The association between violence exposure and general and cause-specific mortality in people using mental health services: cohort study

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

Background: Research suggests mental illness contributes to poor survival among cancer patients. In New York State (NYS), Medicaid is the largest single insurer for individuals with mental illness. We investigated the influence of preexisting mental illness on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. Methods: 9,479 women aged <65 years diagnosed with breast cancer and reported to the NYS Cancer Registry from 2004-2016 were linked with NYS Medicaid claims. Women were grouped as having depression or severe mental illness if they had at least three diagnosis claims for mental illness with at least one claim within three years prior to breast cancer diagnosis. Severe mental illness included schizophrenia, bipolar disorder, and other psychotic disorders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated with Cox regression, adjusting for potential confounders. Results: Women with severe mental illness had greater risks of all-cause (HR 1.49; 95% CI 1.25, 1.78), cancer (HR 1.36; 95% CI 1.09, 1.68), and cardiovascular (HR 2.14; 95% CI 1.22, 3.74) mortality compared to women without mental illness. No association was observed for depression. The association between severe mental illness and all-cause mortality was strongest among Asians (HR 3.85; 95% CI 1.55, 9.60) but also observed in White (HR 1.50; 95% CI 1.17, 1.93) and Black (HR 1.36; 95% CI 1.02, 1.80) women. Additionally, associations were also observed among obese (HR 1.83; 95% CI 1.42, 2.36) and postmenopausal (HR 1.64; 95% CI 1.35, 2.01) women with preexisting severe mental illness, but no association was observed for premenopausal women. Conclusion: Women with preexisting severe mental illness diagnosed with breast cancer have an elevated mortality risk and should be monitored and treated by a coordinated cross-functional clinical team. Citation Format: Wayne R Lawrence, Akiko Hosler, Margaret Gates, Matthew Leinung, Xiuling Zhang, Wangjian Zhang, Maria Schymura, Francis Boscoe. Preexisting mental illness on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A106.

All-cause and cause-specific mortality in people with mental disorders: a population-based study on risk evaluation, effect modifiers and excess life-years lost in Hong Kong.

Cause-specific and all-cause mortalities in vegetarian compared with those in nonvegetarian participants from the Adventist Health Study-2 cohort

Opportunities in mental health services research.

Trends in the Duration of Emergency Department Visits, 2001-2006

Decision letter: Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022

Editor's evaluation: Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022

Hysterectomy with and without oophorectomy and all-cause and cause-specific mortality

Objectives Evidence of an effect of shift work on all-cause and cause-specific mortality is inconsistent. This study aims to examine whether shift work is associated with increased all-cause and cause-specific mortality. Methods We linked 28 731 female nurses (age ≥44 years), recruited in 1993 or 1999 from the Danish nurse cohort where they reported information on shift work (night, evening, rotating, or day), to the Danish Register of Causes of Death to identify deaths up to 2013. We used Cox regression models with age as the underlying scale to examine the associations between night, evening, and rotating shift work (compared to day shift work) and all-cause and cause-specific mortality in models adjusted for potentially confounding variables. Results Of 18 015 nurses included in this study, 1616 died during the study time period from the following causes: cardiovascular disease (N=217), cancer (N= 945), diabetes (N=20), Alzheimer's disease or dementia (N=33), and psychiatric diseases (N=67). We found that working night [hazard ratio (HR) 1.26, 95% confidence interval 95% CI) 1.05-1.51] or evening (HR 1.29, 95% CI 1.11-1.49) shifts was associated with a significant increase in all-cause mortality when compared to working day shift. We found a significant association of night shift work with cardiovascular disease (HR 1.71, 95% CI 1.09-2.69) and diabetes (HR 12.0, 95% CI 3.17-45.2, based on 8 cases) and none with overall cancer mortality (HR 1.05, 95% CI 0.81-1.35) or mortality from psychiatric diseases (HR 1.17, 95% CI 0.47-2.92). Finally, we found strong association between evening (HR 4.28, 95% CI 1.62-11.3) and rotating (HR 5.39, 95% CI 2.35-12.3) shift work and mortality from Alzheimer's disease and dementia (based on 8 and 14 deaths among evening and rotating shift workers, respectively). Conclusions Women working night and evening shifts have increased all-cause, cardiovascular, diabetes, and Alzheimer's and dementia mortality.

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.

Introduction: Tooth loss increases the risk of cardiovascular disease (CVD). However, its association with overall and cancer mortality, especially according to social gradient and smoking status, remains underexplored. Dental caries has recently emerged as a risk factor for CVD, but its association with mortality has not been well studied. This study aims to evaluate the associations between untreated caries, tooth count, and all-cause and cause-specific mortality in the US population. Methods: A prospective cohort of nationally representative samples from the National Health and Nutrition Examination Survey (NHANES) 1999-2010 containing 15,242 adults 30 years or older without heart disease, stroke, and cancer at baseline was included in analyses. Exposures were the total number of permanent teeth (including the third molar) and untreated caries assessed by trained and standardized dentists or health technologists. All-cause and cause-specific (CVD and cancer) mortality were ascertained via linkage to the National Death Index (NDI) through December 31, 2015. A series of weighted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During up to 16 years of follow-up (1,818,040 person-years), 1,850 total deaths were identified (388 from CVD and 428 from cancer). Significant inverse associations between the number of permanent teeth and all-cause, CVD, and cancer mortality were observed. Compared to individuals with 25-32 teeth, the multivariable-adjusted HRs (95% CIs) for participants with 17-24, 1-16, and 0 teeth and all-cause mortality were 1.22 (1.04-1.43), 1.37 (1.13-1.66), and 1.62 (1.37-1.90) (P for trend <.001). For CVD mortality, the corresponding HRs were 1.17 (0.85-1.59), 1.22 (0.82-1.82), and 1.69 (1.16-2.48) (P for trend =.012), and 1.12 (0.77-1.62), 1.23 (0.81-1.86), and 2.09 (1.40-3.11) (P for trend <.001) for cancer mortality. After adjusting for socioeconomic status, healthcare access, lifestyle factors, as well as tooth count, untreated caries were significantly associated with increased risk of all-cause (HR = 1.27, 95%CI = 1.11-1.46) and CVD mortality (HR = 1.67, 95%CI = 1.23-2.28) but not cancer mortality. These findings were robust while restricted to individuals without diabetes at baseline, and also similar according to baseline age (<70/≥70), sex, family income poverty ratio (≤1.3/>1.3), and smoking status (never/ever). Conclusions: Lower number of permanent teeth was associated with increased all-cause, CVD, and cancer mortality. Untreated caries is linked with an increased risk of all-cause and CVD mortality. Citation Format: Jie Liu, Zitong Li, Emily Vogtmann, Chao Cao, Xiaoyu Zong, Andrew Chan, Eric Rimm, Richard Hayes, Graham Colditz, Dominique Michaud, Kaumudi Joshipura, Christian Abnet, Yin Cao. Tooth count, untreated caries, and all-cause and cause-specific mortality [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3393.

Narcolepsy is a sleep disorder potentially affecting mortality, yet evidence on this association remains sparse. To examine whether narcolepsy is associated with an increased risk of all-cause and cause-specific mortality. This retrospective cohort study used data from the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2021, with patients followed up until death or December 31, 2022. Patients were aged 6 years or older with 2 or more narcolepsy diagnoses from psychiatrists or neurologists. Controls were selected from the NHIRD as a population-based sample. Controls without narcolepsy were matched in a 1:4 ratio on sex and birth date (±6 months). Sibling controls were siblings without narcolepsy. Statistical analysis was performed from January to April 2025. Clinical narcolepsy diagnosis, confirmed via NHIRD records (International Classification of Diseases, Ninth Revision, Clinical Modification code 347 or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification code G47.4). The primary outcome was all-cause mortality, measured as hazard ratios (HRs) using Cox proportional hazards regression, adjusted for birth year, sex, income, urbanization, and Charlson Comorbidity Index. Secondary outcomes included cause-specific mortality (natural, unnatural, accidents, suicides). Of 3187 patients with narcolepsy (mean [SD] age, 29.5 [16.1] years; 1674 male patients [52.5%]) and 12 748 controls (mean [SD] age, 29.5 [16.1] years; 6696 male patients [52.5%]), 132 patients with narcolepsy and 456 controls died. Psychiatric comorbidities, especially depression (1167 of 3187 [36.6%] vs 861 of 12 748 [6.8%]) and anxiety (1054 of 3187 [33.1%] vs 853 of 12 748 [6.7%]), were more common in the narcolepsy group than in the control group. Crude all-cause mortality rates were 44.3 per 10 000 person-years among patients with narcolepsy and 38.1 per 10 000 person-years among controls. All-cause mortality was not increased among patients with narcolepsy (HR, 0.96; 95% CI, 0.79-1.17). There was no increase among patients with narcolepsy in cause-specific mortality for natural causes (HR, 0.90; 95% CI, 0.73-1.11), unnatural causes, (HR, 1.41; 95% CI, 0.83-2.40), accidents (HR, 1.37; 95% CI, 0.64-2.95), and suicides (HR, 1.41; 95% CI, 0.62-3.22). The sibling cohort analysis similarly demonstrated no significantly increased risk among patients with narcolepsy of all-cause mortality (HR, 1.14; 95% CI, 0.63-2.06) or cause-specific mortality from natural causes (HR, 0.66; 95% CI, 0.28-1.56), unnatural causes (HR, 2.08; 95% CI, 0.87-4.98), accidents (HR, 1.61; 95% CI, 0.48-5.37), or suicides (HR, 3.43; 95% CI, 0.88-13.28). In this cohort study of Taiwanese residents, narcolepsy was not associated with excess all-cause or cause-specific mortality. These findings reduce immediate clinical concern, but the wide 95% CIs suggest that a modest increase in risk cannot be excluded; replication in other populations with longer follow-up is warranted.

Although high rates of COVID-19-related deaths have been reported for people with intellectual disabilities during the first 2 years of the pandemic, it is unknown to what extent the pandemic has impacted existing mortality disparities for people with intellectual disabilities. In this study, we linked a Dutch population-based cohort that contained information about intellectual disability statuses with the national mortality registry to analyse both cause-specific and all-cause mortality in people with and without intellectual disabilities, and to make comparisons with pre-pandemic mortality patterns. This population-based cohort study used a pre-existing cohort that included the entire Dutch adult population (everyone aged ≥18 years) on Jan 1, 2015, and identified people with presumed intellectual disabilities through data linkage. For all individuals within the cohort who died up to and including Dec 31, 2021, mortality data were obtained from the Dutch mortality register. Therefore, for each individual in the cohort, information was available about demographics (sex and date of birth), indicators of intellectual disability, if any, based on chronic care and (social) services use, and in case of death, the date and underlying cause of death. We compared the first 2 years of the COVID-19 pandemic (2020 and 2021) with the pre-pandemic period (2015-19). The primary outcomes in this study were all-cause and cause-specific mortality. We calculated rates of death and generated hazard ratios (HRs) using Cox regression analysis. At the start of follow-up in 2015, 187 149 Dutch adults with indicators of intellectual disability were enrolled and 12·6 million adults from the general population were included. Mortality from COVID-19 was significantly higher in the population with intellectual disabilities than in the general population (HR 4·92, 95% CI 4·58-5·29), with a particularly large disparity at younger ages that declined with increasing age. The overall mortality disparity during the COVID-19 pandemic (HR 3·38, 95% CI 3·29-3·47) was wider than before the pandemic (3·23, 3·17-3·29). For five disease groups (neoplasms; mental, behavioural, and nervous system; circulatory system; external causes; and other natural causes) higher mortality rates were observed in the population with intellectual disabilities during the pandemic than before the pandemic, and the pre-pandemic to during the pandemic difference in mortality rates was greater in the population with intellectual disabilities than in the general population, although relative mortality risks for most other causes remained within similar ranges compared with pre-pandemic years. The impact of the COVID-19 pandemic on people with intellectual disabilities has been greater than reflected by COVID-19-related deaths alone. Not only was the mortality risk from COVID-19 higher in people with intellectual disabilities than in the general population, but overall mortality disparities were also further exacerbated during the first 2 years of the pandemic. For disability-inclusive future pandemic preparedness this excess mortality risk for people with intellectual disabilities should be addressed. Dutch Ministry of Health, Welfare, and Sport and Netherlands Organization for Health Research and Development.

Mental health care among marginalized populations in the United States