Mind the (Mortality) Gap in Schizophrenia
Mind the (Mortality) Gap in Schizophrenia
Nielsen RE, Uggerby AS, Jensen SO, McGrath JJ
Schizophr Res. 2013 Mar 21. [Epub ahead of print]
This is a longitudinal study using the Danish Psychiatric Research Register and the Danish Cause of Death Register. Over the 3 decades of this study (1980-2010), people with schizophrenia died, on average, 11 years earlier than the general population (73.4 years vs 62.2 years). Moreover, in this study, this gap appears to be widening. An increasing life span of approximately 0.3 years for each calendar year was observed for the general population vs a reduction of 0.05 years for each calendar year for persons with schizophrenia. A similar pattern existed after acts of self-harm as the cause of death were excluded from the analyses.
This study and others have amply demonstrated that patients with schizophrenia die at a younger age than the general population. However, not all studies have agreed that the mortality gap is widening over time. Nielsen and colleagues observed that both primary and secondary care in Denmark are free, but that differences in age of death were found nevertheless. There are several possible explanations, including comorbidity of schizophrenia with other illnesses, environmental and lifestyle differences, and inability of patients with schizophrenia to adhere to care plans (including adherence with lipid-lowering and antihypertensive agents). Most disturbing is the trend, at least in Denmark, showing that the difference in mortality is becoming worse.
For the individual practitioner caring for patients with schizophrenia, it becomes imperative to think of ourselves as a primary access point for overall healthcare. Monitoring of somatic health concerns such as cardiometabolic risk is critical and involves the careful use of medications that can adversely affect this risk, as well as monitoring weight, lipids, and glucose. Perhaps it is time to add blood pressure assessments to our routine as well. Given the ubiquity of cigarette smoking in this population, it is easy to overlook that smoking is equivalent to having multiple other cardiometabolic risk factors.
Abstract
Increasing Mortality Gap for Patients Diagnosed With Schizophrenia Over the Last Three Decades -- A Danish Nationwide Study From 1980 to 2010
Nielsen RE, Uggerby AS, Jensen SO, McGrath JJ
Schizophr Res. 2013 Mar 21. [Epub ahead of print]
Study Summary
This is a longitudinal study using the Danish Psychiatric Research Register and the Danish Cause of Death Register. Over the 3 decades of this study (1980-2010), people with schizophrenia died, on average, 11 years earlier than the general population (73.4 years vs 62.2 years). Moreover, in this study, this gap appears to be widening. An increasing life span of approximately 0.3 years for each calendar year was observed for the general population vs a reduction of 0.05 years for each calendar year for persons with schizophrenia. A similar pattern existed after acts of self-harm as the cause of death were excluded from the analyses.
Viewpoint
This study and others have amply demonstrated that patients with schizophrenia die at a younger age than the general population. However, not all studies have agreed that the mortality gap is widening over time. Nielsen and colleagues observed that both primary and secondary care in Denmark are free, but that differences in age of death were found nevertheless. There are several possible explanations, including comorbidity of schizophrenia with other illnesses, environmental and lifestyle differences, and inability of patients with schizophrenia to adhere to care plans (including adherence with lipid-lowering and antihypertensive agents). Most disturbing is the trend, at least in Denmark, showing that the difference in mortality is becoming worse.
For the individual practitioner caring for patients with schizophrenia, it becomes imperative to think of ourselves as a primary access point for overall healthcare. Monitoring of somatic health concerns such as cardiometabolic risk is critical and involves the careful use of medications that can adversely affect this risk, as well as monitoring weight, lipids, and glucose. Perhaps it is time to add blood pressure assessments to our routine as well. Given the ubiquity of cigarette smoking in this population, it is easy to overlook that smoking is equivalent to having multiple other cardiometabolic risk factors.
Abstract