Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records

Pirathiv Kugathasan; Honghan Wu; Fiona Gaughran; René Ernst Nielsen; Megan Pritchard; Richard Dobson; Robert Stewart; Brendon Stubbs

doi:10.1016/j.schres.2019.10.061

Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records

Pirathiv Kugathasan, Honghan Wu, Fiona Gaughran, René Ernst Nielsen, Megan Pritchard, Richard Dobson, Robert Stewart, Brendon Stubbs

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

Abstract

OBJECTIVE: Single physical comorbidities have been associated with the premature mortality in people with schizophrenia-spectrum disorders (SSD). We investigated the association of physical multimorbidity (≥two physical health conditions) with mortality in people with SSD.

METHODS: A retrospective cohort study between 2013 and 2017. All people with a diagnosis of SSD (ICD-10: F20-F29), who had contact with secondary mental healthcare within South London during 2011-2012 were included. A novel semantic search system captured conditions from electronic mental health records, and all-cause mortality were retrieved. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for associations between physical multimorbidity and all-cause mortality.

RESULTS: Among the 9775 people with SSD (mean (SD) age, 45.9 (15.4); males, 59.3%), 6262 (64%) had physical multimorbidity, and 880 (9%) died during the 5-year follow-up. The top three physical multimorbidity combinations with highest mortality were cardiovascular-respiratory (HR: 2.23; 95% CI, 1.49-3.32), respiratory-skin (HR: 2.06; 95% CI, 1.31-3.24), and respiratory-digestive (HR: 1.88; 95% CI, 1.14-3.11), when adjusted for age, gender, and all other physical disease systems. Combinations of physical diseases with highest PAFs were cardiovascular-respiratory (PAF: 35.7%), neurologic-respiratory (PAF: 32.7%), as well as respiratory-skin (PAF: 29.8%).

CONCLUSIONS: Approximately 2/3 of patients with SSD had physical multimorbidity and the risk of mortality in these patients was further increased compared to those with none or single physical conditions. These findings suggest that in order to reduce the physical health burden and subsequent mortality in people with SSD, proactive coordinated prevention and management efforts are required and should extend beyond the current focus on single physical comorbidities.

Original language	English
Journal	Schizophrenia Research
DOIs	https://doi.org/10.1016/j.schres.2019.10.061
Publication status	E-pub ahead of print - 28 Nov 2019

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Kugathasan, P., Wu, H., Gaughran, F., Nielsen, R. E., Pritchard, M., Dobson, R., Stewart, R., & Stubbs, B. (2019). Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records. Schizophrenia Research. Advance online publication. https://doi.org/10.1016/j.schres.2019.10.061

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title = "Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records",

abstract = "OBJECTIVE: Single physical comorbidities have been associated with the premature mortality in people with schizophrenia-spectrum disorders (SSD). We investigated the association of physical multimorbidity (≥two physical health conditions) with mortality in people with SSD.METHODS: A retrospective cohort study between 2013 and 2017. All people with a diagnosis of SSD (ICD-10: F20-F29), who had contact with secondary mental healthcare within South London during 2011-2012 were included. A novel semantic search system captured conditions from electronic mental health records, and all-cause mortality were retrieved. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for associations between physical multimorbidity and all-cause mortality.RESULTS: Among the 9775 people with SSD (mean (SD) age, 45.9 (15.4); males, 59.3%), 6262 (64%) had physical multimorbidity, and 880 (9%) died during the 5-year follow-up. The top three physical multimorbidity combinations with highest mortality were cardiovascular-respiratory (HR: 2.23; 95% CI, 1.49-3.32), respiratory-skin (HR: 2.06; 95% CI, 1.31-3.24), and respiratory-digestive (HR: 1.88; 95% CI, 1.14-3.11), when adjusted for age, gender, and all other physical disease systems. Combinations of physical diseases with highest PAFs were cardiovascular-respiratory (PAF: 35.7%), neurologic-respiratory (PAF: 32.7%), as well as respiratory-skin (PAF: 29.8%).CONCLUSIONS: Approximately 2/3 of patients with SSD had physical multimorbidity and the risk of mortality in these patients was further increased compared to those with none or single physical conditions. These findings suggest that in order to reduce the physical health burden and subsequent mortality in people with SSD, proactive coordinated prevention and management efforts are required and should extend beyond the current focus on single physical comorbidities.",

author = "Pirathiv Kugathasan and Honghan Wu and Fiona Gaughran and Nielsen, {Ren{\'e} Ernst} and Megan Pritchard and Richard Dobson and Robert Stewart and Brendon Stubbs",

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doi = "10.1016/j.schres.2019.10.061",

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Kugathasan, P, Wu, H, Gaughran, F, Nielsen, RE, Pritchard, M , Dobson, R , Stewart, R & Stubbs, B 2019, 'Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records', Schizophrenia Research. https://doi.org/10.1016/j.schres.2019.10.061

Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records. / Kugathasan, Pirathiv; Wu, Honghan; Gaughran, Fiona et al.
In: Schizophrenia Research, 28.11.2019.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders

T2 - Using a novel semantic search system that captures physical diseases in electronic patient records

AU - Kugathasan, Pirathiv

AU - Wu, Honghan

AU - Gaughran, Fiona

AU - Nielsen, René Ernst

AU - Pritchard, Megan

AU - Dobson, Richard

AU - Stewart, Robert

AU - Stubbs, Brendon

PY - 2019/11/28

Y1 - 2019/11/28

N2 - OBJECTIVE: Single physical comorbidities have been associated with the premature mortality in people with schizophrenia-spectrum disorders (SSD). We investigated the association of physical multimorbidity (≥two physical health conditions) with mortality in people with SSD.METHODS: A retrospective cohort study between 2013 and 2017. All people with a diagnosis of SSD (ICD-10: F20-F29), who had contact with secondary mental healthcare within South London during 2011-2012 were included. A novel semantic search system captured conditions from electronic mental health records, and all-cause mortality were retrieved. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for associations between physical multimorbidity and all-cause mortality.RESULTS: Among the 9775 people with SSD (mean (SD) age, 45.9 (15.4); males, 59.3%), 6262 (64%) had physical multimorbidity, and 880 (9%) died during the 5-year follow-up. The top three physical multimorbidity combinations with highest mortality were cardiovascular-respiratory (HR: 2.23; 95% CI, 1.49-3.32), respiratory-skin (HR: 2.06; 95% CI, 1.31-3.24), and respiratory-digestive (HR: 1.88; 95% CI, 1.14-3.11), when adjusted for age, gender, and all other physical disease systems. Combinations of physical diseases with highest PAFs were cardiovascular-respiratory (PAF: 35.7%), neurologic-respiratory (PAF: 32.7%), as well as respiratory-skin (PAF: 29.8%).CONCLUSIONS: Approximately 2/3 of patients with SSD had physical multimorbidity and the risk of mortality in these patients was further increased compared to those with none or single physical conditions. These findings suggest that in order to reduce the physical health burden and subsequent mortality in people with SSD, proactive coordinated prevention and management efforts are required and should extend beyond the current focus on single physical comorbidities.

AB - OBJECTIVE: Single physical comorbidities have been associated with the premature mortality in people with schizophrenia-spectrum disorders (SSD). We investigated the association of physical multimorbidity (≥two physical health conditions) with mortality in people with SSD.METHODS: A retrospective cohort study between 2013 and 2017. All people with a diagnosis of SSD (ICD-10: F20-F29), who had contact with secondary mental healthcare within South London during 2011-2012 were included. A novel semantic search system captured conditions from electronic mental health records, and all-cause mortality were retrieved. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for associations between physical multimorbidity and all-cause mortality.RESULTS: Among the 9775 people with SSD (mean (SD) age, 45.9 (15.4); males, 59.3%), 6262 (64%) had physical multimorbidity, and 880 (9%) died during the 5-year follow-up. The top three physical multimorbidity combinations with highest mortality were cardiovascular-respiratory (HR: 2.23; 95% CI, 1.49-3.32), respiratory-skin (HR: 2.06; 95% CI, 1.31-3.24), and respiratory-digestive (HR: 1.88; 95% CI, 1.14-3.11), when adjusted for age, gender, and all other physical disease systems. Combinations of physical diseases with highest PAFs were cardiovascular-respiratory (PAF: 35.7%), neurologic-respiratory (PAF: 32.7%), as well as respiratory-skin (PAF: 29.8%).CONCLUSIONS: Approximately 2/3 of patients with SSD had physical multimorbidity and the risk of mortality in these patients was further increased compared to those with none or single physical conditions. These findings suggest that in order to reduce the physical health burden and subsequent mortality in people with SSD, proactive coordinated prevention and management efforts are required and should extend beyond the current focus on single physical comorbidities.

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DO - 10.1016/j.schres.2019.10.061

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SN - 0920-9964

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JF - Schizophrenia Research

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Kugathasan P, Wu H, Gaughran F, Nielsen RE, Pritchard M , Dobson R et al. Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records. Schizophrenia Research. 2019 Nov 28. Epub 2019 Nov 28. doi: 10.1016/j.schres.2019.10.061