Solmi Marco, Croatto Giovanni, Fabiano Nicholas, Wong Stanley, Gupta Arnav, 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, Vieta Eduard, De Prisco Michele, Boyer Laurent, Højlund Mikkel, Correll Christoph U
Department of Psychiatry, University of Ottawa, 501 Smyth road, 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. 2025 Feb;91:56-66. doi: 10.1016/j.euroneuro.2024.11.001. Epub 2024 Dec 2.
The differential influence of sex on premature mortality in schizophrenia is unclear. This study assessed the differences in all-cause and specific cause mortality risks in people with schizophrenia compared to several control groups stratified by sex. We conducted a PRISMA 2020-compliant systematic review and random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) for people with schizophrenia, comparing by sex. We measured publication bias and conducted a quality assessment through the Newcastle-Ottawa scale. We meta-analyzed 43 studies reporting on 2,700,825 people with schizophrenia. Both males and females with schizophrenia had increased all-cause mortality vs. comparison groups (males, RR=2.62, 95%CI 2.35-2.92; females, RR=2.56, 95%CI 2.27-2.87), suicide (males, RR=9.02, 95%CI 5.96-13.67; females, RR=12.09, 95%CI 9.00-16.25), and natural cause mortality (males, RR=2.11, 95%CI 1.88-2.38; females, RR=2.14, 95%CI 1.93-2.38). No statistically significant differences in sex-dependent mortality risk emerged. There was an age-group-dependent increased mortality risk in females < 40 years vs. >/=40 years old (RR=4.23/2.17), and significantly higher risk of death due to neurological disorders (dementia) in males vs. females (RR=5.19/2.40). Increased mortality risks were often associated with specific modifiable risk factors. The increased mortality risk did not improve over time, calling for more studies to identify modifiable factors, and for better physical healthcare for males and females with schizophrenia.
性别对精神分裂症过早死亡的差异影响尚不清楚。本研究评估了精神分裂症患者与按性别分层的几个对照组相比，全因和特定原因死亡风险的差异。我们对队列研究进行了一项符合PRISMA 2020标准的系统评价和随机效应荟萃分析，评估精神分裂症患者的死亡相对风险（RR），并按性别进行比较。我们测量了发表偏倚，并通过纽卡斯尔-渥太华量表进行了质量评估。我们对43项报告2700825例精神分裂症患者的研究进行了荟萃分析。与对照组相比，男性和女性精神分裂症患者的全因死亡率均升高（男性，RR = 2.62，95%CI 2.35 - 2.92；女性，RR = 2.56，95%CI 2.27 - 2.87）、自杀率（男性，RR = 9.02，95%CI 5.96 - 13.67；女性，RR = 12.09，95%CI 9.00 - 16.25）和自然原因死亡率（男性，RR = 2.11，95%CI 1.88 - 2.38；女性，RR = 2.14，95%CI 1.93 - 2.38）。未出现性别依赖性死亡风险的统计学显著差异。40岁以下女性与40岁及以上女性相比，存在年龄组依赖性的死亡风险增加（RR = 4.23/2.17），男性因神经系统疾病（痴呆）导致的死亡风险显著高于女性（RR = 5.19/2.40）。增加的死亡风险通常与特定的可改变风险因素相关。随着时间的推移，增加的死亡风险并未改善，这需要更多研究来确定可改变因素，并为患有精神分裂症的男性和女性提供更好的身体保健。
