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Transformation of excess mortality in people with schizophrenia and bipolar disorder in Taiwan

Published online by Cambridge University Press:  26 April 2017

Y.-J. Pan ,
L.-L. Yeh ,
H.-Y. Chan  and
C.-K. Chang
Y.-J. Pan*
Affiliation:
Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan National Yang-Ming University School of Medicine, Taipei, Taiwan
L.-L. Yeh
Affiliation:
Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
H.-Y. Chan
Affiliation:
Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
C.-K. Chang
Affiliation:
Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology, and Neuroscience), London, UK
*
*Address for correspondence: Y.-J. Pan, Department of Psychiatry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan. (Email: [email protected])
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Abstract

Background

Given the concerns regarding the adverse health outcomes associated with weight gain and metabolic syndrome in relation to use of second-generation antipsychotics (SGAs), we aimed in this study to explore whether the increase in the use of SGAs would have any impacts on the trend of excess mortality in people with schizophrenia and bipolar disorder (BPD).

Method

Two nationwide samples of individuals with schizophrenia and BPD were identified in Taiwan's National Health Insurance Research Database in 2003 and in 2008, respectively. Age- and gender-standardized mortality ratios (SMRs) were calculated for each of the 3-year observation periods. The SMRs were compared between the calendar year cohorts, by disease group, and by causes of death.

Results

The mortality gap for people with schizophrenia decreased slightly, revealing an SMR of 3.40 (95% CI 3.30–3.50) for the 2003 cohort and 3.14 (3.06–3.23) for the 2008 cohort. The mortality gap for BPD individuals remained relatively stable with only those aged 15–44 years having an SMR rising significantly from 7.04 (6.38–7.76) to 9.10 (8.44–9.79). Additionally, in this group of BPD patients aged 15–44 years, the natural-cause-SMR increased from 5.65 (4.93–6.44) to 7.16 (6.46–7.91).

Conclusions

Compared with the general population, the gap in the excess mortality for people with schizophrenia reduced slightly. However, the over 200% difference between the cohorts in the excess mortality for BPD individuals aged 15–44 years could be a warning sign. Future research to further examine the related factors underlying those changes is warranted.

Keywords

Bipolar disorderexcess mortalityschizophreniastandardized mortality ratio
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 14 , October 2017 , pp. 2483 - 2493
Copyright
Copyright © Cambridge University Press 2017 

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