Mortality gap widens; people with mental illness die years too young, but alcoholics fare worst of all

By Kathleen Struck, MedPage Today, May 23, 2013

Woman delivering flowers to gravesiteThe life expectancy gap between the mentally ill and the general population has widened, largely because of comorbidities like cardiovascular disease and cancer, a study found.

READ the studyLawrence D, et al “The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers” BMJ 2013;3 46: f2539 (full text)

During a 20-year period the gap increased by more than 2 years for both men and women so that mentally ill men had a life expectancy that was about 16 years shorter than that of the general population and women with mental illness had a lifespan that was 12 years shorter, David Lawrence, PhD, of the University of Western Australia, in Perth, and colleagues, wrote in BMJ.

That finding emerged from an analysis of population databases covering residents of Western Australia from 1985 to 2005.

More than 77% of excess deaths among the mentally ill were attributed to physical health conditions — including cardiovascular disease (29.9%) and cancer (13.5%) — and 13.9% of excess deaths were attributed to suicide, Lawrence and colleagues wrote.

Among the general population, life expectancy for females increased from 79.3 years in 1985 to 83.8 years in 2005, while for males it increased from 73.1 in 1985 to 79.1 in 2005.

Women and men with alcohol or drug disorders had the lowest life expectancies. For men, life expectancy was 52.7 (95% CI 51.1-54.4) in 1985, 52.5 (95% CI 50.8-54.2) in 1995, and 57.4 (95% CI 56-58.9) in 2005. For women with alcohol or drug disorders life expectancy was 55.4 (95% CI 52-58.5) in 1985, 57.3 (95% CI 54.9-59.7) in 1995, and 63.1 (95% CI 60.1-66.1) in 2005.

In all instances, those figures were 20 years or more shorter than the lifespan of the general population at the same time points.

“The findings of [the] paper … raise disturbing questions about our disregard for the duration and value of the lives of people with mental illness,” wrote Graham Thornicroft, PhD, of the Institute of Psychiatry at King’s College London in an accompanying editorial. “We are coming to understand that this excess mortality is not the result of higher suicide rates, but rather a combination of socioeconomic, healthcare, and clinical risk factors.”

Thornicroft called for public health to prioritize mortality among the mentally ill and evidence-based interventions that could reduce excess mortality. He called the situation “a human rights disgrace.”

“It’s multifactorial, it’s not a simple thing to fix,” commented P.V. Nickell, MD, of Allegheny General Hospital in Pittsburgh, “but that doesn’t mean we shouldn’t really devote the efforts needed to try to get the appropriate care for folks who seem to need it most.”

Limitations of this study included reliance on administrative data that might not have included the uninsured or untreated, the authors stated. Changes in life expectancy over time could have been affected by changes in service and diagnostic practices. Also, changes in cause of death coding could have affected excess-death estimates, such as HIV being coded as a cause of death in Australia only since 1996, which would lead to an underestimation of HIV deaths in the cohort, the authors stated.

“While strategies aimed at the prevention of suicides and violent deaths remain an important component of efforts to reduce excess mortality in people with mental illness, our results show that almost 80% of excess deaths are associated with physical health conditions,” Lawrence wrote, the same as the general population.

“We continue to disregard the physical health needs of people with mental illness and act as if they are of less worth than others,” Thornicroft concluded.

Kisely reported financial support from the Griffith Institute for Health and Medical Research, which funded the study. No other relationships were reported.

Thornicroft, the editorialist, said he had no competing interests.

Primary source: BMJ
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