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The impact of psychiatric and medical comorbidity on the risk of mortality: a population-based analysis

Published online by Cambridge University Press:  28 November 2019

Simon J. C. Davies
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Tomisin Iwajomo
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ontario, Canada Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
Claire de Oliveira
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ontario, Canada Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Judith Versloot
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Institute for Better Health, Mississauga, Ontario, Canada
Robert J. Reid
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Institute for Better Health, Mississauga, Ontario, Canada
Paul Kurdyak
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Corresponding
E-mail address:

Abstract

Background

As life expectancy increases, more people have chronic psychiatric and medical health disorders. Comorbidity may increase the risk of premature mortality, an important challenge for health service delivery.

Methods

Population-based cohort study in Ontario, Canada of all 11 246 910 residents aged ⩾16 and <105 on 1 April 2012 and alive on 31 March 2014. Secondary analyses included subjects having common medical disorders in 10 separate cohorts. Exposures were psychiatric morbidity categories identified using aggregated diagnosis groups (ADGs) from Johns Hopkins Adjusted Clinical Groups software® (v10.0); ADG 25: Persistent/Recurrent unstable conditions; e.g. acute schizophrenic episode, major depressive disorder (recurrent episode), ADG 24: Persistent/Recurrent stable conditions; e.g. depressive disorder, paranoid personality disorder, ADG 23: Time-limited/minor conditions; e.g. adjustment reaction with brief depressive reaction. The outcome was all-cause mortality (April 2014–March 2016).

Results

Over 2 years' follow-up, there were 188 014 deaths (1.7%). ADG 25 conferred an almost threefold excess mortality after adjustment compared to having no psychiatric morbidity [adjusted hazard ratio 2.94 (95% CI 2.91–2.98, p < 0.0001)]. Adjusted hazard ratios for ADG 24 and ADG 23 were 1.12 (95% CI 1.11–1.14, p < 0.0001) and 1.31 (95% CI 1.26–1.36, p < 0.0001). In all 10 medical disorder cohorts, ADG 25 carried significantly greater mortality risk compared to no psychiatric comorbidity.

Conclusions

Psychiatric disorders, particularly those graded persistent/recurrent and unstable, were associated with excess mortality in the whole population, and in the medical disorder cohorts examined. Future research should examine whether service design accounting for psychiatric disorder comorbidity improves outcomes across the spectrum of medical disorders.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2019

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Davies et al. supplementary material

Davies et al. supplementary material

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