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Mortality rate 3.5 times higher among adults with schizophrenia

Adults with schizophrenia had a higher mortality rate compared with the general population in the U.S., with cardiovascular disease as the leading cause of death.

“Adults with schizophrenia are at markedly increased risk of premature death. Despite elevated rates of suicide and other unnatural causes of death, most of the excess mortality has been attributed to cardiovascular disease, respiratory disease, and other natural causes,” Mark Olfson, MD, MPH, of Columbia University, and colleagues wrote. “Many factors, including economic disadvantage, negative health behaviors, and difficulties accessing and adhering to medical treatments, are thought to contribute to premature mortality in schizophrenia. Smoking, limited physical activity, obesity, elevated serum glucose level, hypertension, and dyslipidemia are all significantly more common in schizophrenia than in the general population.”

Mark Olfson

To determine overall and cause-specific mortality rates for adults with schizophrenia in the U.S., researchers assessed a national retrospective longitudinal cohort of patients with schizophrenia in the Medicaid program from 2001 to 2007. The cohort included 1,138,853 individuals aged 20 to 64 years.

Individuals with schizophrenia were more than 3.5 times as likely to die during follow-up compared with adults in the general population.

Cardiovascular disease had the highest mortality rate, at 403.2 per 100,000 person-years, with a standardized mortality ratio of 3.6 (95% CI, 3.5-3.6).

Of the six cancer types analyzed — lung, colon, breast, liver, pancreas, hematologic and other cancer — lung cancer had the highest mortality rate, at 74.8 per 100,000 person-years and a standardized mortality ratio of 2.4 (95% CI, 2.4-2.5).

Researchers found particularly high standardized mortality ratios for chronic obstructive pulmonary disease (9.9; 95% CI, 9.6-10.2) and influenza and pneumonia (7; 95% CI, 6.7-7.4).

The mortality rate for accidental deaths was double that of the rate for suicide (119.7 per 100,000 person-years vs. 52 per 100,000 person-years).

Non-suicidal substance-induced death was also a leading cause of death among individuals with schizophrenia, at a rate of 95.2 per 100,000 person-years, according to researchers.

“The article by Olfson and colleagues in this issue of JAMA Psychiatry is a reminder of how we are failing to meet the needs of people with schizophrenia,” Shuichi Suetani, MBChB, of Queensland Centre for Mental Health Research, Wacol, Australia, and colleagues wrote in an accompanying editorial. “Urgent action to address the mortality gap is a priority for high-income countries and those with low to middle incomes given the epidemiological transition from communicable to non-communicable disorders occurring in the latter. Failure to respond to the challenges identified in the study by Olfson and colleagues will result in a further widening of the life expectancy gap between the general population, whose life expectancy continues to rise, and that of people with severe mental disorders.” – by Amanda Oldt

Disclosure: Olfson reported being the principal investigator of a grant to Columbia University from Sunovion Pharmaceuticals. Suetani reported receiving support from a West Moreton Hospital and Health Service research registrar fellowship. Please see the full study for a list of all researchers’ relevant financial disclosures.