Life expectancy, mortality risks and cause of death in patients with serious mental illness in South East London: a comparison between 2008-2012 and 2013-2017.

Chi-Kang Chang,Rashmi Patel,Philip Mcguire,Wei-Nung Teng,Megan Pritchard,Edward Chesney,Sam Hollandt,Hitesh Shetty,Robert Stewart

doi:10.1017/s0033291721002257

Abstract

People with serious mental illness (SMI) have a significantly shorter life expectancy than the general population. This study investigates whether the mortality rate in this group has changed over the last decade. Using Clinical Record Interactive Search software, we extracted data from a large electronic database of patients in South East London. All patients with schizophrenia, schizoaffective disorder or bipolar disorder from 2008 to 2012 and/or 2013 to 2017 were included. Estimates of life expectancy at birth, standardised mortality ratios and causes of death were obtained for each cohort according to diagnosis and gender. Comparisons were made between cohorts and with the general population using data obtained from the UK Office of National Statistics. In total, 26 005 patients were included. In men, life expectancy was greater in 2013-2017 (64.9 years; 95% CI 63.6-66.3) than in 2008-2012 (63.2 years; 95% CI 61.5-64.9). Similarly, in women, life expectancy was greater in 2013-2017 (69.1 years; 95% CI 67.5-70.7) than in 2008-2012 (68.1 years; 95% CI 66.2-69.9). The difference with general population life expectancy fell by 0.9 years between cohorts in men, and 0.5 years in women. In the 2013-2017 cohorts, cancer accounted for a similar proportion of deaths as cardiovascular disease. Relative to the general population, life expectancy for people with SMI is still much worse, though it appears to be improving. The increased cancer-related mortality suggests that physical health monitoring should consider including cancer as well.

Highlights

Schizophrenia, schizoaffective disorder and bipolar disorder are associated with a life expectancy which is 10–20 years shorter than the general population (Hjorthøj, Stürup, McGrath, & Nordentoft, 2017)
It has been suggested that the size of the life expectancy gap may be increasing, as there is evidence that rates of smoking and deaths from cardiovascular disease are declining in the general population, but not in patients with serious mental illness (SMI) (Hayes, Marston, Walters, King, & Osborn, 2017; Royal College of Physicians; Royal College of Psychiatrists, 2013)
Using a large clinical database from a secondary mental healthcare service in South East London, we found that patients with schizophrenia, schizoaffective disorder or bipolar disorder have a substantially lower life expectancy than the general population

Summary

Introduction

Schizophrenia, schizoaffective disorder and bipolar disorder are associated with a life expectancy which is 10–20 years shorter than the general population (Hjorthøj, Stürup, McGrath, & Nordentoft, 2017). With increasing awareness of the importance of physical healthcare in patients with serious mental illness (SMI), the pressure to intervene and improve outcomes has grown (De Hert et al, 2011). It has been suggested that the size of the life expectancy gap may be increasing, as there is evidence that rates of smoking and deaths from cardiovascular disease are declining in the general population, but not in patients with SMI (Hayes, Marston, Walters, King, & Osborn, 2017; Royal College of Physicians; Royal College of Psychiatrists, 2013). People with serious mental illness (SMI) have a significantly shorter life expectancy than the general population. The difference with general population life expectancy fell by 0.9 years between cohorts in men, and 0.5 years in women. The increased cancer-related mortality suggests that physical health monitoring should consider including cancer as well

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Results

Conclusion