Mortality in persons with mental disorders is substantially overestimated using inpatient psychiatric diagnoses
(2013) In Journal of Psychiatric Research 47(10). p.1298-1303- Abstract
- Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N = 7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001-2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence... (More)
- Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N = 7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001-2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence 44.6% of diagnoses were missed using inpatient data only. When including and accounting for prevalent psychiatric cases, all-cause mortality risk among persons with any mental disorder was overestimated by 153% using only inpatient diagnoses (adjusted hazard ratio [aHR], 5.89; 95% Cl, 5.85-5.92) vs. both inpatient and outpatient diagnoses (aHR, 5.11; 95% Cl, 5.08-5.14). Suicide risk was overestimated by 18.5% (aHRs, 23.91 vs. 20.18), but this varied widely by specific disorders, from 4.4% for substance use to 49.1% for anxiety disorders. The sole use of inpatient diagnoses resulted in even greater overestimation of all-cause or suicide mortality risks when prevalent cases were unidentified (similar to 20-30%) or excluded (similar to 25-40%). However, different methods for handling prevalent cases resulted in only modest variation in risk estimates when using both inpatient and outpatient diagnoses. These findings have important implications for the interpretation of hospital-based studies and the design of future studies. (C) 2013 Elsevier Ltd. All rights reserved. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4106324
- author
- Crump, Casey ; Ioannidis, John P. A. ; Sundquist, Kristina LU ; Winkleby, Marilyn A. and Sundquist, Jan LU
- organization
- publishing date
- 2013
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Mental disorders, Mortality, Suicide
- in
- Journal of Psychiatric Research
- volume
- 47
- issue
- 10
- pages
- 1298 - 1303
- publisher
- Elsevier
- external identifiers
-
- wos:000324004700003
- scopus:84881559066
- pmid:23806577
- ISSN
- 1879-1379
- DOI
- 10.1016/j.jpsychires.2013.05.034
- language
- English
- LU publication?
- yes
- id
- a27b0d5e-2e5d-4f9f-b937-46ab2e4c6b98 (old id 4106324)
- date added to LUP
- 2016-04-01 10:15:56
- date last changed
- 2022-03-27 06:36:37
@article{a27b0d5e-2e5d-4f9f-b937-46ab2e4c6b98,
abstract = {{Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N = 7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001-2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence 44.6% of diagnoses were missed using inpatient data only. When including and accounting for prevalent psychiatric cases, all-cause mortality risk among persons with any mental disorder was overestimated by 153% using only inpatient diagnoses (adjusted hazard ratio [aHR], 5.89; 95% Cl, 5.85-5.92) vs. both inpatient and outpatient diagnoses (aHR, 5.11; 95% Cl, 5.08-5.14). Suicide risk was overestimated by 18.5% (aHRs, 23.91 vs. 20.18), but this varied widely by specific disorders, from 4.4% for substance use to 49.1% for anxiety disorders. The sole use of inpatient diagnoses resulted in even greater overestimation of all-cause or suicide mortality risks when prevalent cases were unidentified (similar to 20-30%) or excluded (similar to 25-40%). However, different methods for handling prevalent cases resulted in only modest variation in risk estimates when using both inpatient and outpatient diagnoses. These findings have important implications for the interpretation of hospital-based studies and the design of future studies. (C) 2013 Elsevier Ltd. All rights reserved.}},
author = {{Crump, Casey and Ioannidis, John P. A. and Sundquist, Kristina and Winkleby, Marilyn A. and Sundquist, Jan}},
issn = {{1879-1379}},
keywords = {{Mental disorders; Mortality; Suicide}},
language = {{eng}},
number = {{10}},
pages = {{1298--1303}},
publisher = {{Elsevier}},
series = {{Journal of Psychiatric Research}},
title = {{Mortality in persons with mental disorders is substantially overestimated using inpatient psychiatric diagnoses}},
url = {{https://lup.lub.lu.se/search/files/1698262/4294946.pdf}},
doi = {{10.1016/j.jpsychires.2013.05.034}},
volume = {{47}},
year = {{2013}},
}