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Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries.
Open accessAbstract
OBJECTIVE: Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler's method. RESULTS: The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. CONCLUSION: Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years.
Overview
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Written from the paper’s full text.
TL;DR
In Denmark, Finland, and Sweden, people hospitalized with bipolar disorder or schizophrenia had 2- to 3-fold overall mortality and substantially reduced life expectancy compared with the general population. Mortality from diseases of the circulatory system was about 2-fold elevated in bipolar disorder and somewhat higher in schizophrenia, except among men in Denmark.
Key findings
- Among 39,375 persons with bipolar disorder and 66,088 with schizophrenia followed in 2000–2006, all-cause SMRs were 2.0–2.8 for bipolar disorder and 2.9–3.9 for schizophrenia; for example, men in Finland had SMR 2.8 for bipolar disorder and 3.3 for schizophrenia, while women in Finland had SMR 2.5 and 3.9, respectively.
- SMRs for diseases of the circulatory system (DCS) in bipolar disorder were approximately 2 in all countries and both sexes, with overall DCS SMRs ranging from 1.7 to 2.2. In schizophrenia, overall DCS SMRs ranged from 1.8 to 2.9 and were higher than in bipolar disorder except for men in Denmark (1.8 vs 2.0).
- Life expectancy at age 15 was 11 to 20 years shorter overall. In the table, differences for men were 12.7–19.8 years for bipolar disorder and 17.1–20.0 years for schizophrenia; for women, differences were 11.0–16.2 years for bipolar disorder and 15.6–16.9 years for schizophrenia.
- During 2000–2006, 2,960 of 5,436 deaths (54%) in bipolar disorder and 6,424 of 9,535 deaths (67%) in schizophrenia would not have occurred if mortality matched the general population; 781 and 1,770 of these excess deaths were from DCS, and the total avoidable deaths across both groups were 9,384 over seven years.
Methods
- Register-based cohort study in Denmark, Finland, and Sweden including all persons with a psychiatric hospitalization with a main diagnosis of bipolar disorder or schizophrenia. Follow-up began on 1 January 2000 or the 15th birthday, whichever came last, and ended on 1 January 2007 or death, whichever came first.
- Diagnoses came from national psychiatric/hospital discharge registers using ICD-8, ICD-9, or ICD-10 as relevant; deaths came from national cause-of-death registers. Schizoaffective disorder was excluded from both diagnostic groups.
- Cause-specific SMRs were age-standardized to the Nordic standard population in 2000 with 95% confidence intervals; life expectancy at 15 was calculated using Wiesler’s method with one-year age stratification; avoidable deaths were calculated as N*((SMR−1)/SMR).
Limitations
- The paper states that schizoaffective disorder was excluded, that ICD diagnoses do not differentiate bipolar I from bipolar II disorder (so bipolar I may be overestimated), that antipsychotic treatment differences may partly explain cardiovascular mortality differences, and that Finland’s fragmented health care access may contribute to its higher SMRs.
- Evident from the text: the cohort includes only patients with a psychiatric hospitalization, so findings may not generalize to non-hospitalized or outpatient-treated patients.
- Evident from the text: register data lack individual confounders such as lifestyle, smoking, alcohol, exercise, and medication adherence; Swedish hospital data were incomplete before 1987, so case ascertainment relied on a 1987–1999 lookback.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The SMR for bipolar disorder for different subgroups of diseases of the circulatory system (DCS) was approximately 2 in all countries and both sexes, and thus lower than the all-cause SMRs, Table 1and 2.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes.”
- Also stated in: § Results · plain
“The SMR for bipolar disorder for different subgroups of diseases of the circulatory system (DCS) was approximately 2 in all countries and both sexes, and thus lower than the all-cause SMRs, Table 1and 2.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Abstract > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“this study show that persons with schizophrenia or bipolar disorder still have a substantially reduced life expectancy.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Apart from this difference the mortality rates and life expectancy are remarkably similar in the three countries.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparison between the Study Countries
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Persons with bipolar disorder in Denmark and Sweden had higher life expectancy than persons with schizophrenia.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The probability of getting a diagnosis of schizophrenia or bipolar disorder before the age of 15 is virtually zero in the Nordic countries.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Even in the Nordic countries with well-developed welfare and public health systems this group of patients experiences an unacceptable high mortality.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter.”
- Also stated in: § Results · plain
“Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being 11 to 20 years shorter.”
- Also stated in: § Conclusion · plain
“Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The probability of getting a diagnosis of schizophrenia or bipolar disorder before the age of 15 is virtually zero in the Nordic countries.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In general SMR for mortality from external causes (accidents, suicide, and homicide) was very high (range from 4 to 10).”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If no excess mortality from external causes was present the numbers was 865 and 1,322, respectively.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The mortality of the general population is an appropriate counterfactual for the mortality that patients with bipolar disorder or schizophrenia would have had in the absence of their psychiatric disorder.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The number of deaths in all three countries that would not have occurred if persons with bipolar disorder or schizophrenia had not had an excess mortality from I00-I99 was 781 and 1,770, respectively.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The mortality of the general population is an appropriate counterfactual for the mortality that patients with bipolar disorder or schizophrenia would have had in the absence of their psychiatric disorder.
- It may state two separate claims as one. 19
- Probably not a substantial claim. 17
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“although men and women in Finland with bipolar disorder have a lower overall mortality measured by SMR than men and women with schizophrenia, the potential loss of living years are larger among persons with bipolar disorder.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparison between the Study Countries
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The SMRs for persons with schizophrenia, was even higher with a SMR for men equaling 3.3, 3.0 and 2.9 in Finland, Denmark, and Sweden, respectively, Table 1 and 2.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During the years 2000 to 2006 the number of deaths in all three countries that would not have occurred in the hypothetical situation that the individuals with a psychiatric disorder had the same mortality as the general population was 2,960 (out of 5,436 deaths, 54%) in the group of persons with bipolar disorder and 6,424 (out of 9,535 deaths, 67%) in the group of schizophrenic persons.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The mortality of the general population is an appropriate counterfactual for the mortality that patients with bipolar disorder or schizophrenia would have had in the absence of their psychiatric disorder.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All-cause mortality was high among persons with bipolar disorder, resulting in a SMR for men in Finland equaling 2.8, in Denmark 2.2, and in Sweden 2.0.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“SMR for DCS among persons with schizophrenia was also lower than overall SMRs in Denmark and Finland, but not in Sweden.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For women with schizophrenia the SMR was 3.9, 2.7 and 2.9 in Finland, Denmark, and Sweden, respectively.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The SMR for women was 2.5 in Finland, 2.3 in Sweden and 2.0 in Denmark.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In the Nordic countries, women and men with severe mental disorders have an approximately 15 and 20 years shorter life expectancy, respectively, than the general population [8].”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Introduction
What the sources say
- Not checked yetcites [8] Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen TM (2011) Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry. bjp.bp.110.085100 [pii];10.1192/bjp.bp.110.085100 [doi]. source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“A study from Denmark showed that patients with bipolar affective disorder or schizophrenia still have an overall cardiac mortality that is higher than in the general population, and that the excess mortality tends to be even larger in the most recent calendar time period [12].”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Introduction
What the sources say
- Not checked yetcites [12] TM Laursen, 2011, Heart disease treatment and mortality in schizophrenia and bipolar disorder - changes in the Danish population between 1994 and 2006, J Psychiatr Res source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Excess mortality from diseases and medical conditions in persons with psychiatric disorders has been extensively reported [1].”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Introduction
What the sources say
- Not checked yetcites [1] EC Harris, 1998, Excess mortality of mental disorder, Br J Psychiatry source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The Swedish Cause of Death Register contains information about all deaths in Sweden and the coding error is estimated from a sample of deaths and was only 3% [20].”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Methods > Assessment of Psychiatric Illness and Cause of Death
What the sources say
- Not checked yetcites [20] LA Johansson, 2000, Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics, Int J Epidemiol source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease [11].”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Introduction
What the sources say
- Not checked yetcites [11] M Nordentoft, 2013, Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in denmark, Finland and sweden, Plos One source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Diseases of the circulatory system are the most common cause of death in the general population in Western countries [9], [10], including Denmark, Finland, and Sweden.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Introduction
What the sources say
- Not checked yetcites [9] Laursen TM (2006) A register based epidemiological description of risk factors and outcomes for major psychiatric disorders, focusing on a comparison between bipolar affective disorder and schizophrenia. PhD thesis. Universty of Aarhus.
- Not checked yetcites [10] CH Hennekens, 2005, Schizophrenia and increased risks of cardiovascular disease, Am Heart J source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In a study including information from 20 million individuals from three Nordic countries with complete national coverage, and with more than 100,000 persons with bipolar disorder or schizophrenia”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The schizoaffective subgroup, often included in the schizophrenia group, with a generally more favourable outcome than schizophrenia, was not included in our analyses.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Reviews have found a huge reduction in life expectancy of approximately 10 to 20 years in persons with schizophrenia.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“On average the excess mortality rate in people with schizophrenia resulted in a SMR equaling 2–3 and a SMR for persons with bipolar disorder equaling a little less than two.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [31]–[41]
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The reductions of life expectancy among persons with bipolar disorder seem to be slightly smaller: approximately 10 years in a study from London [43], and 13 years in a Danish study made on data similar to the Danish data used in Table 3 [44].”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [43] CK Chang, 2011, Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London, PLoS One source
- Not checked yetcites [44] TM Laursen, 2011, Life expectancy among persons with schizophrenia or bipolar affective disorder, Schizophr Res source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the explanation is that e.g. Finnish men with bipolar disorder have a very high mortality rate in the age groups between 15 and 44 years: a person who dies at a young age contributes many years to the potential loss of living years, and thus this measure becomes high although SMRs are not that high.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparison between the Study Countries
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“And lastly, the risk of suicide is very high [40].”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [40] TM Laursen, 2012, Life expectancy and cardiovascular mortality in persons with schizophrenia, Curr Opin Psychiatry source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“physical illnesses in persons with schizophrenia or bipolar disorder are apparently treated insufficiently or diagnosed too late”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [40] TM Laursen, 2012, Life expectancy and cardiovascular mortality in persons with schizophrenia, Curr Opin Psychiatry source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Persons with schizophrenia and bipolar disorder constitute a vulnerable group of patients who need special attention.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This may create higher levels of health inequity in Finland than in Denmark or Sweden.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparison between the Study Countries
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Health care access in Finland is compromised by a fragmented health system more dependent on employment status and income than in Denmark and Sweden.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it shows that although schizophrenia and bipolar disorder are rare disorders, the extent of the increased mortality is a substantial public health problem that has not been addressed.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Preventing the High Mortality
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“some antipsychotic medicine may have negative side effects, although no clear differences between different antipsychotics have been found”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [40] TM Laursen, 2012, Life expectancy and cardiovascular mortality in persons with schizophrenia, Curr Opin Psychiatry source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Most studies find that cardiovascular disorder is the leading cause of death in both disorders.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [31]–[41]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The difference may be related to problems in health care access in Finland.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparison between the Study Countries
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Health care access in Finland is compromised by a fragmented health system more dependent on employment status and income than in Denmark and Sweden.
In the paper
“persons with schizophrenia and bipolar disorder tended to have an unhealthy lifestyle especially regarding diet, smoking, alcohol, and exercise”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [40] TM Laursen, 2012, Life expectancy and cardiovascular mortality in persons with schizophrenia, Curr Opin Psychiatry source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In a recent study from Stockholm County, around 30% of persons with bipolar disorder treated at a specialized affective disorder unit medicated with antipsychotics [42], while in schizophrenia almost none would be without antipsychotics, and also taking larger doses.”
§ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries > Discussion > Comparisons with other Studies
What the sources say
- Not checked yetcites [42] M Adler, 2012, Symptoms and treatment of bipolar patients in Sweden, Int J Psychiatry Clin Pract source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
The probability of getting a diagnosis of schizophrenia or bipolar disorder before the age of 15 is virtually zero in the Nordic countries.
“The probability of getting a diagnosis of schizophrenia or bipolar disorder before the age of 15 is virtually zero in the Nordic countries, and thus the reason for starting follow-up at that time point in life.”
The authors state this as an assumption.
The mortality of the general population is an appropriate counterfactual for the mortality that patients with bipolar disorder or schizophrenia would have had in the absence of their psychiatric disorder.
“the hypothetical situation that the individuals with a psychiatric disorder had the same mortality as the general population”
“By reducing mortality in the group of persons with schizophrenia or bipolar disorder (approximately 100,000 persons) to the level of the general population”
The paper relies on this without support.
Health care access in Finland is compromised by a fragmented health system more dependent on employment status and income than in Denmark and Sweden.
“in Finland availability is compromised by a fragmented health system, where health care access is more dependent on employment status and income level.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“Evidence suggests CVD is the leading cause of death in individuals with SMI.2,27,28”
From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [28]
In the citing paper
“Indeed, both disorders have severe negative consequences for social functioning, work ability, and lifespan.”
From Predicting Diagnostic Progression to Schizophrenia or Bipolar Disorder via Machine Learning (2025) · cites this paper as [3]
In the citing paper
“Mental illness is broadly associated with poorer physical health outcomes; the severity of which is epitomised by a 15- to 20-year mortality gap between individuals with serious mental illness and the general population [104••, 105, 106].”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [105]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Swedish life expectancy is not higher for every patient group
MinorThe statement includes women with schizophrenia, but Table 3 gives them a remaining life expectancy of 50.7 years in Sweden versus 51.9 years in Finland.
“Similarly, life expectancy among persons with bipolar disorder and schizophrenia was higher in Sweden than in the other two Nordic countries.”
“| Schizophrenia | 48.8 | 16.5 | 51.9 | 15.6 | 15.6 | 50.7 | 16.9 |”
Finnish men's all-cause SMR confidence intervals do not overlap
MinorFor Finnish men, the table gives an all-cause SMR interval of 2.5-3.0 for bipolar disorder and 3.2-3.5 for schizophrenia. These intervals do not overlap, contrary to the stated exception.
“| All causes of death | 2.2 (2.0–2.3) | 770 | 2.8 (2.5–3.0) | 485 | 2.0 (1.9–2.2) | 1097 |”
“only men in Finland with schizophrenia had overlapping confidence intervals of the overall SMR with men with bipolar disorder.”
The stated DCS subgroups both include ICD code I20
MinorThe methods place I20 in both the ischaemic heart disease and miscellaneous DCS ranges, although these are presented as separate subgroups.
“ischaemic heart disease (I20–25)”
“a miscellaneous group of Chapter I (I00-I20, I26-I59, I70-I99).”
Finnish women's bipolar DCS deaths do not sum to the overall count
MinorThe listed Finnish women's bipolar-disorder DCS subgroups contain 8 ischaemic heart disease deaths, 33 cerebrovascular deaths, and 30 other DCS deaths: 71 in total, not 121. The ischaemic heart disease count of 8 is also smaller than its listed subset of 24 acute myocardial infarction deaths.
Reported 121 · recomputed 71
“| Overall DCS (I00-I99) | 1.7 (1.5–1.9) | 308 | 2.1 (1.7–2.4) | 121 | 1.8 (1.7–1.9) | 566 |”
Schizophrenia DCS SMRs are lower than all-cause SMRs in Sweden too
MinorThe paper says Sweden is an exception, yet Tables 1 and 2 report Swedish schizophrenia DCS SMRs of 2.5 for men and 2.6 for women, both below their respective all-cause SMRs of 2.9.
“SMR for DCS among persons with schizophrenia was also lower than overall SMRs in Denmark and Finland, but not in Sweden.”
“| Overall DCS | 1.8 (1.6–2.1) | 294 | 2.9 (2.6–3.1) | 471 | 2.5 (2.3–2.7) | 783 |”
Citations
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BackgroundSelf-citation
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Metadata
- Authors
- Laursen, T. M., Wahlbeck, K., Hällgren, J., Westman, J., Ösby, U., Alinaghizadeh, H., Gissler, M., & Nordentoft, M.
- Affiliations
- Aarhus University (DK)
- Finnish Institute for Health and Welfare (FI)
- Karolinska Institutet (SE)
- University of Copenhagen (DK)
- Corresponding author
- Laursen, Thomas Munk
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-06-24
- Volume
- 8
- Issue
- 6
- Pages
- e67133
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3691116
- OpenAlex
- W2063598898
- Semantic Scholar
- 6de46ba13d1d5cdb71f0637d20707d4c3c6bde53
- Cited by
- 313
- References
- 43
- Citations by year
- 2026: 16 · 2025: 9 · 2024: 24 · 2023: 23 · 2022: 24 · 2021: 28 · 2020: 24 · 2019: 37 · 2018: 28 · 2017: 31 · 2016: 31 · 2015: 19 · 2014: 18 · 2013: 1
- FWCI
- 16.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- Stanley Medical Research Institute
- Lundbeckfonden (R155-2012-11280)
- H. Lundbeck A/S
- Medical Research Council (MR/K006525/1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- bipolar disorder, schizophrenia, circulatory diseases, cardiovascular mortality, excess mortality, life expectancy, standardized mortality ratio, mental illness, Nordic countries, Denmark, Sweden, Finland
- MeSH terms
- Bipolar Disorder, Cardiovascular Diseases, Cardiovascular System, Cause of Death, Female, Humans, Life Expectancy, Male, Scandinavian and Nordic Countries, Schizophrenia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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