title: Comorbidities and mortality in bipolar disorder: a Swedish national cohort study.
abstract: OBJECTIVE
  Bipolar disorder is associated with premature mortality, but the specific causes and underlying pathways are unclear.
  
  
  OBJECTIVE
  To examine the physical health effects of bipolar disorder using outpatient and inpatient data for a national population.
  
  
  METHODS
  National cohort study of 6,587,036 Swedish adults, including 6618 with bipolar disorder.
  
  
  METHODS
  Physical comorbidities diagnosed in any outpatient or inpatient setting nationwide and mortality (January 1, 2003, through December 31, 2009).
  
  
  RESULTS
  Women and men with bipolar disorder died 9.0 and 8.5 years earlier on average than the rest of the population, respectively. All-cause mortality was increased 2-fold among women (adjusted hazard ratio [aHR], 2.34; 95% CI, 2.16-2.53) and men (aHR, 2.03; 95% CI, 1.85-2.23) with bipolar disorder, compared with the rest of the population. Patients with bipolar disorder had increased mortality from cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), influenza or pneumonia, unintentional injuries, and suicide for both women and men and cancer for women only. Suicide risk was 10-fold among women (aHR, 10.37; 95% CI, 7.36-14.60) and 8-fold among men (aHR, 8.09; 95% CI, 5.98-10.95) with bipolar disorder, compared with the rest of the population. Substance use disorders contributed only modestly to these findings. The association between bipolar disorder and mortality from chronic diseases (ischemic heart disease, diabetes, COPD, or cancer) was weaker among persons with a prior diagnosis of these conditions (aHR, 1.40; 95% CI, 1.26-1.56) than among those without a prior diagnosis (aHR, 2.38; 95% CI, 1.95-2.90; P(interaction) = .01).
  
  
  CONCLUSIONS
  In this large national cohort study, patients with bipolar disorder died prematurely from multiple causes, including cardiovascular disease, diabetes, COPD, influenza or pneumonia, unintentional injuries, and suicide. However, chronic disease mortality among those with more timely medical diagnosis approached that of the general population, suggesting that better provision of primary medical care may effectively reduce premature mortality among persons with bipolar disorder.
authors.affiliation: Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Casey
authors.initials: C
authors.lastname: Crump
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Winkleby
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult