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Mortality trends in cardiovascular disease in schizophrenia in Sweden

Mortality trends in cardiovascular disease in schizophrenia in Sweden. Urban Ösby MD, PhD, Senior Consultant Psykiatri Nordöst, Stockholm County Council Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. urban.osby@sll.se. Declaration of interest: Urban Ösby.

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Mortality trends in cardiovascular disease in schizophrenia in Sweden

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  1. Mortality trends in cardiovascular disease in schizophrenia in Sweden Urban Ösby MD, PhD, Senior Consultant Psykiatri Nordöst, Stockholm County Council Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden urban.osby@sll.se

  2. Declaration of interest: Urban Ösby Grant support: Stockholm County Council, NARSAD, Bristol-Myers Squibb, Janssen-Cilag Advisory Board/Consultant: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Pfizer Speakers Bureau: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Pfizer

  3. Risk factors for cardiovascular disase

  4. Cardiovascular disease: A Multifactorial Condition Diabetes Lipids ENVIRONMENTAL Hypertension Obesity GENETIC Diet Vasculardisease Age Smoking Gender Sedentary lifestyle Family history Thromboticfactors

  5. Cardiovascular Timeline Foam Cells Fatty Streak Intermediate Lesion Fibrous Plaque Complicated Lesion/Rupture Atheroma Endothelial dysfunction From first decade From third decade From fourth decade Thrombosis, haematoma Smooth muscle and collagen Growth mainly by lipid accumulation Adapted from Stary HC et al. Circulation 1995;92:1355-1374.

  6. L. Wallentin 2000 Causes of death related to age and sex in Sweden Ref: Socialstyrelsen (1997). Hälso- och sjukvårdsstatistisk årsbok 1997. Socialstyrelsen, Stockholm. Inledn./sid 1

  7. SMR (Observed/Expected) for schizophrenia patients in Stockholm County 1973-95 SMR 1 5 10 15 20 25 Infectious Cancer Endocrine Mental Nervous system Cardiovascular Males Cerebrovascular Females Respiratory Gastrointestinal Urogenital Accidents Suicide Undet violence All causes 5 10 15 20 25 1

  8. SMR (Observed/Expected) and Excess deaths (Observed-Expected) for patients with schizophrenia in Stockholm County 1973-95 Ref: Osby U, et al. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000;45(1-2):21-8.

  9. Natural 264 47% Excess deaths by natural and unnatural causes for schizophrenia patients in Stockholm County 73-95 Men Women Unnatural 218 38% Natural 352 62% Unnatural 296 53% Ref: Osby U, et al. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000;45(1-2):21-8.

  10. SMR (O/E) and Excess deaths (O–E) for patients with bipolar disorder in Sweden 1973-95 Ref: Osby U, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58(9):844-50.

  11. SMR (O/E) and Excess deaths (O-E) for patients with unipolar disorder in Sweden 1973-95 Ref: Osby U, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58(9):844-50.

  12. Mortality in the population in Stockholm County Standardized by the sex- and age distribution of patients with schizophrenia in Stockholm County 1976-95 Deaths/100 000 1000 900 800 700 All deaths Natural causes of death 600 500 400 300 Cardiovascular deaths 200 100 Violent deaths Suicide 0 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95

  13. Mortality trends in Stockholm county 1976-94, all causes of death Deaths/100 000 1976 year of reference 1.4 Patients with schizophrenia* 1.2 1 0.8 General population** 0.6 0.4 0.2 0 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 * Controlling for age at first diagnosis and years of follow-up **Standardized by the sex and age distribution of the patients Ref: Osby U, et al. Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. Bmj 2000;321(7259):483-4.

  14. Mortality trends in Stockholm county 1976-79 to 1990-95, natural causes of death Deaths/100 000 76-79 period of reference 1.4 Patients with schizophrenia* 1.2 1 0.8 General population** 0.6 0.4 0.2 0 76-79 80-85 86-89 90-95 * Controlling for age at first diagnosis and years of follow-up **Standardized by the sex and age distribution of the patients

  15. Mortality trends in Stockholm County 1976-79 to 1990-95, cardiovascular causes of death Deaths/100 000 76-79 period of reference 1.4 Patients with schizophrenia* 1.2 1 0.8 0.6 General population** 0.4 0.2 0 76-79 80-85 86-89 90-95 * Controlling for age at first diagnosis and years of follow-up **Standardized by the sex and age distribution of the patients Ref: Osby U, et al. Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. Bmj 2000;321(7259):483-4.

  16. Mortality trends in Sweden 1970-2003 adjusted for age Men

  17. Mortality trends in Sweden 1970-2003adjusted for age

  18. SMR for schizophrenia in Sweden 1970-2003

  19. Time trends for SMR for all causes of death(p<.0001)

  20. Time trends for SMR for cardiovascular death(p<.0001)

  21. Time trends for SMR for death from coronary heart diseasep<.0001)

  22. Time trends for SMR for death from myocardial infarction(p<.0001)

  23. The Good News We are living longer than ever!

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