Regional differences in mortality risk and in attenuating or aggravating factors in schizophrenia: a systematic review and meta-analysis.
Regional differences in mortality risk and in attenuating or aggravating factors in schizophrenia: a systematic review and meta-analysis.
People with schizophrenia die prematurely, yet regional differences are unclear.
PRISMA 2020-compliant systematic review/random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) versus any control group, and moderators, in people with ICD/DSM-defined schizophrenia, comparing countries and continents. We conducted subgroup, meta-regression analyses, and quality assessment. The primary outcome was all-cause mortality. Secondary outcomes were suicide-, /natural-cause- and other-cause-related mortality.
We included 135 studies from Europe (n=70), North-America (n=29), Asia (n=33), Oceania (n=2), Africa (n=1). In incident plus prevalent schizophrenia, differences across continents emerged for all-cause mortality (highest in Africa, RR=5.98, 95%C.I.=4.09-8.74, k=1, lowest in North-America, RR=2.14, 95%C.I.=1.92-2.38, k=16), suicide (highest in Oceania, RR=13.5, 95%C.I.=10.08-18.07, k=1, lowest in North-America, RR=4.4, 95%C.I.=4.07-4.76, k=6), but not for natural-cause mortality. Europe had the largest association between antipsychotics and lower all-cause mortality/suicide (Asia had the smallest or no significant association, respectively), without differences for natural-cause mortality. Higher country socio-demographic index significantly moderated larger suicide-related and smaller natural-cause-related mortality risk in incident schizophrenia, with reversed associations in prevalent schizophrenia. Antipsychotics had a larger/smaller protective association in incident/prevalent schizophrenia regarding all-cause mortality, and smaller protective association for suicide-related mortality in prevalent schizophrenia. Additional regional differences emerged in incident schizophrenia, across countries, and secondary outcomes.
Significant regional differences emerged for all-cause, cause-specific and suicide-related mortality. Natural-cause death was homogeneously increased globally. Moderators differed across countries. Global initiatives are needed to improve physical health in people with schizophrenia, local studies to identify actionable moderators.
Solmi, Marco
e2a424fb-1416-45c4-a39a-4b7ab26ecc9a
Croatto, Giovanni
0c90e3b6-c85f-436d-b49c-a0bf9a51cecb
Fornaro, Michele
efc30c69-8113-44b2-8e33-62cfa95b84ee
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
for the ECNP Physical and meNtal Thematic Working Group (PAN-Health)
Solmi, Marco
e2a424fb-1416-45c4-a39a-4b7ab26ecc9a
Croatto, Giovanni
0c90e3b6-c85f-436d-b49c-a0bf9a51cecb
Fornaro, Michele
efc30c69-8113-44b2-8e33-62cfa95b84ee
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
Solmi, Marco, Croatto, Giovanni and Fornaro, Michele
,
et al. and for the ECNP Physical and meNtal Thematic Working Group (PAN-Health)
(2023)
Regional differences in mortality risk and in attenuating or aggravating factors in schizophrenia: a systematic review and meta-analysis.
European Neuropsychopharmacology.
(In Press)
Abstract
People with schizophrenia die prematurely, yet regional differences are unclear.
PRISMA 2020-compliant systematic review/random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) versus any control group, and moderators, in people with ICD/DSM-defined schizophrenia, comparing countries and continents. We conducted subgroup, meta-regression analyses, and quality assessment. The primary outcome was all-cause mortality. Secondary outcomes were suicide-, /natural-cause- and other-cause-related mortality.
We included 135 studies from Europe (n=70), North-America (n=29), Asia (n=33), Oceania (n=2), Africa (n=1). In incident plus prevalent schizophrenia, differences across continents emerged for all-cause mortality (highest in Africa, RR=5.98, 95%C.I.=4.09-8.74, k=1, lowest in North-America, RR=2.14, 95%C.I.=1.92-2.38, k=16), suicide (highest in Oceania, RR=13.5, 95%C.I.=10.08-18.07, k=1, lowest in North-America, RR=4.4, 95%C.I.=4.07-4.76, k=6), but not for natural-cause mortality. Europe had the largest association between antipsychotics and lower all-cause mortality/suicide (Asia had the smallest or no significant association, respectively), without differences for natural-cause mortality. Higher country socio-demographic index significantly moderated larger suicide-related and smaller natural-cause-related mortality risk in incident schizophrenia, with reversed associations in prevalent schizophrenia. Antipsychotics had a larger/smaller protective association in incident/prevalent schizophrenia regarding all-cause mortality, and smaller protective association for suicide-related mortality in prevalent schizophrenia. Additional regional differences emerged in incident schizophrenia, across countries, and secondary outcomes.
Significant regional differences emerged for all-cause, cause-specific and suicide-related mortality. Natural-cause death was homogeneously increased globally. Moderators differed across countries. Global initiatives are needed to improve physical health in people with schizophrenia, local studies to identify actionable moderators.
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Accepted/In Press date: 21 December 2023
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Full list of authors: Marco Solmi, Giovanni Croatto, Michele Fornaro, Lynne Kolton Schneider, S. Christy Rohani-Montez, Leanne Fairley, Nathalie Smith, István Bitter, Philip Gorwood, Heidi Taipale, Jari Tiihonen, Samuele Cortese, Elena Dragioti, Ebba Du Rietz, Rene Ernst Nielsen, Joseph Firth, Paolo Fusar-Poli, Catharina Hartman, Richard I G Holt, Anne Hoye, Ai Koyanagi, Henrik Larsson, Kelli Lehto, Peter Lindgren, Mirko Manchia, Merete Nordentoft, Karolina Skonieczna-Żydecka, Brendon Stubbs, Davy Vancampfort, Laurent Boyer, Michele De Prisco, Eduard Vieta, Christoph U. Correll, for the ECNP Physical And meNtal Health Thematic Working Group (PAN-Health)
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Local EPrints ID: 485929
URI: http://eprints.soton.ac.uk/id/eprint/485929
ISSN: 0924-977X
PURE UUID: d659acde-41b1-45ff-b928-94fee8e69215
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Date deposited: 04 Jan 2024 04:45
Last modified: 18 Mar 2024 03:31
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Author:
Marco Solmi
Author:
Giovanni Croatto
Author:
Michele Fornaro
Corporate Author: et al.
Corporate Author: for the ECNP Physical and meNtal Thematic Working Group (PAN-Health)
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