当前位置: X-MOL 学术World Psychiatry › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors.
World Psychiatry ( IF 73.3 ) Pub Date : 2022-06-01 , DOI: 10.1002/wps.20994
Christoph U Correll 1, 2, 3 , Marco Solmi 4, 5, 6, 7 , Giovanni Croatto 8 , Lynne Kolton Schneider 9 , S Christy Rohani-Montez 9 , Leanne Fairley 9 , Nathalie Smith 9 , István Bitter 10 , Philip Gorwood 11, 12 , Heidi Taipale 13, 14, 15, 16 , Jari Tiihonen 13, 14, 15
Affiliation  

People with schizophrenia die 15-20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random-effects meta-analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all-cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific-cause mortality. Publication bias, subgroup and meta-regression analyses, and quality assessment (Newcastle-Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all-cause mortality was increased in people with schizophrenia versus any non-schizophrenia control group (RR=2.52, 95% CI: 2.38-2.68, n=79), with the largest risk in first-episode (RR=7.43, 95% CI: 4.02-13.75, n=2) and incident (i.e., earlier-phase) schizophrenia (RR=3.52, 95% CI: 3.09-4.00, n=7) versus the general population. Specific-cause mortality was highest for suicide or injury-poisoning or undetermined non-natural cause (RR=9.76-8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79-7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio-cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All-cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001-0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all-cause and suicide-related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide-related mortality risk in incident schizophrenia samples. All-cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all-cause mortality (RR=1.62, 95% CI: 1.47-1.80, n=3). Antipsychotics were protective against all-cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59-0.84, n=11), with largest effects for second-generation long-acting injectable anti-psychotics (SGA-LAIs) (RR=0.39, 95% CI: 0.27-0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34-0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39-0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44-0.63, n=4). Antipsychotics were also protective against natural cause-related mortality, yet first-generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust the analyses moderated larger natural-cause mortality risk, and more recent study year moderated larger protective effects of antipsychotics. These results indicate that the excess mortality in schizophrenia is associated with several modifiable factors. Targeting comorbid substance abuse, long-term maintenance antipsychotic treatment and appropriate/earlier use of SGA-LAIs and clozapine could reduce this mortality gap.

中文翻译:

精神分裂症患者的死亡率:相对风险和加重或减弱因素的系统回顾和荟萃分析。

精神分裂症患者会提前 15-20 岁死亡。了解死亡风险和加重/减弱因素对于缩小这一差距至关重要。我们对前瞻性和回顾性、全国性和有针对性的队列研究进行了系统回顾和随机效应荟萃分析,评估了精神分裂症患者与一般人群或与身体合并症相匹配的群体或患有不同精神疾病的群体的死亡风险,并评估了调节因素。主要结局是全因死亡风险比(RR);关键的次要结局是自杀和自然原因导致的死亡率。其他次要结局包括任何其他特定原因死亡率。进行了发表偏倚、亚组和荟萃回归分析以及质量评估(纽卡斯尔-渥太华量表)。在 1957 年至 2021 年的 135 项研究中(精神分裂症:N=4,536,447;一般人群对照:N=1,115,600,059;其他精神疾病对照:N=3,827,955),与任何非精神分裂症对照组相比,精神分裂症患者的全因死亡率有所增加(RR=2.52,95% CI:2.38-2.68,n=79),首发风险最大(RR=7.43,95% CI:4.02-13.75,n=2)和事件(即更早-阶段)精神分裂症(RR=3.52,95% CI:3.09-4.00,n=7)与一般人群相比。自杀、受伤、中毒或未确定的非自然原因导致的特殊原因死亡率最高 (RR=9.76-8.42),自然原因中的肺炎次之 (RR=7.00,95% CI: 6.79-7.23),通过传染性或非自然原因导致的死亡率下降。内分泌或呼吸系统或泌尿生殖系统或糖尿病原因(RR = 3至4),酒精或胃肠道或肾脏或神经系统或心脑血管或所有自然原因(RR = 2至3),以及肝脏或脑血管,或乳房或结肠或胰腺或任何癌症原因(RR=1.33 至 1.96)。与中位研究年相比,全因死亡率略有增加,但显着增加(β=0.0009,95% CI:0.001-0.02,p=0.02)。与≥40岁的精神分裂症患者相比,年龄<40岁的精神分裂症患者的全因死亡率和自杀相关死亡率增加,并且在精神分裂症事件样本中,较高比例的女性增加了自杀相关死亡风险。事件中的全因死亡率高于流行的精神分裂症(RR=3.52 vs. 2.86,p=0.009)。共病物质使用障碍增加全因死亡率(RR=1.62,95% CI:1.47-1.80,n=3)。与不使用抗精神病药物相比,抗精神病药物可降低全因死亡率(RR=0.71,95% CI:0.59-0.84,n=11),其中第二代长效注射型抗精神病药物(SGA-LAI)效果最大( RR=0.39,95% CI:0.27-0.56,n=3),氯氮平(RR=0.43,95% CI:0.34-0.55,n=3),任何 LAI(RR=0.47,95% CI:0.39-0.58) ,n=2),以及任何 SGA(RR=0.53,95% CI:0.44-0.63,n=4)。抗精神病药物还可以预防自然原因相关的死亡,然而,第一代抗精神病药(FGA)与精神分裂症中自杀和自然原因导致的死亡率增加有关。较高的研究质量和用于调整分析的变量数量调节了较大的自然原因死亡风险,并且最近的研究年份调节了抗精神病药物较大的保护作用。这些结果表明,精神分裂症的死亡率过高与几个可改变的因素有关。针对共病药物滥用、长期维持抗精神病药物治疗以及适当/早期使用 SGA-LAI 和氯氮平可以缩小这一死亡率差距。
更新日期:2022-05-09
down
wechat
bug