M152. IS MEDICAL SERVICES UTILISATION A MODERATING FACTOR OF EARLY EXCESS MORTALITY IN PATIENTS WITH SCHIZOPHRENIA

Abstract

BackgroundUnlike the general population, patients with schizophrenia have an excess of chronic physical morbidities such as diabetes, cardiovascular and respiratory disorders. In addition, they do no gain from primary and secondary medical services due to gaps in the accessibility and quality of those services. The result is a shorter life expectancy of about 20 years mostly due to preventable physical illnesses, of otherwise people with an exclusive brain disorder.In this study, we aimed to explore how does utilization of medical services moderate the association between physical morbidity and early mortality in schizophrenia patientsMethodsA retrospective cohort study derived from Clalit Health Services electronic database (the largest health provider in Israel, covers 53% of the national population). A three years follow-up (2012–2014) of 24,679 individuals with a diagnosis of schizophrenia (ICD 10 Code: F.20) and control general population (N=2,295,579), up to 75 years old age.ResultsSchizophrenia was associated with HR 3.52 (95% CI 3.35–3.72) for mortality, adjusted for age, sex and socioeconomic status. Patients’ mortality rate was 5.6% with about half dying from physical illnesses (cardiovascular, neoplasms, respiratory, and digestive disorders). Metabolic syndrome parameters were more prevalent in the schizophrenia population, with the exception of hypertension. While the adjusted Odd Ratio (OR) for primary physician (GP) contact was 0.42 for schizophrenia patients, the OR for hospitalization was 1.25 with more than double mean length of hospitalization. A higher number of contacts with GP or specialists was associated with lower mortality in patients with metabolic disturbancesDiscussionPatients with schizophrenia tend to die earlier, mostly from preventable physical illnesses also in Israel. Utilizing primary and secondary medical services was associated with better survival rates when having metabolic dysregulation. The main health policy implication of the study results is a call to establish a national system to detect and manage physical morbidity by increasing the accessibility of primary and secondary medical services for this high-risk population