How do ethnicity and deprivation impact on life expectancy at birth in people with serious mental illness? Observational study in the UK.

Jayati Das-Munshi,Chin-Kuo Chang,Alex Dregan,Matthew Hotopf,Graham Thornicroft,Craig Morgan,Robert Stewart,Stephani L Hatch

doi:10.1017/s0033291720001087

Abstract

Across international contexts, people with serious mental illnesses (SMI) experience marked reductions in life expectancy at birth. The intersection of ethnicity and social deprivation on life expectancy in SMI is unclear. The aim of this study was to assess the impact of ethnicity and area-level deprivation on life expectancy at birth in SMI, defined as schizophrenia-spectrum disorders, bipolar disorders and depression, using data from London, UK. Abridged life tables to calculate life expectancy at birth, in a cohort with clinician-ascribed ICD-10 schizophrenia-spectrum disorders, bipolar disorders or depression, managed in secondary mental healthcare. Life expectancy in the study population with SMI was compared with life expectancy in the general population and with those residing in the most deprived areas in England. Irrespective of ethnicity, people with SMI experienced marked reductions in life expectancy at birth compared with the general population; from 14.5 years loss in men with schizophrenia-spectrum and bipolar disorders, to 13.2 years in women. Similar reductions were noted for people with depression. Across all diagnoses, life expectancy at birth in people with SMI was lower than the general population residing in the most deprived areas in England. Irrespective of ethnicity, reductions in life expectancy at birth among people with SMI are worse than the general population residing in the most deprived areas in England. This trend in people with SMI is similar to groups who experience extreme social exclusion and marginalisation. Evidence-based interventions to tackle this mortality gap need to take this into account.

Highlights

People with conditions such as schizophrenia or bipolar disorders experience marked reductions in life expectancy compared with the general population, ranging from 13 to 15 years (Hjorthøj, Stürup, McGrath, & Nordentoft, 2017) and in some contexts up to 20 years (Fekadu et al, 2018; Hjorthøj et al, 2017; Liu et al, 2017)
A total of 18 641 individuals contributed data to analyses relating to schizophrenia, schizoaffective, other schizophrenia-spectrum disorders and bipolar disorders and 20 203 individuals contributed data to analyses relating to depression
Life expectancy at birth was on average 12.6 years to 15.0 years lower compared to the life expectancy at birth among the general population; while among women, this was just over 13 years lower compared to women in the general population, across all serious mental disorder diagnoses assessed

Summary

Introduction

People with conditions such as schizophrenia or bipolar disorders experience marked reductions in life expectancy compared with the general population, ranging from 13 to 15 years (Hjorthøj, Stürup, McGrath, & Nordentoft, 2017) and in some contexts up to 20 years (Fekadu et al, 2018; Hjorthøj et al, 2017; Liu et al, 2017). Irrespective of ethnicity, people with SMI experienced marked reductions in life expectancy at birth compared with the general population; from 14.5 years loss in men with schizophrenia-spectrum and bipolar disorders, to 13.2 years in women. Irrespective of ethnicity, reductions in life expectancy at birth among people with SMI are worse than the general population residing in the most deprived areas in England This trend in people with SMI is similar to groups who experience extreme social exclusion and marginalisation. Evidence-based interventions to tackle this mortality gap need to take this into account

Objectives

Methods

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Conclusion