Hjorthøj Carsten, Stürup Anne Emilie, McGrath John J, Nordentoft Merete
Copenhagen University Hospital, Mental Health Centre Copenhagen, Hellerup, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen and Aarhus, Denmark.
Copenhagen University Hospital, Mental Health Centre Copenhagen, Hellerup, Denmark.
Lancet Psychiatry. 2017 Apr;4(4):295-301. doi: 10.1016/S2215-0366(17)30078-0. Epub 2017 Feb 22.
Several studies and meta-analyses have shown that mortality in people with schizophrenia is higher than that in the general population but have used relative measures, such as standardised mortality ratios. We did a systematic review and meta-analysis to estimate years of potential life lost and life expectancy in schizophrenia, which are more direct, absolute measures of increased mortality.
We searched MEDLINE, PsycINFO, Embase, Cinahl, and Web of Science for published studies on years of potential life lost and life expectancy in schizophrenia. Data from individual studies were combined in meta-analyses as weighted averages. We did subgroup analyses for sex, geographical region, timing of publication, and risk of bias (estimated with the Newcastle-Ottawa Scale).
We identified 11 studies in 13 publications covering all inhabited continents except South America (Africa n=1, Asia n=1, Australia n=1, Europe n=7, and North America n=3) that involved up to 247 603 patients. Schizophrenia was associated with a weighted average of 14·5 years of potential life lost (95% CI 11·2-17·8), and was higher for men than women (15·9, 13·8-18·0 vs 13·6, 11·4-15·8). Loss was least in the Asian study and greatest in Africa. The overall weighted average life expectancy was 64·7 years (95% CI 61·1-71·3), and was lower for men than women (59·9 years, 95% CI 55·5-64·3 vs 67·6 years, 63·1-72·1). Life expectancy was lowest in Asia and Africa. Timing of publication and risk of bias had little effect on results.
The effects of schizophrenia on years potential life lost and life expectancy seem to be substantial and not to have lessened over time. Development and implementation of interventions and initiatives to reduce this mortality gap are urgently needed.
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多项研究和荟萃分析表明，精神分裂症患者的死亡率高于普通人群，但这些研究采用的是相对指标，如标准化死亡率。我们进行了一项系统评价和荟萃分析，以估计精神分裂症患者的潜在寿命损失年数和预期寿命，这是衡量死亡率增加的更直接、绝对的指标。
我们检索了MEDLINE、PsycINFO、Embase、Cinahl和Web of Science等数据库，查找关于精神分裂症患者潜在寿命损失年数和预期寿命的已发表研究。将各个研究的数据合并为加权平均值进行荟萃分析。我们按性别、地理区域、发表时间和偏倚风险（用纽卡斯尔-渥太华量表评估）进行了亚组分析。
我们在13篇出版物中确定了11项研究，涵盖除南美洲外的所有有人居住的大陆（非洲1项、亚洲1项、澳大利亚1项、欧洲7项、北美洲3项），涉及多达247603名患者。精神分裂症与加权平均14.5年的潜在寿命损失相关（95%置信区间11.2-17.8），男性高于女性（分别为15.9，13.8-18.0和13.6，11.4-15.8）。亚洲研究中的损失最少，非洲最大。总体加权平均预期寿命为64.7岁（95%置信区间61.1-71.3），男性低于女性（分别为59.9岁，95%置信区间55.5-64.3和67.6岁，63.1-72.1）。亚洲和非洲的预期寿命最低。发表时间和偏倚风险对结果影响不大。
精神分裂症对潜在寿命损失年数和预期寿命的影响似乎很大，且并未随时间减少。迫切需要制定和实施干预措施及倡议，以缩小这一死亡率差距。
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