Psychological Medicine

Original Articles

Long-term mortality of persons with severe mental illness and diabetes: a population-based cohort study in Denmark

A. R. Ribea1 c1, T. M. Laursena2, A. Sandbaeka3, M. Charlesa3, M. Nordentofta4 and M. Vestergaarda1a3

a1 Research Unit for General Practice, Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark

a2 National Center for Register-Based Research, Faculty of Social Sciences, Aarhus University, Aarhus, Denmark

a3 Section for General Practice, Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark

a4 Psychiatric Center Copenhagen, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark

Abstract

Background Persons with severe mental illness (SMI) have excess mortality, which may partly be explained by their high prevalence of diabetes.

Method We compared the overall and cause-specific mortality in persons with SMI and diabetes with that of the general Danish population between 1997 and 2009 by linking data from Danish national registries.

Results The cohort counted 4 734 703 persons, and during follow-up 651 080 persons died of whom 1083 persons had SMI and diabetes. Compared with the background population, the overall mortality rate ratios (MRRs) for persons with SMI and diabetes were 4.14 [95% confidence interval (CI) 3.81–4.51] for men and 3.13 (95% CI 2.88–3.40) for women. The cause-specific MRRs for persons with SMI and diabetes were lowest for malignant neoplasms (women: MRR = 1.98, 95% CI 1.64–2.39; men: MRR = 2.08, 95% CI 1.69–2.56) and highest for unnatural causes of death (women: MRR = 12.31, 95% CI 6.80–22.28; men: MRR = 7.89, 95% CI 5.51–11.29). The cumulative risks of death within 7 years of diabetes diagnosis for persons with SMI and diabetes were 15.0% (95% CI 12.4–17.6%) for those younger than 50 years, 30.7% (95% CI 27.8–33.4%) for those aged 50–69 years, and 63.8% (95% CI 58.9–68.2%) for those aged 70 years or older. Among persons suffering from both diseases, 33.4% of natural deaths were attributed to diabetes and 14% of natural deaths were attributed to the interaction between diabetes and SMI.

Conclusions Long-term mortality is high for persons with SMI and diabetes. This calls for effective intervention from a coordinated and collaborating healthcare system.

(Received September 27 2013)

(Revised January 10 2014)

(Accepted January 21 2014)

(Online publication March 24 2014)

Key words

  • Bipolar affective disorder;
  • diabetes mellitus;
  • mortality;
  • schizophrenia;
  • severe mental illness

Correspondence

c1 Address for correspondence: A. R. Ribe, M.D., Research Unit for General Practice, Department of Public Health, Faculty of Health Sciences, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark. (Email: ar@alm.au.dk)

Footnotes

  This study was presented orally at the 15th European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) and the 29th European Conference on Psychosomatic Research (ECPR), Aarhus University, 28 June 2012.

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