Research background
Mental disorders are associated with an increased risk of death and a shortened life expectancy. For schizophrenia, schizoaffective disorder, and bipolar disorder, life expectancy at birth is about 10-20 years shorter than in the general population. The latest evidence from the UK suggests that the risk of death may also be increasing.
A variety of explanations have been proposed, including an increase in suicides and accidental deaths, inadequate physical and mental health care, and alcoholism, illegal drug use and smoking.
Smoking can be particularly important because of its very high prevalence. In the case of schizophrenia, meta-analyses estimate that more than half of people with schizophrenia smoke. In the UK, around 45% of people with schizophrenia and 37% of people with bipolar disorder smoke, twice as many as the rest of the population. Because of these differences, they are more likely to die from smoking-related diseases. The standardized mortality rate for tobacco-related diseases was 2.45 (95% CI: 2.41-2.48) in schizophrenia and 1.57 (95% CI: 1.53-1.62) in bipolar disorder.
In the general population, the life expectancy of smokers is 7-10 years shorter than that of non-smokers. To the best of our knowledge, the effects of smoking on life expectancy in people with mental disorders have not yet been studied. In this study, the aim of the study was to estimate life expectancy at birth based on the smoking status of people clinically diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder, using data from a large electronic secondary mental health care database.
Overview of the study
Studying patients diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder in south-east London, England, from 2007 to 2018, the effects of smoking on their life expectancy and survival rates were studied. Smoking status is determined using unstructured text data extracted from electronic health records.
Finally, 20,155 patients were enrolled, of which 16,717 (77.4%) were current smokers and 3438 (15.9%) were non-smokers.
Among female participants, life expectancy at birth was 67.6 years (95% CI: 66.4-68.8) for current smokers and 74.9 years (95% CI: 72.8-77.0) for non-smokers, with a difference of 7.3 years.
Among male participants, life expectancy at birth was 63.5 years (95% CI: 62.5-64.5) for current smokers and 68.5 years (95% CI: 64.4-72.6) for non-smokers, with a difference of 5.0 years.
The adjusted survival model found that the current smoking status was different from that of females (aHR: 1.42, 95% CI: 1.21-1.66, p< 0.001) and males (aHR: 1.49; 95% CI: 1.25-1.79, p <0.001) was associated with an increased risk of death. In terms of effect size, these risks are similar to those associated with comorbid alcohol or opioid use disorders.
conclusion
Smoking may be the main cause of shortened life expectancy in psychopaths. In women with schizophrenia, schizoaffective disorder, or bipolar disorder, current smokers have a life expectancy of 7.3 years less than non-smokers. Among men, the current life expectancy of smokers is 5 years shorter.
Because smoking is so prevalent in this population, these differences will account for a large proportion of the cumulative loss of lifespan in the population. Reducing smoking in people with these diseases, if effective interventions are fully implemented, may be the most effective way to close the mortality gap between them and the general population.
![The wife suffered from schizophrenia, but the husband asked the mother's family for money, and the sister: the sister had no money[fig]](data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACwAAAAAAQABAAACAkQBADs=)