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Risk of mortality and complications in patients with schizophrenia and diabetes mellitus: population-based cohort study

Published online by Cambridge University Press:  07 January 2021

Joe Kwun Nam Chan
Affiliation:
Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
Corine Sau Man Wong
Affiliation:
Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
Philip Chi Fai Or
Affiliation:
Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
Eric Yu Hai Chen
Affiliation:
Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong; and State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
Wing Chung Chang
Affiliation:
Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong; and State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
Corresponding
E-mail address:

Abstract

Background

Schizophrenia patients have markedly elevated prevalence of diabetes compared with the general population. However, risk of mortality and diabetes-related complications among schizophrenia patients with co-occurring diabetes is understudied.

Aims

We investigated whether schizophrenia increased the risk of overall mortality, complications and post-complication mortality in people with diabetes.

Method

This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68 682 patients with incident diabetes only between 2001 and 2016 in Hong Kong using a medical record database of public healthcare services. Association between schizophrenia and all-cause mortality was examined with a Cox proportional hazards model. Effect of schizophrenia on first-year complication occurrence following diabetes diagnosis and post-complication mortality rates were evaluated.

Results

Schizophrenia was associated with increased all-cause mortality (adjusted hazards ratio [aHR] 1.11, 95% CI 1.05–1.18), particularly among men and older age groups. Schizophrenia patients with diabetes had higher metabolic complication rate (aHR 1.99, 95% CI 1.63–2.42), lower microvascular complication rate (aHR 0.75, 95% CI 0.65–0.86) and comparable macrovascular complication rate (aHR 0.93, 95% CI 0.85–1.03), relative to patients with diabetes only. Among patients with diabetes complications, schizophrenia was associated with elevated all-cause mortality after macrovascular (aHR 1.19, 95% CI 1.04–1.37) and microvascular (aHR 1.33, 95% CI 1.08–1.64) complications. Gender-stratified analyses revealed that a significant effect of schizophrenia on heightened post-complication mortality was observed in men only.

Conclusions

Schizophrenia patients with co-occurring diabetes are at increased risk of excess mortality, including post-complication mortality. Further research identifying effective interventions is warranted to optimise diabetes-related outcomes in this vulnerable population.

Type
Paper
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

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Footnotes

*

These authors contributed equally to the article.

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