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Pre-existing chronic physical morbidity and excess mortality in people with schizophrenia: a population-based cohort study

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Abstract

Purpose

Schizophrenia is associated with increased premature mortality and physical morbidity. This study aimed to examine prevalence of pre-existing chronic physical diseases, and association between physical multimorbidity burden and mortality rates among patients with newly diagnosed schizophrenia.

Methods

This population-based cohort study investigated patients with first-recorded diagnosis of schizophrenia between January 2006 and December 2016, using territory-wide medical-record database of public healthcare service in Hong Kong. Physical morbidities were measured by Charlson Comorbidity Index (CCI), taking into consideration both number and severity of physical diseases, and were grouped into nine broad disease categories for analyses. Physical multimorbidity burden was stratified into three levels according to CCI of 0, 1 or ≥ 2. Cox proportional hazards regression models were used to examine associations of physical multimorbidity with mortality rates.

Results

Of the 13,945 patients, 8.6% (n = 1207) had pre-existing physical morbidity. Patients with physical morbidity exhibited elevated all-cause mortality rate relative to those without physical morbidity [adjusted HR 2.38 (95% CI 2.04–2.77)]. Gastrointestinal/liver diseases, diabetes and cardiovascular diseases constituted the three most frequently diagnosed physical morbidities, whereas cancers displayed the highest all-cause mortality rate. An increase in physical multimorbidity burden was associated with increased all-cause mortality rate [CCI = 1: 1.98 (1.64–2.40); CCI ≥ 2: 3.08 (2.51–3.77), CCI = 0 as reference].

Conclusion

Schizophrenia patients with pre-existing physical morbidity had two-fold increased risk of premature mortality compared to those without physical morbidity. Physical multimorbidity confers incremental impact on excess mortality. Early detection and intervention of physical morbidity in the initial phase of schizophrenia is necessary to reduce avoidable mortality.

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Acknowledgements

The authors would like to thank the colleagues in Hospital Authority for their kind assistance in data retrieval for the current investigation.

Funding

The study was supported by the Hong Kong Research Grants Council (17124715). Additional financial support to undertake this research was provided by the State Key Laboratory of Brain & Cognitive Sciences, the University of Hong Kong.

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Authors and Affiliations

  1. Department of Psychiatry, The University of Hong KongQueen Mary Hospital, Pokfulam, Hong Kong

    Joe Kwun Nam Chan, Corine Sau Man Wong, Nicholas Chak Lam Yung, Eric Yu Hai Chen & Wing Chung Chang

  2. State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong

    Eric Yu Hai Chen & Wing Chung Chang

Authors
  1. Joe Kwun Nam Chan
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  2. Corine Sau Man Wong
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  3. Nicholas Chak Lam Yung
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  4. Eric Yu Hai Chen
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  5. Wing Chung Chang
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Contributions

Authors WCC, CSMW and JKNC designed and conceptualized the study. Author JKNC conducted statistical analysis and wrote the first draft of the manuscript. Authors WCC, JKNC and CSMW interpreted the study data. Author WCC revised and finalized the manuscript. All authors provided critical feedback to the manuscript and have approved the final manuscript.

Corresponding author

Correspondence to Wing Chung Chang.

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The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Chan, J.K.N., Wong, C.S.M., Yung, N.C.L. et al. Pre-existing chronic physical morbidity and excess mortality in people with schizophrenia: a population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 57, 485–493 (2022). https://doi.org/10.1007/s00127-021-02130-9

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  • DOI: https://doi.org/10.1007/s00127-021-02130-9

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