Adults With Schizophrenia At Risk of Cardiovascular Death

Adults with schizophrenia are 3.5 times as likely to die prematurely as adults in the general population, according to a new study published in JAMA Psychiatry. Cardiovascular and respiratory diseases were found to be the chief causes of mortality for adults with schizophrenia, with tobacco use identified as a modifiable risk factor, according to the study, which was partially funded by AHRQ. In the study, “Premature Mortality Among Adults With Schizophrenia in the United States,” researchers examined records of more than 1.1 million Medicaid patients with schizophrenia nationwide, looking at the cause of death for the 74,003 who died. Of the 65,553 deaths with a known cause, 9,812 were due to unnatural causes, including suicide, homicide, accidents and substance abuse. The remaining 55,741 deaths were due to natural causes, primarily cardiovascular disease, lung cancer, chronic obstructive pulmonary disease and influenza and pneumonia. The authors concluded that aggressive identification of cardiovascular risk factors and steps to reduce tobacco use and substance abuse should be among the highest priorities for treating adults with schizophrenia.

2015 Oct 28:1-10. doi: 10.1001/jamapsychiatry.2015.1737. [Epub ahead of print]

Premature Mortality Among Adults With Schizophrenia in the United States.

Olfson M1, Gerhard T2, Huang C3, Crystal S3, Stroup TS1.

Author information

Abstract

IMPORTANCE:

Although adults with schizophrenia have a significantly increased risk of premature mortality, sample size limitations of previous research have hindered the identification of the underlying causes.

OBJECTIVE:

To describe overall and cause-specific mortality rates and standardized mortality ratios (SMRs) for adults with schizophrenia compared with the US general population.

DESIGN, SETTING, AND PARTICIPANTS:

We identified a national retrospective longitudinal cohort of patients with schizophrenia 20 to 64 years old in the Medicaid program (January 1, 2001, to December 31, 2007). The cohort included 1 138 853 individuals, 4 807 121 years of follow-up, and 74 003 deaths, of which 65 553 had a known cause.

MAIN OUTCOMES AND MEASURES:

Mortality ratios for the schizophrenia cohort standardized to the general population with respect to age, sex, race/ethnicity, and geographic region were estimated for all-cause and cause-specific mortality. Mortality rates per 100 000 person-years and the mean years of potential life lost per death were also determined. Death record information was obtained from the National Death Index.

RESULTS:

Adults with schizophrenia were more than 3.5 times (all-cause SMR, 3.7; 95% CI, 3.7-3.7) as likely to die in the follow-up period as were adults in the general population. Cardiovascular disease had the highest mortality rate (403.2 per 100 000 person-years) and an SMR of 3.6 (95% CI, 3.5-3.6). Among 6 selected cancers, lung cancer had the highest mortality rate (74.8 per 100 000 person-years) and an SMR of 2.4 (95% CI, 2.4-2.5). Particularly elevated SMRs were observed for chronic obstructive pulmonary disease (9.9; 95% CI, 9.6-10.2) and influenza and pneumonia (7.0; 95% CI, 6.7-7.4). Accidental deaths (119.7 per 100 000 person-years) accounted for more than twice as many deaths as suicide (52.0 per 100 000 person-years). Nonsuicidal substance-induced death, mostly from alcohol or other drugs, was also a leading cause of death (95.2 per 100 000 person-years).

CONCLUSIONS AND RELEVANCE:

In a US national cohort of adults with schizophrenia, excess deaths from cardiovascular and respiratory diseases implicate modifiable cardiovascular risk factors, including especially tobacco use. Excess deaths directly attributable to alcohol or other drugs highlight threats posed by substance abuse. More aggressive identification and management of cardiovascular risk factors, as well as reducing tobacco use and substance abuse, should be leading priorities in the medical care of adults with schizophrenia.