Journal
BRITISH JOURNAL OF PSYCHIATRY
Volume 219, Issue 1, Pages 375-382Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1192/bjp.2020.151
Keywords
Schizophrenia; diabetes mellitus; mortality; diabetes complications; population-based study
Categories
Funding
- Hong Kong Research Grants Council [17124715]
- State Key Laboratory of Brain & Cognitive Sciences, the University of Hong Kong
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Schizophrenia patients with co-occurring diabetes have a higher risk of excess mortality, particularly among men and older age groups. They also have a higher rate of metabolic complications, lower rate of microvascular complications, and comparable rate of macrovascular complications compared to patients with diabetes only. Schizophrenia is associated with elevated all-cause mortality after macrovascular and microvascular complications in patients with diabetes.
Background 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.
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