[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Marder  SREssock  SMMiller  ALBuchanan  RWCasey  DEDavis  JMKane  JMLieberman  JASchooler  NRCovell  NStroup  SWeissman  EMWirshing  DAHall  CSPogach  LPi-Sunyer  XBigger  JT  JrFriedman  AKleinberg  DYevich  SJDavis  BShon  S Physical health monitoring of patients with schizophrenia.  Am J Psychiatry 2004;1611334- 1349PubMedGoogle ScholarCrossref
Brown  S Excess mortality of schizophrenia: a meta-analysis.  Br J Psychiatry 1997;171502- 508PubMedGoogle ScholarCrossref
Harris  ECBarraclough  B Excess mortality of mental disorder.  Br J Psychiatry 1998;17311- 53PubMedGoogle ScholarCrossref
Ösby  UCorreia  NBrandt  LEkbom  ASparén  P Time trends in schizophrenia mortality in Stockholm County, Sweden: cohort study  BMJ 2000;321483- 484PubMedGoogle ScholarCrossref
Hansen  VJacobsen  BKArenesen  E Cause-specific mortality in psychiatric patients after deinstitutionalisation.  Br J Psychiatry 2001;179438- 443PubMedGoogle ScholarCrossref
Joukamaa  MHeliovaara  MKnekt  PAromaa  ARaitasalo  RLehtinen  V Mental disorders and cause-specific mortality.  Br J Psychiatry 2001;179498- 502PubMedGoogle ScholarCrossref
Lawrence  DMHolman  CDJablensky  AVHobbs  MS Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980-1998.  Br J Psychiatry 2003;18231- 36PubMedGoogle ScholarCrossref
Enger  CWeatherby  LReynolds  RFGlasser  DBWalker  AM Serious cardiovascular events and mortality among patients with schizophrenia.  J Nerv Ment Dis 2004;19219- 27PubMedGoogle ScholarCrossref
Grinshpoon  ABarchana  MPonizovsky  ALipshitz  INahon  DTal  OWeizman  ALevav  I Cancer in schizophrenia: is the risk higher or lower?  Schizophr Res 2005;73333- 341PubMedGoogle ScholarCrossref
Dalton  SOLaursen  TMMellemkjær  LJohansen  CMortensen  PB Risk for cancer in parents of patients with schizophrenia.  Am J Psychiatry 2004;161903- 908PubMedGoogle ScholarCrossref
Walley  TMantgani  A The UK General Practice Research Database.  Lancet 1997;3501097- 1099PubMedGoogle ScholarCrossref
Jick  SSKaye  JAVasilakis-Scaramozza  CGarcia Rodriguez  LARuigomez  AMeier  CRSchlienger  RGBlack  CJick  H Validity of the general practice research database.  Pharmacotherapy 2003;23686- 689PubMedGoogle ScholarCrossref
Nazareth  IKing  MHaines  ARangel  LMyers  S Accuracy of diagnosis of psychosis on general practice computer system.  BMJ 1993;30732- 34PubMedGoogle ScholarCrossref
Perry  J OXMIS Problem Codes for Primary Medical Care.  Oxford, England OXMIS Publications1978;
Cancer Research UK, Statistics on the most common causes of death from cancer in the UK. 2005;http://info.cancerresearchuk.org/cancerstats/mortality/cancerdeaths/Accessed February 20, 2006
Morris  RCarstairs  V Which deprivation? a comparison of selected deprivation indices.  J Public Health Med 1991;13318- 326PubMedGoogle Scholar
Bazire  S Psychotropic Drug Directory.  Bath, England Bath Press2003;
British Medical Association and Royal Pharmaceutical Society of Great Britain, British National Formulary 46.  London, England British Medical Association Books2003;
StataCorp, Stata Statistical Software: Release 8.2.  College Station, Tex StataCorp2003;
Kendrick  T Cardiovascular and respiratory risk factors and symptoms among general practice patients with long-term mental illness.  Br J Psychiatry 1996;169733- 739PubMedGoogle ScholarCrossref
Kelly  CMcCreadie  RG Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland.  Am J Psychiatry 1999;1561751- 1757PubMedGoogle Scholar
McCreadie  RGThe Scottish Schizophrenia Lifestyle Group, Diet, smoking and cardiovascular risk in people with schizophrenia.  Br J Psychiatry 2003;183534- 539PubMedGoogle ScholarCrossref
Original Article
February 2007

Relative Risk of Cardiovascular and Cancer Mortality in People With Severe Mental Illness From the United Kingdom's General Practice Research Database

Author Affiliations

Author Affiliations: Department of Mental Health Sciences (Drs Osborn and King and Mr Levy) and Department of Primary Care and Population Sciences (Drs Nazareth and Petersen and Mr Islam), Royal Free and University College Medical School, London, England.

Arch Gen Psychiatry. 2007;64(2):242-249. doi:10.1001/archpsyc.64.2.242

Context  People with severe mental illness (SMI) appear to have an elevated risk of death from cardiovascular disease, but results regarding cancer mortality are conflicting.

Objective  To estimate this excess mortality and the contribution of antipsychotic medication, smoking, and social deprivation.

Design  Retrospective cohort study.

Setting  United Kingdom's General Practice Research Database.

Patients  Two cohorts were compared: people with SMI diagnoses and people without such diagnoses.

Main Outcome Measure  Mortality rates for coronary heart disease (CHD), stroke, and the 7 most common cancers in the United Kingdom.

Results  A total of 46 136 people with SMI and 300 426 without SMI were selected for the study. Hazard ratios (HRs) for CHD mortality in people with SMI compared with controls were 3.22 (95% confidence interval [CI], 1.99-5.21) for people 18 through 49 years old, 1.86 (95% CI, 1.63-2.12) for those 50 through 75 years old, and 1.05 (95% CI, 0.92-1.19) for those older than 75 years. For stroke deaths, the HRs were 2.53 (95% CI, 0.99-6.47) for those younger than 50 years, 1.89 (95% CI, 1.50-2.38) for those 50 through 75 years old, and 1.34 (95% CI, 1.17-1.54) for those older than 75 years. The only significant result for cancer deaths was an unadjusted HR for respiratory tumors of 1.32 (95% CI, 1.04-1.68) for those 50 to 75 years old, which lost statistical significance after controlling for smoking and social deprivation. Increased HRs for CHD mortality occurred irrespective of sex, SMI diagnosis, or prescription of antipsychotic medication during follow-up. However, a higher prescribed dose of antipsychotics predicted greater risk of mortality from CHD and stroke.

Conclusions  This large community sample demonstrates that people with SMI have an increased risk of death from CHD and stroke that is not wholly explained by antipsychotic medication, smoking, or social deprivation scores. Rates of nonrespiratory cancer mortality were not raised. Further research is required concerning prevention of this mortality, including cardiovascular risk assessment, monitoring of antipsychotic medication, and attention to diet and exercise.