Mortality trends in cardiovascular disease in schizophrenia in Sweden

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Mortality trends in cardiovascular disease in
schizophrenia in Sweden
Urban Ösby MD, PhD, Senior Consultant Psykiatri
Nordöst, Stockholm County Council Department of
Clinical Neuroscience, Karolinska Institutet,
Stockholm, Sweden
urban.osby_at_sll.se
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Declaration of interest Urban Ösby
Grant support Stockholm County Council, NARSAD,
Bristol-Myers Squibb, Janssen-Cilag Advisory
Board/Consultant AstraZeneca, Bristol-Myers
Squibb, Eli Lilly, Pfizer Speakers
Bureau AstraZeneca, Bristol-Myers Squibb, Eli
Lilly, Pfizer
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Risk factors for cardiovascular disase
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Cardiovascular disease A Multifactorial Condition
Diabetes
Lipids
ENVIRONMENTAL
Hypertension
Obesity
GENETIC
Diet
Vasculardisease
Age
Smoking
Gender
Sedentary lifestyle
Family history
Thromboticfactors
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Cardiovascular Timeline
Foam Cells
Fatty Streak
Intermediate Lesion
Fibrous Plaque
Complicated Lesion/Rupture
Atheroma
Endothelial dysfunction
From first decade
From third decade
From fourth decade
Thrombosis, haematoma
Smooth muscle and collagen
Growth mainly by lipid accumulation
Adapted from Stary HC et al. Circulation
1995921355-1374.
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L. Wallentin 2000
Causes of death related to age and sex in Sweden
Ref Socialstyrelsen (1997). Hälso- och
sjukvårdsstatistisk årsbok 1997. Socialstyrelsen,
Stockholm.
Inledn./sid 1
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SMR (Observed/Expected) for schizophrenia
patients in Stockholm County 1973-95
SMR
1
5
10
15
20
25
Infectious
Cancer
Endocrine
Mental
Nervous system
Cardiovascular
Males
Cerebrovascular
Females
Respiratory
Gastrointestinal
Urogenital
Accidents
Suicide
Undet violence
All causes
5
10
15
20
25
1
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SMR (Observed/Expected) and Excess deaths
(Observed-Expected) for patients with
schizophrenia in Stockholm County 1973-95
Ref Osby U, et al. Mortality and causes of death
in schizophrenia in Stockholm county, Sweden.
Schizophr Res 200045(1-2)21-8.
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Excess deaths by natural and unnatural causes for
schizophrenia patients in Stockholm County 73-95
Men
Women
Unnatural 218
38
Natural 352
62
Unnatural 296
53
Ref Osby U, et al. Mortality and causes of death
in schizophrenia in Stockholm county, Sweden.
Schizophr Res 200045(1-2)21-8.
10
SMR (O/E) and Excess deaths (OE) for patients
with bipolar disorder in Sweden 1973-95
Ref Osby U, et al. Excess mortality in bipolar
and unipolar disorder in Sweden. Arch Gen
Psychiatry 200158(9)844-50.
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SMR (O/E) and Excess deaths (O-E) for patients
with unipolar disorder in Sweden 1973-95
Ref Osby U, et al. Excess mortality in bipolar
and unipolar disorder in Sweden. Arch Gen
Psychiatry 200158(9)844-50.
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Mortality in the population in Stockholm County

Standardized by the sex- and age distribution of
patients with schizophrenia in Stockholm County
1976-95
Deaths/100 000
1000
900
800
700
All deaths
Natural causes of death
600
500
400
300
Cardiovascular deaths
200
100
Violent deaths
Suicide
0
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
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Mortality trends in Stockholm county 1976-94, all
causes of death
Deaths/100 000
1976 year of reference
1.4
Patients with schizophrenia
1.2
1
0.8
General population
0.6
0.4
0.2
0
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
Controlling for age at first diagnosis and
years of follow-up Standardized by the sex and
age distribution of the patients
Ref Osby U, et al. Time trends in schizophrenia
mortality in Stockholm county, Sweden cohort
study. Bmj 2000321(7259)483-4.
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Mortality trends in Stockholm county 1976-79 to
1990-95, natural causes of death
Deaths/100 000
76-79 period of reference
1.4
Patients with schizophrenia
1.2
1
0.8
General population
0.6
0.4
0.2
0
76-79
80-85
86-89
90-95
Controlling for age at first diagnosis and
years of follow-up Standardized by the sex and
age distribution of the patients
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Mortality trends in Stockholm County 1976-79 to
1990-95, cardiovascular causes of death
Deaths/100 000
76-79 period of reference
1.4
Patients with schizophrenia
1.2
1
0.8
0.6
General population
0.4
0.2
0
76-79
80-85
86-89
90-95
Controlling for age at first diagnosis and
years of follow-up Standardized by the sex and
age distribution of the patients
Ref Osby U, et al. Time trends in schizophrenia
mortality in Stockholm county, Sweden cohort
study. Bmj 2000321(7259)483-4.
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Mortality trends in Sweden 1970-2003 adjusted
for age
Men
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Mortality trends in Sweden 1970-2003adjusted for
age
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SMR for schizophrenia in Sweden 1970-2003
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Time trends for SMR for all causes of death
(plt.0001)
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Time trends for SMR for cardiovascular death
(plt.0001)
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Time trends for SMR for death from coronary heart
disease plt.0001)
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Time trends for SMR for death from myocardial
infarction (plt.0001)
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