Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors

Kilbourne, Amy M.; Morden, Nancy E.; Austin, Karen; Ilgen, Mark; McCarthy, John F.; Dalack, Gregory; Blow, Frederic C.

doi:10.1016/j.genhosppsych.2009.07.008

« Previous Next »General Hospital Psychiatry
Volume 31, Issue 6 , Pages 555-563, November 2009

Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors

Amy M. Kilbourne, Ph.D., M.P.H.
- VA Ann Arbor HSR&D Center of Excellence and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Corresponding author. VA Ann Arbor Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA. Tel.: +1 734 845 5046; fax: +1 734 845 3249.
Nancy E. Morden, M.D., M.P.H.
- Department of Community and Family Medicine, Dartmouth Medical School and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
Karen Austin, M.P.H.
- VA Ann Arbor HSR&D Center of Excellence and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA
Mark Ilgen, Ph.D.
- VA Ann Arbor HSR&D Center of Excellence and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
John F. McCarthy, Ph.D.
- VA Ann Arbor HSR&D Center of Excellence and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
Gregory Dalack, M.D.
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
Frederic C. Blow, Ph.D.
- VA Ann Arbor HSR&D Center of Excellence and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

Received 25 February 2009; accepted 14 July 2009. published online 28 August 2009.

Abstract

Objective

People with mental disorders are estimated to die 25 years younger than the general population, and heart disease (HD) is a major contributor to their mortality. We assessed whether Veterans Affairs (VA) health system patients with mental disorders were more likely to die from HD than patients without these disorders, and whether modifiable factors may explain differential mortality risks.

Methods

Subjects included VA patients who completed the 1999 Large Health Survey of Veteran Enrollees (LHSV) and were either diagnosed with schizophrenia, bipolar disorder, other psychotic disorders, major depressive disorder or other depression diagnosis or diagnosed with none of these disorders. LHSV data on patient sociodemographic, clinical and behavioral factors (e.g., physical activity, smoking) were linked to mortality data from the National Death Index of the Centers for Disease Control and Prevention. Hierarchical multivariable Cox proportional hazards models were used to assess 8-year HD-related mortality risk by diagnosis, adding patient sociodemographic, clinical and behavioral factors.

Results

Of 147,193 respondents, 11,809 (8%) died from HD. After controlling for sociodemographic and clinical factors, we found that those with schizophrenia [hazard ratio (HR)=1.25; 95% confidence interval (95% CI): 1.15–1.36; P<.001] or other psychotic disorders (HR=1.41; 95% CI: 1.27–1.55; P<.001) were more likely to die from HD than those without mental disorders. Controlling for behavioral factors diminished, but did not eliminate, the impact of psychosis on mortality. Smoking (HR=1.32; 95% CI: 1.26–1.39; P<.001) and inadequate physical activity (HR=1.66; 95% CI: 1.59–1.74; P<.001) were also associated with HD-related mortality.

Conclusions

Patients with psychosis were more likely to die from HD. For reduction of HD-related mortality, early interventions that promote smoking cessation and physical activity among veterans with psychotic disorders are warranted.

Keywords: Heart-disease-related mortality, Mental disorders, Modifiable risk factors, Mortality