Life expectancy among persons with schizophrenia or bipolar affective disorder

doi:10.1016/j.schres.2011.06.008

Schizophrenia Research

Volume 131, Issues 1–3, September 2011, Pages 101-104

https://doi.org/10.1016/j.schres.2011.06.008 Get rights and content

Abstract

Context

Mortality rates among individuals with schizophrenia or bipolar disorder are elevated compared to the general population.

Objective

The objective was to estimate life-expectancy (average age at death) among these persons and make a comparison to people in the general population.

Methods

Life-expectancy was calculated by means of survival analysis techniques using the entire Danish population as a cohort.

Results

Life-expectancy was 18.7 years shorter for schizophrenic men compared to men in the general population. Corresponding numbers for schizophrenic women was 16.3 years, for bipolar men 13.6 years, and for bipolar women 12.1 years.

Conclusions

Life-expectancy was much shorter in persons with schizophrenia or bipolar disorder. Excess mortality from physical diseases and medical conditions exerts a far greater influence on the curtailed life-expectancy, when compared against the impact of death by external causes.

Introduction

Studies have consistently found a mortality rate ratio (MRR) of approximately 2 to 3 (Harris and Barraclough, 1998, Osby et al., 2000, Osby et al., 2001, Laursen et al., 2007, Saha et al., 2007, Laursen et al., 2009) in persons with schizophrenia or bipolar disorder, indicating that they have an average mortality rate that is 2–3 times higher, compared to the general population. MRRs for suicide are particularly high (approximately 20) (Nordentoft et al., 2004), and thus suicide has received much attention in the investigation of excess mortality among psychiatric patients.

However, an MRR of 20 for suicide and an MRR of 2.5 for all cause mortality tend to conceal the importance and impact of mortality from physical diseases and medical conditions. An alternative approach to measuring the excess mortality among people with schizophrenia and bipolar disorder is to calculate the years of potential life lost. If a person dies at a young age, e.g. 55 years old, and the expected age at death in the population was 75, a total of 20 years of potential life is lost. Calculating the excess mortality as potential years of life lost presents several advantages compared to the MRR. These include: taking into account the effect of very common causes of death with relatively low excess mortality; it gives more weight to deaths that occur among younger persons (which is often the case among persons with severe mental disorder); and finally it presents a straightforward and understandable measure of the magnitude of the excess mortality.

The study aimed primarily to estimate average age at death among persons with schizophrenia or bipolar disorder compared to people in the general population who are free of psychiatric disease. This was performed by survival analysis techniques using the entire Danish population. A second aim was to examine the impact of the excess mortality from external causes versus that from physical diseases and medical conditions on the expected age at death.

Section snippets

Method

I identified all persons residing in Denmark between 2000 and 2006, using the Danish Civil Registration System (CRS). The register records information on gender, date of birth, place of birth, and vital status, e.g., date of death and emigration. The accuracy of the vital status data is close to 100% (Pedersen et al., 2006). The number of persons at risk of dying during 2000–2006 was calculated in 1-year age groups from 15 to 110 years old. Persons who died or emigrated before age 15 years were

Results

In total 5,036,662 persons were at risk of dying during the period 2000–2006, and 400,575 of them actually died. A total of N = 4,581,311 persons had no psychiatric contacts of which N = 326,502 died. Additional years of life expected at age 15 years in the unexposed general population component of the cohort were 61.5 for men and 65.9 for women, giving expected ages at death of 76.5 and 80.9 years, respectively. This is slightly higher than the official life expectancy for the total population in

Discussion

This paper adds to the ongoing debate around the impact of physical health among persons with schizophrenia or bipolar disorder (Colton and Manderscheid, 2006, Newcomer and Hennekens, 2007, Laursen et al., 2009).

In the present study, the difference between the expected age at death for persons with schizophrenia versus the general population comparison group was smaller than that reported by a similar investigation of persons with schizophrenia in Finland (Tiihonen et al., 2009), probably

Role of funding source

Funding for this study was provided by The Stanley Medical Research Institute. The Stanley Medical Research Institute had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Contributors

Dr. Thomas Munk Laursen (TML) designed the study and wrote the protocol. Author TML managed the literature searches and analyses. Author TML undertook the statistical analysis, and author TML wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

None.

Acknowledgments

This study was supported by The Stanley Medical Research Institute.

The author thanks Dr. Esben Agerbo for helping with the analysis and interpretation of data and Dr. Roger T Webb and Dr. Trine Munk-Olsen for reading and commenting the paper.

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View full text

Life expectancy among persons with schizophrenia or bipolar affective disorder

Abstract

Context

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Method

Results

Discussion

Role of funding source

Contributors

Conflict of interest

Acknowledgments

Eur. Psychiatry

Schizophr. Res.

Lancet

Survival Analysis Using the SAS System: A Practical Guide, 5th Edition 2001 Edn

Statistical Models in Epidemiology Oxford University

Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states

Prev. Chronic Dis.

Excess mortality of mental disorder

Br. J. Psychiatry

World Health Organization: Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD8)

Reliability of clinical ICD-10 schizophrenia diagnoses

Nord. J. Psychiatry

The Danish registers of causes of death

Dan. Med. Bull.