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Sex-stratified mortality estimates in people with schizophrenia: a systematic review and meta-analysis of cohort studies of 2,700,825 people with schizophrenia

Sex-stratified mortality estimates in people with schizophrenia: a systematic review and meta-analysis of cohort studies of 2,700,825 people with schizophrenia
Sex-stratified mortality estimates in people with schizophrenia: a systematic review and meta-analysis of cohort studies of 2,700,825 people with schizophrenia
The differential influence of sex on premature mortality in schizophrenia is unclear. This study assessed the differences in all-cause and specific cause mortality risks in people with schizophrenia compared to several control groups stratified by sex. We conducted a PRISMA 2020-compliant systematic review and random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) for people with schizophrenia, comparing by sex. We measured publication bias and conducted a quality assessment through the Newcastle-Ottawa scale. We meta-analyzed 43 studies reporting on 2,700,825 people with schizophrenia. Both males and females with schizophrenia had increased all-cause mortality vs. comparison groups (males, RR=2.62, 95%CI 2.35-2.92; females, RR=2.56, 95%CI 2.27-2.87), suicide (males, RR=9.02, 95%CI 5.96-13.67; females, RR=12.09, 95%CI 9.00-16.25), and natural cause mortality (males, RR=2.11, 95%CI 1.88-2.38; females, RR=2.14, 95%CI 1.93-2.38). No statistically significant differences in sex-dependent mortality risk emerged. There was an age-group-dependent increased mortality risk in females < 40 years vs. >/=40 years old (RR=4.23/2.17), and significantly higher risk of death due to neurological disorders (dementia) in males vs. females (RR=5.19/2.40). Increased mortality risks were often associated with specific modifiable risk factors. There were minimal statistically significant differences in sex-dependent mortality risks in people with schizophrenia. However, it revealed areas of targeted intervention efforts.
Schizophrenia; mortality; sex; antipsychotic; systematic review; meta-analysis.
0924-977X
56-66
Solmi, Marco
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Wong, Stanley
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Gupta, Arnav
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Fornaro, Michele
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Schneider, Lynne Kolton
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Fairley, Leanne
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Smith, Nathalie
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Bitter, Istvan
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Taipale, Heidi
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Firth, Joseph
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Hartman, Catharina
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Larsson, Henrik
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Lehto, Kelli
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Lindgren, Peter
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Manchia, Mirko
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Nordentoft, Merete
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Skonieczna-żydecka, Karolina
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Stubbs, Brendon
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Boyer, Laurent
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Højlund, Mikkel
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Correll, Christoph U.
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ECNP Physical And meNtal Health Thematic Working Group (PAN-Health)
Solmi, Marco
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Croatto, Giovanni
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Fabiano, Nicholas
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Wong, Stanley
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Gupta, Arnav
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Fornaro, Michele
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Schneider, Lynne Kolton
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Tiihonen, Jari
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Cortese, Samuele
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Dragioti, Elena
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Firth, Joseph
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Lehto, Kelli
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Lindgren, Peter
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Manchia, Mirko
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Stubbs, Brendon
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Vieta, Eduard
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De Prisco, Michele
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Boyer, Laurent
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Højlund, Mikkel
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Correll, Christoph U.
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Solmi, Marco, Croatto, Giovanni, Fabiano, Nicholas, Wong, Stanley, Gupta, Arnav, Fornaro, Michele, Schneider, Lynne Kolton, Rohani-Montez, S. Christy, Fairley, Leanne, Smith, Nathalie, Bitter, Istvan, Gorwood, Philip A.P.M., Taipale, Heidi, Tiihonen, Jari, Cortese, Samuele, Dragioti, Elena, Du Rietz, Ebba, Nielsen, René Ernst, Firth, Joseph, Fusar-Poli, Paolo, Hartman, Catharina, Holt, Richard I.G., Hoye, Anne, Koyanagi, Ai, Larsson, Henrik, Lehto, Kelli, Lindgren, Peter, Manchia, Mirko, Nordentoft, Merete, Skonieczna-żydecka, Karolina, Stubbs, Brendon, Vancampfort, Davy, Vieta, Eduard, De Prisco, Michele, Boyer, Laurent, Højlund, Mikkel and Correll, Christoph U. , ECNP Physical And meNtal Health Thematic Working Group (PAN-Health) (2024) Sex-stratified mortality estimates in people with schizophrenia: a systematic review and meta-analysis of cohort studies of 2,700,825 people with schizophrenia. European Neuropsychopharmacology, 91, 56-66. (doi:10.1016/j.euroneuro.2024.11.001).

Record type: Article

Abstract

The differential influence of sex on premature mortality in schizophrenia is unclear. This study assessed the differences in all-cause and specific cause mortality risks in people with schizophrenia compared to several control groups stratified by sex. We conducted a PRISMA 2020-compliant systematic review and random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) for people with schizophrenia, comparing by sex. We measured publication bias and conducted a quality assessment through the Newcastle-Ottawa scale. We meta-analyzed 43 studies reporting on 2,700,825 people with schizophrenia. Both males and females with schizophrenia had increased all-cause mortality vs. comparison groups (males, RR=2.62, 95%CI 2.35-2.92; females, RR=2.56, 95%CI 2.27-2.87), suicide (males, RR=9.02, 95%CI 5.96-13.67; females, RR=12.09, 95%CI 9.00-16.25), and natural cause mortality (males, RR=2.11, 95%CI 1.88-2.38; females, RR=2.14, 95%CI 1.93-2.38). No statistically significant differences in sex-dependent mortality risk emerged. There was an age-group-dependent increased mortality risk in females < 40 years vs. >/=40 years old (RR=4.23/2.17), and significantly higher risk of death due to neurological disorders (dementia) in males vs. females (RR=5.19/2.40). Increased mortality risks were often associated with specific modifiable risk factors. There were minimal statistically significant differences in sex-dependent mortality risks in people with schizophrenia. However, it revealed areas of targeted intervention efforts.

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Sex-stratified mortality estimates in people with schizophrenia - Accepted Manuscript
Restricted to Repository staff only until 2 December 2025.
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Accepted/In Press date: 4 November 2024
e-pub ahead of print date: 2 December 2024
Published date: 2 December 2024
Keywords: Schizophrenia; mortality; sex; antipsychotic; systematic review; meta-analysis.
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Identifiers

Local EPrints ID: 496562
URI: http://eprints.soton.ac.uk/id/eprint/496562
DOI: doi:10.1016/j.euroneuro.2024.11.001
ISSN: 0924-977X
PURE UUID: 7d437661-4b2c-4939-b98e-510571be4dd5
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 19 Dec 2024 17:34
Last modified: 20 Dec 2024 02:47

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Contributors

Author: Marco Solmi
Author: Giovanni Croatto
Author: Nicholas Fabiano
Author: Stanley Wong
Author: Arnav Gupta
Author: Michele Fornaro
Author: Lynne Kolton Schneider
Author: S. Christy Rohani-Montez
Author: Leanne Fairley
Author: Nathalie Smith
Author: Istvan Bitter
Author: Philip A.P.M. Gorwood
Author: Heidi Taipale
Author: Jari Tiihonen
Author: Samuele Cortese ORCID iD
Author: Elena Dragioti
Author: Ebba Du Rietz
Author: René Ernst Nielsen
Author: Joseph Firth
Author: Paolo Fusar-Poli
Author: Catharina Hartman
Author: Richard I.G. Holt
Author: Anne Hoye
Author: Ai Koyanagi
Author: Henrik Larsson
Author: Kelli Lehto
Author: Peter Lindgren
Author: Mirko Manchia
Author: Merete Nordentoft
Author: Karolina Skonieczna-żydecka
Author: Brendon Stubbs
Author: Davy Vancampfort
Author: Eduard Vieta
Author: Michele De Prisco
Author: Laurent Boyer
Author: Mikkel Højlund
Author: Christoph U. Correll
Corporate Author: ECNP Physical And meNtal Health Thematic Working Group (PAN-Health)

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