Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area
Background People with schizophrenia have a high premature mortality risk. Obesity is a key potential underlying risk factor that is relatively unevaluated to date.Aims In this study, we investigated the associations of routinely recorded body size with all-cause mortality and deaths from common cau...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | General Psychiatry |
| Online Access: | https://gpsych.bmj.com/content/35/5/e100819.full |
| _version_ | 1811233900532334592 |
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| author | Robert Stewart Hitesh Shetty Matthew Broadbent Jianhua Chen Yifeng Xu Gayan Perera |
| author_facet | Robert Stewart Hitesh Shetty Matthew Broadbent Jianhua Chen Yifeng Xu Gayan Perera |
| author_sort | Robert Stewart |
| collection | DOAJ |
| description | Background People with schizophrenia have a high premature mortality risk. Obesity is a key potential underlying risk factor that is relatively unevaluated to date.Aims In this study, we investigated the associations of routinely recorded body size with all-cause mortality and deaths from common causes in a large cohort of people with schizophrenia spectrum disorders.Methods We assembled a retrospective observational cohort using data from a large mental health service in South London. We followed all patients over the age of 18 years with a clinical diagnosis of schizophrenia spectrum disorders from the date of their first recorded body mass index (BMI) between 1 January 2007 and 31 March 2018.Results Of 11 900 patients with a BMI recording, 1566 died. The Cox proportional hazards regression models, after adjusting for sociodemographic, socioeconomic variables and comorbidities, indicated that all-cause mortality was only associated with underweight status compared with healthy weight status (hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.01 to 1.76). Obesity (HR: 1.24, 95% CI: 1.01 to 1.52) and morbid obesity (HR: 1.54, 95% CI: 1.03 to 2.42) were associated with all-cause mortality in the 18–45 years age range, and obesity was associated with lower risk (HR: 0.66, 95% CI: 0.50 to 0.87) in those aged 65+ years. Cancer mortality was raised in underweight individuals (HR: 1.93, 95% CI: 1.03 to 4.10) and respiratory disease mortality raised in those with morbid obesity (HR: 2.17, 95% CI: 1.02 to 5.22).Conclusions Overall, being underweight was associated with higher mortality in this disorder group; however, this was potentially accounted for by frailty in older age groups, and obesity was a risk factor for premature mortality in younger ages. The impact of obesity on life expectancy for people with schizophrenia spectrum disorders is clear from our findings. A deeper biological understanding of the relationship between these diseases and schizophrenia will help improve clinical practice. |
| first_indexed | 2024-04-12T11:26:56Z |
| format | Article |
| id | doaj.art-c7f3d850a44d41dbbe382e81e2f90e3b |
| institution | Directory Open Access Journal |
| issn | 2517-729X |
| language | English |
| last_indexed | 2024-04-12T11:26:56Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | General Psychiatry |
| spelling | doaj.art-c7f3d850a44d41dbbe382e81e2f90e3b2022-12-22T03:35:12ZengBMJ Publishing GroupGeneral Psychiatry2517-729X2022-11-0135510.1136/gpsych-2022-100819Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment areaRobert Stewart0Hitesh Shetty1Matthew Broadbent2Jianhua Chen3Yifeng Xu4Gayan Perera5Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King`s College London, London, UKInstitute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UKNational Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UKShanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China1 Shanghai Mental Health Center Editorial Office, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaPsychological Medicine, King`s College London (Institute of Psychiatry, Psychology and Neuroscience), London, UKBackground People with schizophrenia have a high premature mortality risk. Obesity is a key potential underlying risk factor that is relatively unevaluated to date.Aims In this study, we investigated the associations of routinely recorded body size with all-cause mortality and deaths from common causes in a large cohort of people with schizophrenia spectrum disorders.Methods We assembled a retrospective observational cohort using data from a large mental health service in South London. We followed all patients over the age of 18 years with a clinical diagnosis of schizophrenia spectrum disorders from the date of their first recorded body mass index (BMI) between 1 January 2007 and 31 March 2018.Results Of 11 900 patients with a BMI recording, 1566 died. The Cox proportional hazards regression models, after adjusting for sociodemographic, socioeconomic variables and comorbidities, indicated that all-cause mortality was only associated with underweight status compared with healthy weight status (hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.01 to 1.76). Obesity (HR: 1.24, 95% CI: 1.01 to 1.52) and morbid obesity (HR: 1.54, 95% CI: 1.03 to 2.42) were associated with all-cause mortality in the 18–45 years age range, and obesity was associated with lower risk (HR: 0.66, 95% CI: 0.50 to 0.87) in those aged 65+ years. Cancer mortality was raised in underweight individuals (HR: 1.93, 95% CI: 1.03 to 4.10) and respiratory disease mortality raised in those with morbid obesity (HR: 2.17, 95% CI: 1.02 to 5.22).Conclusions Overall, being underweight was associated with higher mortality in this disorder group; however, this was potentially accounted for by frailty in older age groups, and obesity was a risk factor for premature mortality in younger ages. The impact of obesity on life expectancy for people with schizophrenia spectrum disorders is clear from our findings. A deeper biological understanding of the relationship between these diseases and schizophrenia will help improve clinical practice.https://gpsych.bmj.com/content/35/5/e100819.full |
| spellingShingle | Robert Stewart Hitesh Shetty Matthew Broadbent Jianhua Chen Yifeng Xu Gayan Perera Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area General Psychiatry |
| title | Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area |
| title_full | Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area |
| title_fullStr | Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area |
| title_full_unstemmed | Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area |
| title_short | Body mass index and mortality in patients with schizophrenia spectrum disorders: a cohort study in a South London catchment area |
| title_sort | body mass index and mortality in patients with schizophrenia spectrum disorders a cohort study in a south london catchment area |
| url | https://gpsych.bmj.com/content/35/5/e100819.full |
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