Avoidable mortality in people with schizophrenia or bipolar disorder in E ngland
Abstract
Objective: To quantify the extent of ‘avoidable mortality’ in those with schizophrenia or bipolar disorder and to quantify the effect a reduction in these might have on the mortality gap associated with severe mental illness. Method: A cohort was studied of people aged <75 years, discharged from inpatient care with schizophrenia or bipolar disorder in 2006–2007, and followed up for 365 days. Standardised mortality ratios (SMR s) were calculated followed by hypothetical SMR s, estimating the residual mortality gap if ‘avoidable’ causes and suicide in the cohorts had occurred at the same level as those in the general population. Results: Avoidable deaths comprised 60.2% and 59.2% of all deaths in the schizophrenia and bipolar disorder cohorts respectively. All‐cause SMR s were 4.23 (95% CI 3.85–4.60) and 2.60 (2.21–3.00) respectively. After discounting the excess attributable to avoidable causes and suicide, the SMR s fell to 2.38 (2.09–2.66) and 1.66 (1.35–1.98) respectively. Conclusion: Bringing mortality from avoidable causes and suicide down to general population levels would reduce the overall mortality excess in severe mental illness substantially, by about 50%, but would not eliminate it. Other underlying factors beyond those conventionally considered as ‘avoidable’ need further research.
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Polypharmacy is increasingly common in bipolar disorder and may be contributing to the worsening CVD mortality compared with the general population in the 2010-2014 period.
“Polypharmacy is increasingly common in bipolar disorder61 and may be contributing to the worsening CVD mortality compared with the general population in the 2010–2014 period.”
From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [61]
Cardiovascular disease is the leading cause of premature mortality in individuals with SMI.
“cardiovascular disease emerges as the leading cause of premature mortality in individuals with SMI, as supported by substantial evidence [19–22].”
From A retrospective and comprehensive analysis of excess life-years lost, mortality risk, and cause of death among severe mental illness in China (2025) · cites this paper as [19]
The most important cause for this shortened life expectancy is cardiovascular disease (CVD).
“The most important cause for this shortened life expectancy is cardiovascular disease (CVD) 6 .”
From Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis (2016) · cites this paper as [6]
About 60% of the excess mortality observed in severe mental illness is due to physical comorbidities, predominantly cardiovascular diseases.
“About 60% of the excess mortality observed in SMI is due to physical comorbidities, predominantly cardiovascular diseases (CVD) (6).”
People with schizophrenia and other psychotic disorders die earlier than their peers in the general population, by around 15-20 years according to recent estimates.
“People with schizophrenia and other psychotic disorders die earlier than their peers in the general population, with recent estimates suggesting by around 15–20 years.1–10”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [3]
Consistent evidence has accrued that people with psychotic disorder have higher mortality rates than the general population.
“Over the past decades, consistent evidence has accrued that people with psychotic disorder have higher mortality rates than the general population.1–9”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [3]
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“Among physical illnesses, cardiovascular disease emerges as the leading cause of premature mortality in individuals with SMI, as supported by substantial evidence [19–22].”
- Authors
- Hoang, U., Goldacre, M. J., & Stewart, R.
- Affiliations
- University of Oxford (GB)
- King's College London (GB)
- Corresponding author
- Hoang, U.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2012-12-09
- Volume
- 127
- Issue
- 3
- Pages
- 195-201
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2116643778
- Cited by
- 109
- References
- 22
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 13 · 2021: 9 · 2020: 8 · 2019: 5 · 2018: 8 · 2017: 9 · 2016: 4 · 2015: 11 · 2014: 16 · 2013: 2
- FWCI
- 6.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Open Research (University of Surrey) (submittedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- avoidable mortality, schizophrenia, bipolar disorder, severe mental illness, mortality gap, suicide, standardized mortality ratio, older adults, hospital discharge, excess mortality
- MeSH terms
- Adult, Aged, Bipolar Disorder, Cause of Death, England, Female, Follow-Up Studies, Humans, Male, Middle Aged, Schizophrenia, Suicide, Cohort Studies, Sex Distribution
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