title: Mortality in schizophrenia and bipolar disorder: Clinical and serological predictors.
abstract: Persons with schizophrenia and with bipolar disorder have a reduced life expectancy due largely to death from natural causes. The reasons for this increased mortality have not been completely defined. We prospectively assessed a cohort of persons with schizophrenia and one with bipolar disorder with a clinical evaluation and a blood sample from which immune and infectious disease markers were measured. Mortality was determined with data from the National Death Index following a period of up to 14years. We examined the role of demographic, clinical, and serological factors on mortality in bivariate and multivariate models. A total of 43/710 (6.1%) persons with schizophrenia and 12/406 (3.0%) with bipolar disorder died of natural causes. In the schizophrenia group, mortality was predicted by the following variables in a multivariate model: cigarette smoking (RR=6.93, 95% CI 1.59, 30.1, p=0.0099); autoimmune disorder (RR=8.08, 95% CI 2.50, 26.1, p=0.00047); gastrointestinal disorder (GI) (RR=3.53, 95% CI 1.43, 8.69 p=0.0061); and reduced maternal education (RR=0.84, 95% CI 0.72, 0.97), p=0.018. The combination of smoking and an autoimmune disorder yielded an unadjusted relative risk of 18.1 for mortality, and the combination of smoking and a GI disorder an unadjusted relative risk of 9.45, compared with individuals with neither risk factor. In the bipolar disorder group, significant bivariate predictors of mortality included lower cognitive score (RR=0.95, p=.0085) and the presence of type 1 or 2 diabetes (RR=3.90, p=.026). Given the extraordinary high risk of death due to smoking in schizophrenia, smoking cessation remains an urgent priority.
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States. Electronic address: Fdickerson@sheppardpratt.org.
authors.forename: Faith
authors.initials: F
authors.lastname: Dickerson
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
authors.forename: Andrea
authors.initials: A
authors.lastname: Origoni
authors.affiliation: Schroeder Statistical Consulting, LLC, Ellicott City, MD, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schroeder
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
authors.forename: Lucy A B
authors.initials: LA
authors.lastname: Schweinfurth
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
authors.forename: Cassie
authors.initials: C
authors.lastname: Stallings
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
authors.forename: Christina L G
authors.initials: CL
authors.lastname: Savage
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Katsafanas
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Banis
authors.affiliation: Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, United States.
authors.forename: Sunil
authors.initials: S
authors.lastname: Khushalani
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Yolken
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000097:blood* / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D012559:Schizophrenia / Q000097:blood* / Q000401:mortality*; D012907:Smoking / Q000097:blood / Q000401:mortality
keywords: Bipolar disorder; Cigarette smoking; Premature death; Schizophrenia