-occurring substance use disorders and depression in these conditions may improve life expectancy.”
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