Life years lost associated with mental illness: A cohort study of beneficiaries of a South African medical insurance scheme.

Male Humans Female South Africa / epidemiology Cohort Studies Mental Disorders / epidemiology Substance-Related Disorders / epidemiology Life Expectancy Insurance
Excess mortality Life years lost Mental disorders South Africa

Journal

Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073

Informations de publication

Date de publication:
01 11 2023
Historique:
received: 17 02 2023
revised: 02 08 2023
accepted: 03 08 2023
medline: 11 9 2023
pubmed: 7 8 2023
entrez: 6 8 2023
Statut: ppublish

Résumé

People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown. We analysed reimbursement claims from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders. We followed 1,070,183 beneficiaries for a median of three years, of whom 282,926 (26.4 %) received mental health diagnoses. Men with a mental health diagnosis lost 3.83 life years (95 % CI 3.58-4.10) compared to men without. Women with a mental health diagnosis lost 2.19 life years (1.97-2.41) compared to women without. Excess mortality varied by sex and diagnosis, from 11.50 LYL (95 % CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (men: 3.42, women: 1.94). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder. Mental diagnoses are based on reimbursement claims. Premature mortality among South African individuals with mental disorders is high. Our findings support interventions for the prevention, early detection, and treatment of physical comorbidities in this population. Targeted programs for suicide prevention and substance use treatment, particularly among men, can help reduce excess mortality from unnatural causes.

Sections du résumé

BACKGROUND
People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown.
METHODS
We analysed reimbursement claims from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders.
RESULTS
We followed 1,070,183 beneficiaries for a median of three years, of whom 282,926 (26.4 %) received mental health diagnoses. Men with a mental health diagnosis lost 3.83 life years (95 % CI 3.58-4.10) compared to men without. Women with a mental health diagnosis lost 2.19 life years (1.97-2.41) compared to women without. Excess mortality varied by sex and diagnosis, from 11.50 LYL (95 % CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (men: 3.42, women: 1.94). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder.
LIMITATIONS
Mental diagnoses are based on reimbursement claims.
CONCLUSIONS
Premature mortality among South African individuals with mental disorders is high. Our findings support interventions for the prevention, early detection, and treatment of physical comorbidities in this population. Targeted programs for suicide prevention and substance use treatment, particularly among men, can help reduce excess mortality from unnatural causes.

Identifiants

DOI: 10.1016/j.jad.2023.08.013 PMID: 37544483
pubmed: 37544483
pii: S0165-0327(23)00989-8
doi: 10.1016/j.jad.2023.08.013
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

204-212

Subventions

Organisme : NIAID NIH HHS
ID : U01 AI069924
Pays : United States

Commentaires et corrections

Type : UpdateOf

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare no conflicts of interest.

Auteurs

Yann Ruffieux (Y)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Anja Wettstein (A)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Gary Maartens (G)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

Naomi Folb (N)

Medscheme, Cape Town, South Africa.

Cristina Mesa-Vieira (C)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School of Health Sciences, University of Bern, Bern, Switzerland.

Christiane Didden (C)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Sociology, Ludwig-Maximilians-Universität München, Germany.

Mpho Tlali (M)

Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa.

Chanwyn Williams (C)

Medscheme, Cape Town, South Africa.

Morna Cornell (M)

Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa.

Michael Schomaker (M)

Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa; Department of Statistics, Ludwig-Maximilians-Universität München, Germany.

Leigh F Johnson (LF)

Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa.

John A Joska (JA)

HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa; Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Matthias Egger (M)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Andreas D Haas (AD)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. Electronic address: andreas.haas@unibe.ch.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Life years lost associated with mental...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique australe › République d'Afrique du Sud › Life years lost associated with mental...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Life years lost associated with mental...
questionsmedicales.fr › Troubles mentaux › Life years lost associated with mental...
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Life years lost associated with mental...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Espérance de vie › Life years lost associated with mental...
questionsmedicales.fr › Organisations et économie des soins de santé › Économie › Financement organisé › Assurance › Life years lost associated with mental...