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Article: Risk of mortality and complications in patients with schizophrenia and diabetes mellitus: population-based cohort study

TitleRisk of mortality and complications in patients with schizophrenia and diabetes mellitus: population-based cohort study
Authors
KeywordsSchizophrenia
diabetes mellitus
mortality
diabetes complications
population-based study
Issue Date2021
PublisherCambridge University Press. The Journal's web site is located at http://bjp.rcpsych.org/
Citation
British Journal of Psychiatry, 2021, v. 219 n. 1, p. 375-382 How to Cite?
AbstractBackground: Schizophrenia patients have markedly elevated prevalence of diabetes compared with the general population. However, risk of mortality and diabetes-related complications among schizophrenia patients with co-occurring diabetes is understudied. Aims: We investigated whether schizophrenia increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. Method: This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68 682 patients with incident diabetes only between 2001 and 2016 in Hong Kong using a medical record database of public healthcare services. Association between schizophrenia and all-cause mortality was examined with a Cox proportional hazards model. Effect of schizophrenia on first-year complication occurrence following diabetes diagnosis and post-complication mortality rates were evaluated. Results: Schizophrenia was associated with increased all-cause mortality (adjusted hazards ratio [aHR] 1.11, 95% CI 1.05–1.18), particularly among men and older age groups. Schizophrenia patients with diabetes had higher metabolic complication rate (aHR 1.99, 95% CI 1.63–2.42), lower microvascular complication rate (aHR 0.75, 95% CI 0.65–0.86) and comparable macrovascular complication rate (aHR 0.93, 95% CI 0.85–1.03), relative to patients with diabetes only. Among patients with diabetes complications, schizophrenia was associated with elevated all-cause mortality after macrovascular (aHR 1.19, 95% CI 1.04–1.37) and microvascular (aHR 1.33, 95% CI 1.08–1.64) complications. Gender-stratified analyses revealed that a significant effect of schizophrenia on heightened post-complication mortality was observed in men only. Conclusions: Schizophrenia patients with co-occurring diabetes are at increased risk of excess mortality, including post-complication mortality. Further research identifying effective interventions is warranted to optimise diabetes-related outcomes in this vulnerable population.
Persistent Identifierhttp://hdl.handle.net/10722/299780
ISSN
2020 Impact Factor: 9.319
2015 SCImago Journal Rankings: 2.674

 

DC FieldValueLanguage
dc.contributor.authorChan, JKN-
dc.contributor.authorWong, CSM-
dc.contributor.authorOr, PCF-
dc.contributor.authorChen, EYH-
dc.contributor.authorChang, WC-
dc.date.accessioned2021-05-26T03:28:57Z-
dc.date.available2021-05-26T03:28:57Z-
dc.date.issued2021-
dc.identifier.citationBritish Journal of Psychiatry, 2021, v. 219 n. 1, p. 375-382-
dc.identifier.issn0007-1250-
dc.identifier.urihttp://hdl.handle.net/10722/299780-
dc.description.abstractBackground: Schizophrenia patients have markedly elevated prevalence of diabetes compared with the general population. However, risk of mortality and diabetes-related complications among schizophrenia patients with co-occurring diabetes is understudied. Aims: We investigated whether schizophrenia increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. Method: This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68 682 patients with incident diabetes only between 2001 and 2016 in Hong Kong using a medical record database of public healthcare services. Association between schizophrenia and all-cause mortality was examined with a Cox proportional hazards model. Effect of schizophrenia on first-year complication occurrence following diabetes diagnosis and post-complication mortality rates were evaluated. Results: Schizophrenia was associated with increased all-cause mortality (adjusted hazards ratio [aHR] 1.11, 95% CI 1.05–1.18), particularly among men and older age groups. Schizophrenia patients with diabetes had higher metabolic complication rate (aHR 1.99, 95% CI 1.63–2.42), lower microvascular complication rate (aHR 0.75, 95% CI 0.65–0.86) and comparable macrovascular complication rate (aHR 0.93, 95% CI 0.85–1.03), relative to patients with diabetes only. Among patients with diabetes complications, schizophrenia was associated with elevated all-cause mortality after macrovascular (aHR 1.19, 95% CI 1.04–1.37) and microvascular (aHR 1.33, 95% CI 1.08–1.64) complications. Gender-stratified analyses revealed that a significant effect of schizophrenia on heightened post-complication mortality was observed in men only. Conclusions: Schizophrenia patients with co-occurring diabetes are at increased risk of excess mortality, including post-complication mortality. Further research identifying effective interventions is warranted to optimise diabetes-related outcomes in this vulnerable population.-
dc.languageeng-
dc.publisherCambridge University Press. The Journal's web site is located at http://bjp.rcpsych.org/-
dc.relation.ispartofBritish Journal of Psychiatry-
dc.rightsBritish Journal of Psychiatry. Copyright © Cambridge University Press.-
dc.rightsThis article has been published in a revised form in [Journal] [http://doi.org/XXX]. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © copyright holder.-
dc.subjectSchizophrenia-
dc.subjectdiabetes mellitus-
dc.subjectmortality-
dc.subjectdiabetes complications-
dc.subjectpopulation-based study-
dc.titleRisk of mortality and complications in patients with schizophrenia and diabetes mellitus: population-based cohort study-
dc.typeArticle-
dc.identifier.emailWong, CSM: wongcsm@hku.hk-
dc.identifier.emailChen, EYH: eyhchen@hku.hk-
dc.identifier.emailChang, WC: changwc@hku.hk-
dc.identifier.authorityWong, CSM=rp02625-
dc.identifier.authorityChen, EYH=rp00392-
dc.identifier.authorityChang, WC=rp01465-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1192/bjp.2020.248-
dc.identifier.pmid33407970-
dc.identifier.scopuseid_2-s2.0-85106966928-
dc.identifier.hkuros322491-
dc.identifier.volume219-
dc.identifier.issue1-
dc.identifier.spage375-
dc.identifier.epage382-
dc.publisher.placeUnited Kingdom-

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