Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study
Summary: Background: Prior research provides suggestive evidence on an association between stress-related disorders and mortality. No previous study has however addressed the role of familial confounding on such association. Methods: We conducted a nationwide cohort study of 189,757 individuals wit...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-07-01
|
| Series: | The Lancet Regional Health. Europe |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776222000953 |
| _version_ | 1818007732622458880 |
|---|---|
| author | Fan Tian Qing Shen Yihan Hu Weimin Ye Unnur A. Valdimarsdóttir Huan Song Fang Fang |
| author_facet | Fan Tian Qing Shen Yihan Hu Weimin Ye Unnur A. Valdimarsdóttir Huan Song Fang Fang |
| author_sort | Fan Tian |
| collection | DOAJ |
| description | Summary: Background: Prior research provides suggestive evidence on an association between stress-related disorders and mortality. No previous study has however addressed the role of familial confounding on such association. Methods: We conducted a nationwide cohort study of 189,757 individuals with a first-onset stress-related disorder between January 1, 1981 and December 31, 2016 in Sweden (i.e., exposed patients), 1,896,352 matched unexposed individuals, and 207,479 unaffected full siblings of the exposed patients. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cause-specific mortality. Findings: During a mean follow-up of 9.42 years, an elevated risk of all-cause mortality was observed during the entire follow-up among patients with stress-related disorders, compared with either unexposed individuals or their unaffected full siblings. Such excess risk was most pronounced within the first year after diagnosis of stress-related disorders (HR, 3.19 [95% CI, 2.87-3.54] in population-based comparison; HR, 3.21 [95% CI, 2.56-4.02] in sibling-based comparison). The excess risk decreased but remained statistically significant thereafter (HR, 1.64 [95% CI, 1.60-1.67] in population-based comparison; HR, 1.61 [95% CI, 1.54-1.68] in sibling-based comparison). An increased risk was observed for almost all cause-specific mortality, with greater risk increase for deaths from unnatural causes, especially suicide, and potentially avoidable causes. Interpretation: Stress-related disorders were associated with an increased risk of all-cause mortality and multiple cause-specific mortality, and the risk elevation was independent of familial confounding. The excess mortality attributable to unnatural causes and potentially avoidable causes highlights the importance of clinical surveillance of major health hazards among patients with stress-related disorders. Funding: EU Horizon 2020 Research and Innovation Action Grant, 1.3.5 Project for Disciplines of Excellence at West China Hospital of Sichuan University, National Natural Science Foundation of China, Icelandic Research Fund (Grant of Excellence), ERC Consolidator Grant, and Swedish Research Council. |
| first_indexed | 2024-04-14T05:19:31Z |
| format | Article |
| id | doaj.art-7a47c94c46a447ce9d08c94125937c65 |
| institution | Directory Open Access Journal |
| issn | 2666-7762 |
| language | English |
| last_indexed | 2024-04-14T05:19:31Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj.art-7a47c94c46a447ce9d08c94125937c652022-12-22T02:10:14ZengElsevierThe Lancet Regional Health. Europe2666-77622022-07-0118100402Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort studyFan Tian0Qing Shen1Yihan Hu2Weimin Ye3Unnur A. Valdimarsdóttir4Huan Song5Fang Fang6Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, ChinaInstitute of Environmental Medicine, Karolinska Institute, Stockholm, SwedenInstitute of Environmental Medicine, Karolinska Institute, Stockholm, SwedenDepartment of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, SwedenInstitute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USAWest China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China; Corresponding author at: West China Biomedical Big Data Center, West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China.Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Corresponding author.Summary: Background: Prior research provides suggestive evidence on an association between stress-related disorders and mortality. No previous study has however addressed the role of familial confounding on such association. Methods: We conducted a nationwide cohort study of 189,757 individuals with a first-onset stress-related disorder between January 1, 1981 and December 31, 2016 in Sweden (i.e., exposed patients), 1,896,352 matched unexposed individuals, and 207,479 unaffected full siblings of the exposed patients. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cause-specific mortality. Findings: During a mean follow-up of 9.42 years, an elevated risk of all-cause mortality was observed during the entire follow-up among patients with stress-related disorders, compared with either unexposed individuals or their unaffected full siblings. Such excess risk was most pronounced within the first year after diagnosis of stress-related disorders (HR, 3.19 [95% CI, 2.87-3.54] in population-based comparison; HR, 3.21 [95% CI, 2.56-4.02] in sibling-based comparison). The excess risk decreased but remained statistically significant thereafter (HR, 1.64 [95% CI, 1.60-1.67] in population-based comparison; HR, 1.61 [95% CI, 1.54-1.68] in sibling-based comparison). An increased risk was observed for almost all cause-specific mortality, with greater risk increase for deaths from unnatural causes, especially suicide, and potentially avoidable causes. Interpretation: Stress-related disorders were associated with an increased risk of all-cause mortality and multiple cause-specific mortality, and the risk elevation was independent of familial confounding. The excess mortality attributable to unnatural causes and potentially avoidable causes highlights the importance of clinical surveillance of major health hazards among patients with stress-related disorders. Funding: EU Horizon 2020 Research and Innovation Action Grant, 1.3.5 Project for Disciplines of Excellence at West China Hospital of Sichuan University, National Natural Science Foundation of China, Icelandic Research Fund (Grant of Excellence), ERC Consolidator Grant, and Swedish Research Council.http://www.sciencedirect.com/science/article/pii/S2666776222000953Stress-related disordersPost-traumatic stress disorderReaction to severe stressAll-cause mortalityCause-specific mortalityAvoidable mortality |
| spellingShingle | Fan Tian Qing Shen Yihan Hu Weimin Ye Unnur A. Valdimarsdóttir Huan Song Fang Fang Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study The Lancet Regional Health. Europe Stress-related disorders Post-traumatic stress disorder Reaction to severe stress All-cause mortality Cause-specific mortality Avoidable mortality |
| title | Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study |
| title_full | Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study |
| title_fullStr | Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study |
| title_full_unstemmed | Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study |
| title_short | Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study |
| title_sort | association of stress related disorders with subsequent risk of all cause and cause specific mortality a population based and sibling controlled cohort study |
| topic | Stress-related disorders Post-traumatic stress disorder Reaction to severe stress All-cause mortality Cause-specific mortality Avoidable mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2666776222000953 |
| work_keys_str_mv | AT fantian associationofstressrelateddisorderswithsubsequentriskofallcauseandcausespecificmortalityapopulationbasedandsiblingcontrolledcohortstudy AT qingshen associationofstressrelateddisorderswithsubsequentriskofallcauseandcausespecificmortalityapopulationbasedandsiblingcontrolledcohortstudy AT yihanhu associationofstressrelateddisorderswithsubsequentriskofallcauseandcausespecificmortalityapopulationbasedandsiblingcontrolledcohortstudy AT weiminye associationofstressrelateddisorderswithsubsequentriskofallcauseandcausespecificmortalityapopulationbasedandsiblingcontrolledcohortstudy AT unnuravaldimarsdottir associationofstressrelateddisorderswithsubsequentriskofallcauseandcausespecificmortalityapopulationbasedandsiblingcontrolledcohortstudy AT huansong associationofstressrelateddisorderswithsubsequentriskofallcauseandcausespecificmortalityapopulationbasedandsiblingcontrolledcohortstudy AT fangfang associationofstressrelateddisorderswithsubsequentriskofallcauseandcausespecificmortalityapopulationbasedandsiblingcontrolledcohortstudy |