Educational attainment and mortality in schizophrenia.
cardiovascular disease
education
mortality
schizophrenia
socioeconomic
Journal
Acta psychiatrica Scandinavica
ISSN: 1600-0447
Titre abrégé: Acta Psychiatr Scand
Pays: United States
ID NLM: 0370364
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
revised:
30
01
2022
received:
30
09
2021
accepted:
01
02
2022
pubmed:
14
2
2022
medline:
14
4
2022
entrez:
13
2
2022
Statut:
ppublish
Résumé
Individuals suffering from schizophrenia have a reduced life expectancy with cardiovascular disease (CVD) as a major contributor. Low educational attainment is associated with schizophrenia, as well as with all-cause and CVD mortality. However, it is unknown to what extent low educational attainment can explain the increased mortality in individuals with schizophrenia. Here, we quantify associations between educational attainment and all-cause and CVD mortality in individuals with schizophrenia, and compare them with the corresponding associations in the general population. All Norwegian citizens born between January 1, 1925, and December 31, 1959, were followed up from January 1, 1990, to December 31, 2014. The total sample included 1,852,113 individuals, of which 6548 were registered with schizophrenia. We estimated hazard ratios (HR) for all-cause and CVD mortality with Cox models, in addition to life years lost. Educational attainment for index persons and their parents were included in the models. In the general population individuals with low educational attainment had higher risk of all-cause (HR: 1.48 [95% CI: 1.47-1.49]) and CVD (HR: 1.59 [95% CI: 1.57-1.61]) mortality. In individuals with schizophrenia these estimates were substantially lower (all-cause: HR: 1.13 [95% CI: 1.05-1.21] and CVD: HR: 1.12 [95% CI: 0.98-1.27]). Low educational attainment accounted for 3.28 (3.21-3.35) life years lost in males and 2.48 (2.42-2.55) years in females in the general population, but was not significantly associated with life years lost in individuals with schizophrenia. Results were similar for parental educational attainment. Our results indicate that while individuals with schizophrenia in general have lower educational attainment and higher mortality rates compared with the general population, the association between educational attainment and mortality is smaller in schizophrenia subjects than in the general population.
Sections du résumé
BACKGROUND
Individuals suffering from schizophrenia have a reduced life expectancy with cardiovascular disease (CVD) as a major contributor. Low educational attainment is associated with schizophrenia, as well as with all-cause and CVD mortality. However, it is unknown to what extent low educational attainment can explain the increased mortality in individuals with schizophrenia.
AIM
Here, we quantify associations between educational attainment and all-cause and CVD mortality in individuals with schizophrenia, and compare them with the corresponding associations in the general population.
METHOD
All Norwegian citizens born between January 1, 1925, and December 31, 1959, were followed up from January 1, 1990, to December 31, 2014. The total sample included 1,852,113 individuals, of which 6548 were registered with schizophrenia. We estimated hazard ratios (HR) for all-cause and CVD mortality with Cox models, in addition to life years lost. Educational attainment for index persons and their parents were included in the models.
RESULTS
In the general population individuals with low educational attainment had higher risk of all-cause (HR: 1.48 [95% CI: 1.47-1.49]) and CVD (HR: 1.59 [95% CI: 1.57-1.61]) mortality. In individuals with schizophrenia these estimates were substantially lower (all-cause: HR: 1.13 [95% CI: 1.05-1.21] and CVD: HR: 1.12 [95% CI: 0.98-1.27]). Low educational attainment accounted for 3.28 (3.21-3.35) life years lost in males and 2.48 (2.42-2.55) years in females in the general population, but was not significantly associated with life years lost in individuals with schizophrenia. Results were similar for parental educational attainment.
CONCLUSIONS
Our results indicate that while individuals with schizophrenia in general have lower educational attainment and higher mortality rates compared with the general population, the association between educational attainment and mortality is smaller in schizophrenia subjects than in the general population.
Identifiants
pubmed: 35152418
doi: 10.1111/acps.13407
pmc: PMC9305099
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
481-493Informations de copyright
© 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.
Références
Lancet. 2019 Nov 16;394(10211):1827-1835
pubmed: 31668728
Schizophr Bull. 2021 Mar 16;47(2):474-484
pubmed: 33009566
Soc Psychiatry Psychiatr Epidemiol. 2004 Feb;39(2):87-96
pubmed: 15052389
Psychiatr Serv. 2000 Feb;51(2):223-8
pubmed: 10655007
Schizophr Res. 2011 Nov;132(2-3):228-32
pubmed: 21868200
J Gen Intern Med. 2016 Sep;31(9):1083-91
pubmed: 27149967
Acta Psychiatr Scand. 2022 May;145(5):481-493
pubmed: 35152418
Sci Rep. 2021 Feb 22;11(1):4296
pubmed: 33619316
Sci Rep. 2020 Apr 7;10(1):6018
pubmed: 32265532
Nature. 2016 May 11;533(7604):539-42
pubmed: 27225129
Lancet. 2011 Aug 27;378(9793):752-3
pubmed: 21414659
JAMA Psychiatry. 2020 May 1;77(5):503-512
pubmed: 31913414
Psychol Med. 2013 Oct;43(10):2057-66
pubmed: 23298736
World Psychiatry. 2020 Feb;19(1):61-68
pubmed: 31922669
BMJ. 2016 Apr 11;353:i1732
pubmed: 27067249
Eur J Prev Cardiol. 2019 Jul;26(10):1096-1103
pubmed: 30691303
Front Psychiatry. 2014 Sep 26;5:137
pubmed: 25309466
Int J Cardiol. 2015;190:302-7
pubmed: 25935617
Schizophr Bull. 2022 Mar 1;48(2):463-473
pubmed: 34730178
PLoS One. 2020 Mar 6;15(3):e0228073
pubmed: 32142521
Nat Commun. 2018 Aug 6;9(1):3078
pubmed: 30082721
Schizophr Res. 2019 Apr;206:284-290
pubmed: 30446270
Epidemiol Psychiatr Sci. 2018 Oct;27(5):519-527
pubmed: 28580898
Psychol Med. 2020 Sep;50(12):1949-1965
pubmed: 32684198
Acta Psychiatr Scand. 2020 May;141(5):439-451
pubmed: 32022895
Tidsskr Nor Laegeforen. 2012 Jan 24;132(2):147-51
pubmed: 22278269
Nature. 2014 Apr 3;508(7494):S14-5
pubmed: 24695329
PLoS Med. 2018 Jan 2;15(1):e1002476
pubmed: 29293492
Mol Psychiatry. 2022 Jan;27(1):281-295
pubmed: 34079068
Nord J Psychiatry. 2018 May;72(4):296-302
pubmed: 29523041
Transl Psychiatry. 2016 May 03;6:e796
pubmed: 27138795
Nat Rev Cardiol. 2021 Feb;18(2):136-145
pubmed: 33128044
JAMA Psychiatry. 2015 Jul;72(7):635-41
pubmed: 25830477
Acta Psychiatr Scand. 2019 Jun;139(6):558-571
pubmed: 30844079
Lancet Public Health. 2017 Dec;2(12):e541-e550
pubmed: 29253439
BMC Public Health. 2017 Mar 30;17(1):281
pubmed: 28356092
N Engl J Med. 2008 Jul 17;359(3):262-73
pubmed: 18635431
J Epidemiol Community Health. 2006 May;60(5):436-41
pubmed: 16614335