King's College London

Research portal

O3.3. COMORBID SUBSTANCE USE DISORDERS ASSOCIATED WITH LIFE EXPECTANCY REDUCTION IN PEOPLE WITH PSYCHOTIC DISORDERS: AN ELECTRONIC CASE REGISTER STUDY

Research output: Contribution to journalMeeting abstract

Original languageEnglish
Pages (from-to)S166
Number of pages1
JournalSchizophrenia Bulletin
Volume45
Issue numberS2
Early online date9 Apr 2019
DOIs
E-pub ahead of print9 Apr 2019
Published9 Apr 2019

King's Authors

Abstract

Background
People with psychotic disorders have a markedly reduced life expectancy compared to the general population. Comorbid substance use disorders (dual diagnosis) contribute towards poorer treatment engagement and worse clinical outcomes but their impact on mortality is uncertain. We estimated the association of comorbid substance use disorders with life expectancy in a large sample of patients with psychotic disorders using an electronic health record (EHR) case register.

Methods
Data were obtained from 29,412 people with schizophrenia (61.9%), schizoaffective disorder (4.9%) or bipolar disorder (33.2%) receiving mental healthcare from the South London and Maudsley NHS Foundation Trust between 1st January 2007 and 31st December 2017. The Clinical Record Interactive Search tool (CRIS) was used to extract data on age, gender, ethnicity, comorbid substance use disorders (ICD-10 F10-19) and mortality from anonymised EHRs. The Chiang II method was used to estimate life expectancy from birth associated with substance use disorders using life-table data obtained from the UK Office of National Statistics.

Results
3,657 patients had a comorbid substance use disorder of whom 70.1% were male. The most frequently documented comorbid substance use disorders were related to alcohol (44.9%), multiple drug use (31.3%) and cannabis (25.2%). 3,396 patients died during the study period. The life expectancy for patients with a comorbid substance use disorder was 63.1 years (95% CI 60.7 – 65.5) for men and 63.4 years (95% CI 60.2 – 66.7) for women. The life expectancy for patients without a comorbid substance use disorder was 65.1 years (95% CI 64.1 – 66.0) for men and 69.8 years (95% CI 68.9 – 70.8) for women. Patients with a comorbid substance use disorder were more likely to die of unnatural causes (28.5%) compared to those without (10.0%).

Discussion
Comorbid substance use disorders were most frequently recorded among male patients but associated with greatest reduction in life expectancy among female patients. Patients with a comorbid substance use disorder were almost three times more likely to die from unnatural causes (accidental, suicide or homicide). These findings demonstrate the need to better address comorbid substance use disorder in people with psychotic disorders, particularly among female patients who experienced a marked reduction of around six years in life expectancy.

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454