TY - JOUR
T1 - Sex-stratified mortality estimates in people with schizophrenia
T2 - A systematic review and meta-analysis of cohort studies of 2,700,825 people with schizophrenia
AU - ECNP Physical And meNtal Health Thematic Working Group (PAN-Health)
AU - Solmi, Marco
AU - Croatto, Giovanni
AU - Fabiano, Nicholas
AU - Wong, Stanley
AU - Gupta, Arnav
AU - Fornaro, Michele
AU - Schneider, Lynne Kolton
AU - Rohani-Montez, S. Christy
AU - Fairley, Leanne
AU - Smith, Nathalie
AU - Bitter, István
AU - Gorwood, Philip
AU - Taipale, Heidi
AU - Tiihonen, Jari
AU - Cortese, Samuele
AU - Dragioti, Elena
AU - Rietz, Ebba Du
AU - Nielsen, Rene Ernst
AU - Firth, Joseph
AU - Fusar-Poli, Paolo
AU - Hartman, Catharina
AU - Holt, Richard I.G.
AU - Høye, Anne
AU - Koyanagi, Ai
AU - Larsson, Henrik
AU - Lehto, Kelli
AU - Lindgren, Peter
AU - Manchia, Mirko
AU - Nordentoft, Merete
AU - Skonieczna-Żydecka, Karolina
AU - Stubbs, Brendon
AU - Vancampfort, Davy
AU - Vieta, Eduard
AU - De Prisco, Michele
AU - Boyer, Laurent
AU - Højlund, Mikkel
AU - Correll, Christoph U.
N1 - Publisher Copyright:
© 2024
PY - 2025/2
Y1 - 2025/2
N2 - 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. The increased mortality risk did not improve over time, calling for more studies to identify modifiable factors, and for better physical healthcare for males and females with schizophrenia.
AB - 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. The increased mortality risk did not improve over time, calling for more studies to identify modifiable factors, and for better physical healthcare for males and females with schizophrenia.
KW - Antipsychotic
KW - Meta-analysis
KW - Mortality
KW - Schizophrenia
KW - Sex
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85210747597&partnerID=8YFLogxK
U2 - 10.1016/j.euroneuro.2024.11.001
DO - 10.1016/j.euroneuro.2024.11.001
M3 - Review article
AN - SCOPUS:85210747597
SN - 0924-977X
VL - 91
SP - 56
EP - 66
JO - European Neuropsychopharmacology
JF - European Neuropsychopharmacology
ER -
