TY - JOUR

T1 - A comprehensive analysis of mortality-related health metrics associated with mental disorders

T2 - a nationwide, register-based cohort study

AU - Plana-Ripoll, Oleguer

AU - Pedersen, Carsten Bøcker

AU - Agerbo, Esben

AU - Holtz, Yan

AU - Erlangsen, Annette

AU - Canudas-Romo, Vladimir

AU - Andersen, Per Kragh

AU - Charlson, Fiona J

AU - Christensen, Maria K.

AU - Erskine, Holly E

AU - Ferrari, Alize J

AU - Iburg, Kim Moesgaard

AU - Momen, Natalie

AU - Mortensen, Preben Bo

AU - Nordentoft, Merete

AU - Santomauro, Damian F

AU - Scott, James G

AU - Whiteford, Harvey A

AU - Weye, Nanna

AU - McGrath, John J

AU - Laursen, Thomas M

N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.METHODS: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.FINDINGS: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.INTERPRETATION: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.FUNDING: Danish National Research Foundation.

AB - BACKGROUND: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.METHODS: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.FINDINGS: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.INTERPRETATION: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.FUNDING: Danish National Research Foundation.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cause of Death

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Female

KW - Humans

KW - Male

KW - Mental Disorders/mortality

KW - Middle Aged

KW - Mood Disorders/mortality

KW - Mortality, Premature

KW - Quality Indicators, Health Care

KW - Registries

KW - Substance-Related Disorders/mortality

KW - Suicide/statistics & numerical data

KW - Young Adult

U2 - 10.1016/S0140-6736(19)32316-5

DO - 10.1016/S0140-6736(19)32316-5

M3 - Journal article

C2 - 31668728

VL - 394

SP - 1827

EP - 1835

JO - The Lancet Oncology

JF - The Lancet Oncology

SN - 1470-2045

IS - 10211

ER -