Changing relative and absolute socioeconomic health inequalities in Ontario, Canada: A population-based cohort study of adult premature mortality, 1992 to 2017

Abstract Aims Bipolar disorder is associated with premature mortality, but evidence is mostly derived from Western countries. There has been no research evaluating shortened lifespan in bipolar disorder using life-years lost (LYLs), which is a recently developed mortality metric taking into account illness onset for life expectancy estimation. The current study aimed to examine the extent of premature mortality in bipolar disorder patients relative to the general population in Hong Kong (HK) in terms of standardised mortality ratio (SMR) and excess LYLs, and changes of mortality rate over time. Methods This population-based cohort study investigated excess mortality in 12 556 bipolar disorder patients between 2008 and 2018, by estimating all-cause and cause-specific SMRs, and LYLs. Trends in annual SMRs over the 11-year study period were assessed. Study data were retrieved from a territory-wide medical-record database of HK public healthcare services. Results Patients had higher all-cause [SMR: 2.60 (95% CI: 2.45–2.76)], natural-cause [SMR: 1.90 (95% CI: 1.76–2.05)] and unnatural-cause [SMR: 8.63 (95% CI: 7.34–10.03)] mortality rates than the general population. Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Men and women with bipolar disorder had 6.78 (95% CI: 6.00–7.84) years and 7.35 (95% CI: 6.75–8.06) years of excess LYLs, respectively. The overall mortality gap remained similar over time, albeit slightly improved in men with bipolar disorder. Conclusions Bipolar disorder is associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to natural causes. Persistent mortality gap underscores an urgent need for targeted interventions to improve physical health of patients with bipolar disorder.

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Faculty Opinions recommendation of Premature mortality in persons with epilepsy and schizophrenia: A population-based nationwide cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735745027.793560732 ◽

2019 ◽

Author(s):

Marco Mula

Keyword(s):

Cohort Study ◽

Premature Mortality ◽

Population Based

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Excess Mortality and Life-Years Lost in People With Schizophrenia and Other Non-affective Psychoses: An 11-Year Population-Based Cohort Study

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa137 ◽

2020 ◽

Author(s):

Nicholas Chak Lam Yung ◽

Corine Sau Man Wong ◽

Joe Kwun Nam Chan ◽

Eric Yu Hai Chen ◽

Wing Chung Chang

Keyword(s):

Cohort Study ◽

Excess Mortality ◽

Psychotic Disorders ◽

Premature Mortality ◽

Mortality Rates ◽

Population Based ◽

Affective Psychoses ◽

Targeted Interventions ◽

Life Years ◽

Life Years Lost

Abstract Psychotic disorders are associated with premature mortality, but research was primarily based on Western countries and rarely examined non-affective psychoses other than schizophrenia (ONAP). This population-based cohort study investigated excess mortality in 46 896 schizophrenia and 20 651 ONAP patients between January 2006 and December 2016 in Hong Kong (HK), by estimating all-cause and cause-specific standardized mortality ratios (SMRs), and life-years lost (LYLs), a recently developed, more precise reduced life expectancy measure taking into account the illness onset (age at first-recorded diagnosis). Changes in mortality metrics over the study period were assessed. Study data were retrieved from a territory-wide medical-record database of public healthcare services to 7.5 million HK residents. Results showed that schizophrenia and ONAP patients had higher all-cause (schizophrenia: SMR: 2.49 [95% CI: 2.43–2.55]; ONAP: 2.00 [1.92–2.09]), natural-cause (1.80 [1.74–1.85]; 1.47 [1.40–1.54]), and unnatural-cause (6.97 [6.47–7.49]; 8.53 [7.61–9.52]) mortality rates than general population. Respiratory diseases, cardiovascular diseases, and cancers accounted for the majority of deaths in patient cohorts. Men and women with schizophrenia had 9.53 years and 8.07 years of excess LYLs, respectively. For ONAP, excess LYLs was 8.18 years for men and 5.44 years for women. The overall mortality gap remained similar for both patient groups over time despite their improved longevity and declined unnatural-cause mortality rates. Taken together, schizophrenia and ONAP are associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to a natural cause. Persistent mortality gap highlights an urgent need for targeted interventions to improve the physical health of patients with psychotic disorders.

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Incidence of malignancy and related mortality after kidney transplantation: a nationwide, population-based cohort study in Korea

Scientific Reports ◽

10.1038/s41598-020-78283-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Seri Jeong ◽

Ho Sup Lee ◽

Seom Gim Kong ◽

Da Jung Kim ◽

Sangjin Lee ◽

...

Keyword(s):

Cohort Study ◽

Kidney Transplantation ◽

Hodgkin Lymphoma ◽

De Novo ◽

Kaposi Sarcoma ◽

Premature Mortality ◽

Population Based ◽

Non Hodgkin Lymphoma ◽

Kidney Recipients ◽

Premature Deaths

AbstractPost-transplant malignancy (PTM) is a leading cause of premature mortality among kidney transplantation recipients. However, population-based cohort studies that cover incidence, mortality, and risk factors for PTM are rarely reported, especially in East Asia. We designed a retrospective cohort study using a national population-based database. A total of 9915 kidney recipients between 2003 and 2016 were included. During this period, 598 cases (6.0%) of de novo PTM occurred. The most common PTM was thyroid cancer (14.2%), followed by colorectal (11.2%), kidney (10.7%), and stomach cancers (8.9%). The standardised incidence ratio for all-site cancer was 3.9. The risks of Kaposi sarcoma (192.9) and kidney cancer (21.1) were more than 10 times those of the general population. Cancer-related deaths were 89 (14.9%) with liver cancer being the highest (14.6%), followed by lung cancer (13.5%), non-Hodgkin lymphoma (NHL) (12.4%), stomach cancer (9.0%), and colorectal cancer (7.9%). The standardised mortality ratio (SMR) was slightly elevated (1.4). A notable increase in SMR was observed for lymphoma (9.3 for Hodgkin lymphoma and 5.5 for NHL). Older age and graft failure were significantly related to PTM. These findings reflecting geographical variation have implications for the development of strategies for fatal cancers to prevent premature deaths from PTM.

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Correction: Persistence of Health Inequalities in Childhood Injury in the UK; A Population-Based Cohort Study of Children under 5

PLoS ONE ◽

10.1371/journal.pone.0119358 ◽

2015 ◽

Vol 10 (3) ◽

pp. e0119358

Author(s):

Keyword(s):

Cohort Study ◽

Health Inequalities ◽

Population Based ◽

Childhood Injury ◽

The Uk ◽

Children Under 5

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307Association between patterns of comorbid mental disorders and mortality-related estimates. A Danish register-based cohort study

International Journal of Epidemiology ◽

10.1093/ije/dyab168.537 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Oleguer Plana-Ripoll ◽

John J McGrath

Keyword(s):

Substance Use ◽

Cohort Study ◽

Mental Disorders ◽

Life Expectancy ◽

Substance Use Disorders ◽

Excess Mortality ◽

Premature Mortality ◽

Population Based ◽

Substantial Contribution ◽

Comorbid Mental Disorders

Abstract Background Comorbidity within mental disorders is common, and people with two or more types of mental disorders have shorter life expectancy compared to those with exactly one type. The aims of this study were to: (a) describe the prevalence of combinations of mental disorders; and (b) estimate the excess mortality for each of these combinations. Methods We conducted a population-based cohort study including all 7,505,576 persons living in Denmark in 1995-2016. Using national registers, we described the most common combinations of mental disorders and investigated excess mortality by means of mortality rate ratios (MRRs) and differences in life expectancy. Results At the end of the 22-year observation, 6.2% individuals were diagnosed with exactly one disorder, and 5.3% with two or more types. People with any combination of disorders had higher mortality rates than those without any diagnosis (MRRs ranging from 1.10 [95% CI 0.67 – 1.84] to 5.97 [95% CI 5.52 – 6.45]) and shorter life expectancies compared to the general population (estimates ranging from 5.06 years [95% CI 5.01 – 5.11] to 17.46 years [95% CI 16.86 – 18.03]). Conclusions Mood disorders and neurotic disorders commonly co-occur, and contribute to many different sets of comorbid mental disorders. The association between mental disorders comorbidity and mortality revealed the prominent role of substance use disorders. Key messages Our study provides prevalence estimates of the most common sets of mental disorders. In light of the substantial contribution of substance use disorders to premature mortality, efforts related to the ‘primary prevention of secondary comorbidity’ warrant added scrutiny.

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