title: Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression.
abstract: Even though individuals with psychiatric conditions have a prevalence of smoking approximately 2-4 times greater than the general population, surprisingly little evidence exists to inform an assessment of the full range of tobacco-related mortality in such populations. The current study aims to provide mortality estimates for conditions causally related to tobacco use among individuals hospitalized with a primary psychiatric diagnosis in California from 1990 to 2005. Restricting cases to those of individuals aged 35 or older at the mid-point of their follow-up period, we assembled cohorts of individuals with ICD-9 diagnoses of schizophrenia and related disorders ("schizophrenia"; n = 174,277), depressive disorders (n = 338,250), or bipolar disorder (n = 78,739). Inpatient records were linked to death-certificate data. We generated age-, sex-, and race-adjusted standardized mortality ratios (SMRs) for the 19 diseases identified by the Centers for Disease Control and Prevention as being causally linked to tobacco use. The SMRs for all tobacco-linked diseases combined were: schizophrenia, 2.45 (95% CI = 2.41-2.48); bipolar, 1.57 (95% CI = 1.53-1.62); and depression, 1.95 (95% CI = 1.93-1.98). Tobacco-related conditions comprised approximately 53% (23,620/44,469) of total deaths in the schizophrenia, 48% (6004/12,564) in the bipolar, and 50% (35,729/71,058) in the depression cohorts. Addressing tobacco use in psychiatric populations is a critical clinical and public-health concern, especially in light of the currently limited clinical attention devoted to tobacco use in these groups.
authors.affiliation: Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia V2N 4Z9, Canada; Centre for Addiction and Mental Health, 33 Russell St., Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Health Science Building, Toronto, Ontario M5T 3M7, Canada. Electronic address: Russ.Callaghan@unbc.ca.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Callaghan
authors.forename: Scott
authors.initials: S
authors.lastname: Veldhuizen
authors.forename: Trincy
authors.initials: T
authors.lastname: Jeysingh
authors.forename: Chloe
authors.initials: C
authors.lastname: Orlan
authors.forename: Candida
authors.initials: C
authors.lastname: Graham
authors.forename: Gwen
authors.initials: G
authors.lastname: Kakouris
authors.forename: Gary
authors.initials: G
authors.lastname: Remington
authors.forename: Jodi
authors.initials: J
authors.lastname: Gatley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D012737:Sex Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000401:mortality*
keywords: Bipolar disorder; Depression; Schizophrenia; Standardized mortality rates; Tobacco-related conditions