Study findings confirm the increased risk of death from physical diseases among patients with schizophrenia, and reveal cancer mortality as an issue among middle-aged patients.
“Contrary to the idea that those with serious mental illness die young from traumatic events, our study highlights that individuals with schizophrenia are getting old and getting sick, with rates of mortality significantly higher in every age group from 20 to 89,” say lead researcher Maia Kredentser (University of Manitoba, Winnipeg, Manitoba, Canada) and team.
In the population-based cohort, the overall mortality rate between 1999 and 2008 was 20.0% among 9038 schizophrenia patients, compared with 9.4% among 969,090 people without schizophrenia, the team reports in The Journal of Clinical Psychiatry.
The increased mortality rate was present for patients of every age except those aged 90 years or more. The effect was stronger among younger patients, with the risk of death from all causes relative to controls increased 4.14-, 2.50- and 1.42-fold among patients aged 10 to 39 years, 40 to 59 years, and 60 years or older, respectively.
The highest relative risk of death among schizophrenia patients came from suicide, at an 8.67-fold increase. But lung cancer, circulatory diseases, cardiovascular disorders and injuries all carried a significantly elevated death risk, with increases ranging from 1.45- to 2.35-fold. Again, the effects of these individual causes of death were present across age groups, but more so in younger than older patients.
There have been conflicting results regarding the effect of cancer on mortality in schizophrenia patients. Kredentser et al found that it did have a significant effect, but only for patients aged 40 to 59 years, who were 2.48-fold more likely than controls to die of cancer (28.7 vs 11.6 deaths per 1000 people).
The researchers say that their findings have important implications, noting that “[c]oordination of care is poor for patients with serious mental illness”.
They say: “Primary care for those with schizophrenia must include careful monitoring for respiratory and circulatory illness at all ages, and lung cancer in middle age.”
However, Kredentser and team note that care of cancer patients with schizophrenia in “highly integrated” healthcare systems is reportedly as good as that of mentally healthy patients.
“Such findings speak to the importance of continuity of care in schizophrenia, involving extensive interprofessional and intraprofessional collaboration in medical, psychiatric, and social services,” they conclude.
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