Abstract
Bipolar disorder is associated with premature mortality, but evidence is mostly derived from Western countries. There has been no research evaluating shortened lifespan in bipolar disorder using life-years lost (LYLs), which is a recently developed mortality metric taking into account illness onset for life expectancy estimation. The current study aimed to examine the extent of premature mortality in bipolar disorder patients relative to the general population in Hong Kong (HK) in terms of standardised mortality ratio (SMR) and excess LYLs, and changes of mortality rate over time. This population-based cohort study investigated excess mortality in 12 556 bipolar disorder patients between 2008 and 2018, by estimating all-cause and cause-specific SMRs, and LYLs. Trends in annual SMRs over the 11-year study period were assessed. Study data were retrieved from a territory-wide medical-record database of HK public healthcare services. Patients had higher all-cause [SMR: 2.60 (95% CI: 2.45-2.76)], natural-cause [SMR: 1.90 (95% CI: 1.76-2.05)] and unnatural-cause [SMR: 8.63 (95% CI: 7.34-10.03)] mortality rates than the general population. Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Men and women with bipolar disorder had 6.78 (95% CI: 6.00-7.84) years and 7.35 (95% CI: 6.75-8.06) years of excess LYLs, respectively. The overall mortality gap remained similar over time, albeit slightly improved in men with bipolar disorder. Bipolar disorder is associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to natural causes. Persistent mortality gap underscores an urgent need for targeted interventions to improve physical health of patients with bipolar disorder.
Highlights
Bipolar disorder is a severe mental disorder which affects more than 1% of the population and constitutes one of the main causes of disability worldwide (McIntyre et al, 2020)
All-cause standardised mortality ratio (SMR) for bipolar disorder was significantly increased in the total sample (SMR = 2.60, 95% confidence intervals (CIs): 2.45–2.76) and in each demographic subgroup relative to the general population (Tables 1 and 2)
Estimated life-years lost (LYLs) for men with bipolar disorder was 19.90 years compared with 13.12 years for men in the general population, with a difference of 6.78 excess LYLs
Summary
Bipolar disorder is a severe mental disorder which affects more than 1% of the population and constitutes one of the main causes of disability worldwide (McIntyre et al, 2020). People with bipolar disorder have markedly elevated risk of premature mortality (Hayes et al, 2015), with approximately 8–15-years shorter lifespan relative to the general population (Chang et al, 2011; Laursen, 2011; Kodesh et al, 2012; Ajetunmobi et al, 2013; Crump et al, 2013; Kessing et al, 2015; Pan et al, 2020). Comprehensive evaluation of premature mortality patterns associated with bipolar disorder is crucial for developing effective strategies and optimising healthcare service delivery to reduce avoidable deaths in this vulnerable population
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