Solmi Marco, Croatto Giovanni, Fornaro Michele, Schneider Lynne Kolton, Rohani-Montez S Christy, Fairley Leanne, Smith Nathalie, Bitter István, Gorwood Philip, Taipale Heidi, Tiihonen Jari, Cortese Samuele, Dragioti Elena, Rietz Ebba Du, Nielsen Rene Ernst, Firth Joseph, Fusar-Poli Paolo, Hartman Catharina, Holt Richard I G, Høye Anne, Koyanagi Ai, Larsson Henrik, Lehto Kelli, Lindgren Peter, Manchia Mirko, Nordentoft Merete, Skonieczna-Żydecka Karolina, Stubbs Brendon, Vancampfort Davy, Boyer Laurent, De Prisco Michele, Vieta Eduard, Correll Christoph U
SCIENCES lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy.
Eur Neuropsychopharmacol. 2024 Mar;80:55-69. doi: 10.1016/j.euroneuro.2023.12.010. Epub 2024 Feb 17.
People with schizophrenia die prematurely, yet regional differences are unclear. PRISMA 2020-compliant systematic review/random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) versus any control group, and moderators, in people with ICD/DSM-defined schizophrenia, comparing countries and continents. We conducted subgroup, meta-regression analyses, and quality assessment. The primary outcome was all-cause mortality. Secondary outcomes were suicide-, /natural-cause- and other-cause-related mortality. We included 135 studies from Europe (n = 70), North-America (n = 29), Asia (n = 33), Oceania (n = 2), Africa (n = 1). In incident plus prevalent schizophrenia, differences across continents emerged for all-cause mortality (highest in Africa, RR=5.98, 95 %C.I.=4.09-8.74, k = 1, lowest in North-America, RR=2.14, 95 %C.I.=1.92-2.38, k = 16), suicide (highest in Oceania, RR=13.5, 95 %C.I.=10.08-18.07, k = 1, lowest in North-America, RR=4.4, 95 %C.I.=4.07-4.76, k = 6), but not for natural-cause mortality. Europe had the largest association between antipsychotics and lower all-cause mortality/suicide (Asia had the smallest or no significant association, respectively), without differences for natural-cause mortality. Higher country socio-demographic index significantly moderated larger suicide-related and smaller natural-cause-related mortality risk in incident schizophrenia, with reversed associations in prevalent schizophrenia. Antipsychotics had a larger/smaller protective association in incident/prevalent schizophrenia regarding all-cause mortality, and smaller protective association for suicide-related mortality in prevalent schizophrenia. Additional regional differences emerged in incident schizophrenia, across countries, and secondary outcomes. Significant regional differences emerged for all-cause, cause-specific and suicide-related mortality. Natural-cause death was homogeneously increased globally. Moderators differed across countries. Global initiatives are needed to improve physical health in people with schizophrenia, local studies to identify actionable moderators.
精神分裂症患者过早死亡，但地区差异尚不清楚。对评估国际疾病分类/精神疾病诊断与统计手册定义的精神分裂症患者相对于任何对照组的死亡率相对风险（RR）及调节因素的队列研究进行符合PRISMA 2020标准的系统评价/随机效应荟萃分析，并比较不同国家和各大洲的情况。我们进行了亚组分析、元回归分析和质量评估。主要结局是全因死亡率。次要结局是自杀、自然原因和其他原因相关的死亡率。我们纳入了来自欧洲（n = 70）、北美（n = 29）、亚洲（n = 33）、大洋洲（n = 2）、非洲（n = 1）的135项研究。在新发和现患精神分裂症患者中，各大洲在全因死亡率方面存在差异（非洲最高，RR = 5.98，95%置信区间= 4.09 - 8.74，k = 1；北美最低，RR = 2.14，95%置信区间= 1.92 - 2.38，k = 16），自杀率方面也存在差异（大洋洲最高，RR = 13.5，95%置信区间= 10.08 - 18.07，k = 1；北美最低，RR = 4.4，95%置信区间= 4.07 - 4.76，k = 6），但自然原因死亡率方面没有差异。欧洲抗精神病药物与较低的全因死亡率/自杀率之间的关联最大（亚洲分别最小或无显著关联），自然原因死亡率方面无差异。在新发精神分裂症中，较高的国家社会人口指数显著调节了较大的自杀相关死亡率风险和较小的自然原因相关死亡率风险，在现患精神分裂症中关联相反。抗精神病药物在新发/现患精神分裂症患者的全因死亡率方面有较大/较小的保护关联，在现患精神分裂症患者的自杀相关死亡率方面有较小的保护关联。在新发精神分裂症患者中，不同国家和次要结局方面还出现了其他地区差异。在全因、特定原因和自杀相关死亡率方面出现了显著的地区差异。全球自然原因死亡均有增加。不同国家的调节因素有所不同。需要全球倡议来改善精神分裂症患者的身体健康，开展本地研究以确定可采取行动的调节因素。
