Skip to main content Accessibility help
×
Home

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

  • Simon J. C. Davies (a1) (a2), Tomisin Iwajomo (a1) (a3), Claire de Oliveira (a1) (a3) (a4), Judith Versloot (a4) (a5), Robert J. Reid (a4) (a5) and Paul Kurdyak (a1) (a2) (a3) (a4)...

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.

Copyright

Corresponding author

Author for correspondence: Simon J. C. Davies, E-mail: simon_davies@camh.net

References

Hide All
Antoniou, T, Zagorski, B, Loutfy, MR, Strike, C and Glazier, RH (2011) Validation of case-finding algorithms derived from administrative data for identifying adults living with human immunodeficiency virus infection. PLoS ONE 6, e21748.
Austin, PC, Daly, PA and Tu, JV (2002) A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario. American Heart Journal 144, 290296.
Austin, PC, Newman, A and Kurdyak, PA (2012 a) Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a population-based cohort of adults with schizophrenia in Ontario, Canada. Psychiatry Research 196, 3237.
Austin, PC, Shah, BR, Newman, A and Anderson, GM (2012 b) Using the Johns Hopkins’ Aggregated Diagnosis Groups (ADGs) to predict 1-year mortality in population-based cohorts of patients with diabetes in Ontario, Canada. Diabetic Medicine 29, 11341141.
Barnett, K, Mercer, SW, Norbury, M, Watt, G, Wyke, S and Guthrie, B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380, 3743.
Benchimol, EI, Guttmann, A, Mack, DR, Nguyen, GC, Marshall, JK, Gregor, JC, Wong, J, Forster, AJ and Manuel, DG (2014) Validation of international algorithms to identify adults with inflammatory bowel disease in health administrative data from Ontario, Canada. Journal of Clinical Epidemiology 67, 887896.
Bondesson, E, Larrosa Pardo, F, Stigmar, K, Ringqvist, Å, Petersson, IF, Jöud, A and Schelin, MEC (2018) Comorbidity between pain and mental illness – evidence of a bidirectional relationship. European Journal of Pain 22, 13041311.
Boyd, C and Fortin, M (2010) Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Reviews 32, 451474.
Chiu, M, Lebenbaum, M, Lam, K, Chong, N, Azimaee, M, Iron, K, Manuel, D and Guttmann, A (2016) Describing the linkages of the immigration, refugees and citizenship Canada permanent resident data and vital statistics death registry to Ontario's administrative health database. BMC Medical Informatics and Decision Making 16, 135.
Chwastiak, L, Vanderlip, E and Katon, W (2014) Treating complexity: collaborative care for multiple chronic conditions. International Review of Psychiatry 26, 638647.
Colton, C and Manderscheid, RW (2006) Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease 3, A42.
Druss, BG (2007) Improving medical care for persons with serious mental illness: challenges and solutions. Journal of Clinical Psychiatry 68(suppl. 4), 4044.
Fors, BM, Isacson, D, Bingefors, K and Widerlov, B (2007) Mortality among persons with schizophrenia in Sweden: an epidemiological study. Nordic Journal of Psychiatry 61, 252259.
Gatov, E, Rosella, L, Chiu, M and Kurdyak, PA (2017) Trends in standardized mortality among individuals with schizophrenia, 1993-2012: a population-based, repeated cross-sectional study. Canadian Medical Association Journal 189, E1177E1187.
Gershon, A, Wang, C, Guan, J, Vasilevska-Ristovska, J, Cicutto, L and To, T (2009 a) Identifying individuals with physcian diagnosed COPD in health administrative databases. COPD: Journal of Chronic Obstructive Pulmonary Disease 6, 388394.
Gershon, AS, Wang, C, Guan, J, Vasilevska-Ristovska, J, Cicutto, L and To, T (2009 b) Identifying patients with physician-diagnosed asthma in health administrative databases. Canadian Respiratory Journal 16, 183188.
Goodrich, DE, Kilbourne, AM, Nord, KM and Bauer, MS (2013) Mental health collaborative care and its role in primary care settings. Current Psychiatry Reports 15, 383.
Gulland, A (2016) Action is urged to improve physical health in severe mental illness. British Medical Journal 355, i5729.
Hall, S, Schulze, K, Groome, P, Mackillop, W and Holowaty, E (2006) Using cancer registry data for survival studies: the example of the Ontario Cancer Registry. Journal of Clinical Epidemiology 59, 6776.
Hux, JE, Ivis, F, Flintoft, V and Bica, A (2002) Diabetes in Ontario Determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 25, 512516.
Joukamaa, M, Heliovaara, M, Knekt, P, Aromaa, A, Raitasalo, R and Lehtinen, V (2006) Schizophrenia, neuroleptic medication and mortality. British Journal of Psychiatry 188, 122127.
Katon, W, Fan, M-Y, Unützer, J, Taylor, J, Pincus, H and Schoenbaum, M (2008) Depression and diabetes: a potentially lethal combination. Journal of General Internal Medicine 23, 15711575.
Kurdyak, P, Vigod, S, Duchen, R, Jacob, B, Stukel, T and Kiran, T (2017) Diabetes quality of care and outcomes: comparison of individuals with and without schizophrenia. General Hospital Psychiatry 46, 713.
Laursen, TM, Munk-Olsen, T, Nordentoft, M and Mortensen, PB (2007) Increased mortality among patients admitted with major psychiatric disorders: a register-based study comparing mortality in unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia. Journal of Cliical Psychiatry 68, 899907.
Mathers, CD and Loncar, D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3, e442.
Mercer, SW, Gunn, J, Bower, P, Wyke, S and Guthrie, B (2012) Managing patients with mental and physical multimorbidity. British Medical Journal 345, e5559.
Pan, A, Lucas, M, Sun, Q, van Dam, RM, Franco, OH, Manson, JE, Willett, WC, Ascherio, A and Hu, FB (2010) Bidirectional association between depression and type 2 diabetes mellitus in women. Archives of Internal Medicine 170, 18841891.
Schultz, SE, Rothwell, DM, Chen, Z and Tu, K (2013) Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records. Chronic Diseases and Injuries in Canada 33, 160166.
Statistics Canada (2006) Census of Population. Available at http://www12.statcan.gc.ca/census-recensement/2006/index-eng.cfm (Accessed 21 August 2018).
Thornicroft, G (2011) Physical health disparities and mental illness: the scandal of premature mortality. British Journal of Psychiatry 199, 441442.
Tu, K, Campbell, NR, Chen, Z-L, Cauch-Dudek, KJ and McAlister, FA (2007) Accuracy of administrative databases in identifying patients with hypertension. Open Medicine 1, e18e26.
Unützer, J and Ratzliff, AH (2015) Evidence base and core principles. In Raney LE (ed.) Integrated Care: Working at the Interface of Primary Care and Behavioral Health. Arlington, VA: American Psychiatric Publishing, pp. 316.
Wahlbeck, K, Westman, J, Nordentoft, M, Gissler, M and Laursen, TM (2011) Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry 199, 453458.
Weiner, JP (ed.) (2011) The Johns Hopkins ACG® System, technical reference guide, version 10.0. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health.
Wells, K, Golding, J and Burnam, M (1998) Psychiatric disorder in a sample of the general population with and without chronic medical conditions. American Journal of Psychiatry 145, 976998.
Widdifield, J, Bombardier, C, Bernatsky, S, Paterson, JM, Green, D, Young, J, Ivers, N, Butt, DA, Jaakkimainen, RL, Thorne, JC and Tu, K (2014) An administrative data validation study of the accuracy of algorithms for identifying rheumatoid arthritis: the influence of the reference standard on algorithm performance. BMC Musculoskeletal Disorders 15, 216.

Keywords

Type Description Title
WORD
Supplementary materials

Davies et al. supplementary material
Davies et al. supplementary material

 Word (737 KB)
737 KB

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

  • Simon J. C. Davies (a1) (a2), Tomisin Iwajomo (a1) (a3), Claire de Oliveira (a1) (a3) (a4), Judith Versloot (a4) (a5), Robert J. Reid (a4) (a5) and Paul Kurdyak (a1) (a2) (a3) (a4)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed