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Cause-specific excess mortality after first diagnosis of bipolar disorder: population-based cohort study
  1. Tapio Paljärvi1,
  2. Kimmo Herttua2,
  3. Heidi Taipale1,3,4,
  4. Markku Lähteenvuo1,
  5. Antti Tanskanen1,3,
  6. Seena Fazel5,6,
  7. Jari Tiihonen1,3
  1. 1 Niuvanniemi Hospital, Kuopio, Finland
  2. 2 Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
  3. 3 Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
  4. 4 School of Pharmacy, University of Eastern Finland, Kuopio, Finland
  5. 5 Department of Psychiatry, University of Oxford, Oxford, UK
  6. 6 Oxford Health NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Tapio Paljärvi, Niuvanniemi Hospital, Kuopio 70240, Finland; tapio.paljarvi{at}niuva.fi

Abstract

Background Bipolar disorder (BD) is associated with increased mortality, but evidence on cause-specific mortality is limited.

Objective To investigate cause-specific premature excess mortality in BD.

Methods Finnish nationwide cohort study of individuals with and without a diagnosis of BD who were aged 15–64 years during 2004–2018. Standardised mortality ratios (SMRs) with 95% CIs were calculated for BD using the mortality rates in the Finnish general population without BD as weights. Causes of death were defined by the International Classification of Diseases, 10th revision codes.

Findings Of the included 47 018 individuals with BD, 3300 (7%) died during follow-up. Individuals with BD had sixfold higher mortality due to external causes (SMR: 6.01, 95% CI: 5.68, 6.34) and twofold higher mortality due to somatic causes (SMR: 2.06, 95% CI: 1.97, 2.15). Of the deaths due to external causes, 83% (1061/1273) were excess deaths, whereas 51% (1043/2027) of the deaths due to somatic causes were excess. About twice the number of potential years of life were lost in excess due to external causes than due to somatic causes. Alcohol-related causes contributed more to excess mortality than deaths due to cardiovascular disease.

Conclusion External causes of death contributed more to the mortality gap than somatic causes after controlling for age-specific background general population mortality.

Clinical implication A balanced consideration between therapeutic response, different treatment options and risk of cause-specific mortality is needed to prevent premature mortality in BD and to reduce the mortality gap.

  • adult psychiatry
  • depression and mood disorders

Data availability statement

Data may be obtained from a third party and are not publicly available. The data that support the findings of this study may be obtained from the institutions maintaining the registers used in this study. Restrictions apply to the availability of these data.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The data that support the findings of this study may be obtained from the institutions maintaining the registers used in this study. Restrictions apply to the availability of these data.

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Footnotes

  • Contributors TP, HT and JT designed the study. HT contributed to the linkage of the data sources. TP did the statistical analysis. TP wrote the first draft of the manuscript. All authors reviewed and revised the manuscript. JT is the guarantor. TP and HT had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding SF is funded by a Wellcome Trust Senior Clinical Research Fellowship and by the Oxford Health Biomedical Research Centre.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.