King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK; SPECTRUM Consortium, UK.
Schizophr Res. 2021 Dec;238:29-35. doi: 10.1016/j.schres.2021.09.006. Epub 2021 Sep 23.
Severe mental disorders are associated with a life expectancy that is 10-20 years shorter than the general population's. The prevalence of cigarette smoking in these populations is very high. We examined the effect of smoking on life expectancy and survival in patients with a diagnosis of schizophrenia, schizoaffective disorder or bipolar affective disorder from 2007 to 2018 in South East London, UK. Smoking status was determined using unstructured text data extracted from electronic health records. A total of 21,588 patients were identified of which 16,717, (77.4%) were classified as current smokers and 3438 (15.9%) as non-smokers. In female participants, life expectancy at birth was 67.6 years in current smokers (95% CI: 66.4-68.8) and 74.9 years in non-smokers (95% CI: 72.8-77.0), a difference of 7.3 years. In male participants, life expectancy at birth was 63.5 years in current smokers (95% CI: 62.5-64.5) and 68.5 years in non-smokers (95% CI, 64.4-72.6), a difference of 5.0 years. Adjusted survival models found that current smoking status was associated with an increased mortality risk for both females (aHR: 1.42, 95% CI: 1.21-1.66, p < 0.001) and males (aHR: 1.49; 95% CI: 1.25-1.79, p < 0.001). In terms of the effect sizes, these risks were similar to those associated with a diagnosis of co-morbid alcohol or opioid use disorder. Smoking may account for a substantial proportion of the reduced life expectancy in patients with psychotic disorders. Increased emphasis on reducing cigarette smoking in these populations may be the most effective way to reduce the mortality gap with the general population.
严重的精神障碍与预期寿命缩短 10-20 年相关，比普通人群的预期寿命缩短 10-20 年。这些人群的吸烟率非常高。我们在英国伦敦东南部的精神病学、分裂情感障碍或双相情感障碍患者中，从 2007 年到 2018 年，研究了吸烟对预期寿命和生存的影响。吸烟状况是通过从电子健康记录中提取的非结构化文本数据确定的。共确定了 21588 名患者，其中 16717 名（77.4%）被归类为当前吸烟者，3438 名（15.9%）为非吸烟者。在女性参与者中，当前吸烟者的出生预期寿命为 67.6 岁（95%CI：66.4-68.8），非吸烟者为 74.9 岁（95%CI：72.8-77.0），相差 7.3 岁。在男性参与者中，当前吸烟者的出生预期寿命为 63.5 岁（95%CI：62.5-64.5），非吸烟者为 68.5 岁（95%CI，64.4-72.6），相差 5.0 岁。调整后的生存模型发现，当前吸烟状况与女性（aHR：1.42，95%CI：1.21-1.66，p<0.001）和男性（aHR：1.49；95%CI：1.25-1.79，p<0.001）的死亡率风险增加相关。就影响大小而言，这些风险与合并酒精或阿片类药物使用障碍的诊断相关的风险相似。吸烟可能是精神障碍患者预期寿命缩短的一个重要原因。在这些人群中加大力度减少吸烟可能是缩小与普通人群死亡率差距的最有效方法。
