Characterising recent mortality trends in people with bipolar disorder and schizophrenia in England using linked hospital and mortality data

Student thesis: Doctoral ThesisDoctor of Medicine


Background and objectives Mortality is higher in people with severe mental illness than others. An important policy goal is to reduce this ’mortality gap’. The objectives of this thesis were to investigate whether the gap has reduced in recent years in people with bipolar disorder or schizophrenia, to quantify the extent of ’avoidable mortality’ in these people, and to investigate whether the excess mortality risk extends to people with a physical illness as a main diagnosis and comorbid SMI. Method Three separate record linkage studies were undertaken study using Hospital Episode Statistics and death registration data about patients discharged from inpatient care in England between 1999 and 2007. Results Findings showed that the mortality gap widened over the last decade for people with bipolar disorder and schizophrenia. For people discharged with bipolar disorder the SMR increased from 1.3 to 1.9 between 1999 and 2006 (Poisson test of trend, P=0.06). Whilst for people discharged with schizophrenia the SMR increased from 1.6 to 2.2 (P<.001). Potentially avoidable deaths comprised 59-2% and 60.2% of all deaths in people with a diagnosis of bipolar disorder and schizophrenia respectively. The results showed that comorbidity with mental illness in people with a main diagnosis of CVD causes between 12-46% excess deaths compared with those without mental comorbidity, and between 43-68% excess deaths in people with a main diagnosis of Diabetes. Conclusion The total burden of premature deaths in these populations is substantial and increasing. excess in SMI by about 50%, but not eliminate it entirely. These results strongly point to the need for better understanding of the reasons for the persistent mortality gap; and for continued action to target risk factors for both natural and unnatural causes of death in people with SM
Date of Award13 Apr 2013
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorRobert Stewart (Supervisor) & Michael Goldacre (Supervisor)

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