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All cause and cause specific mortality in obsessive-compulsive disorder : nationwide matched cohort and sibling cohort study

de la Cruz, Lorena Fernández ; Isomura, Kayoko ; Lichtenstein, Paul ; Larsson, Henrik ; Kuja-Halkola, Ralf ; Chang, Zheng ; D’Onofrio, Brian M. ; Brikell, Isabell ; Rück, Christian and Sidorchuk, Anna , et al. (2024) In BMJ
Abstract

OBJECTIVE To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN Population based matched cohort and sibling cohort study. SETTING Register linkage in Sweden. PARTICIPANTS Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES All cause and cause specific... (More)

OBJECTIVE To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN Population based matched cohort and sibling cohort study. SETTING Register linkage in Sweden. PARTICIPANTS Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES All cause and cause specific mortality. RESULTS 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding. CONCLUSIONS Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.

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publication status
epub
subject
in
BMJ
article number
e077564
publisher
BMJ Publishing Group
external identifiers
  • scopus:85182795484
  • pmid:38233033
ISSN
0959-8146
DOI
10.1136/bmj-2023-077564
language
English
LU publication?
yes
id
5bedb531-2142-4f7f-9957-9b6d8d35bf3d
date added to LUP
2024-02-20 11:39:12
date last changed
2024-04-20 10:51:50
@article{5bedb531-2142-4f7f-9957-9b6d8d35bf3d,
  abstract     = {{<p>OBJECTIVE To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN Population based matched cohort and sibling cohort study. SETTING Register linkage in Sweden. PARTICIPANTS Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES All cause and cause specific mortality. RESULTS 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding. CONCLUSIONS Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.</p>}},
  author       = {{de la Cruz, Lorena Fernández and Isomura, Kayoko and Lichtenstein, Paul and Larsson, Henrik and Kuja-Halkola, Ralf and Chang, Zheng and D’Onofrio, Brian M. and Brikell, Isabell and Rück, Christian and Sidorchuk, Anna and Mataix-Cols, David}},
  issn         = {{0959-8146}},
  language     = {{eng}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ}},
  title        = {{All cause and cause specific mortality in obsessive-compulsive disorder : nationwide matched cohort and sibling cohort study}},
  url          = {{http://dx.doi.org/10.1136/bmj-2023-077564}},
  doi          = {{10.1136/bmj-2023-077564}},
  year         = {{2024}},
}