Chen Danni, Momen Natalie C, Ejlskov Linda, Bødkergaard Katrine, Werenberg Dreier Julie, Sørensen Henrik Toft, Laustsen Lisbeth Mølgaard, Harper Sam, Hakulinen Christian, McGrath John J, Plana-Ripoll Oleguer
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
World Psychiatry. 2025 Feb;24(1):92-102. doi: 10.1002/wps.21278.
Mental disorders are associated with elevated mortality rates and reduced life expectancy. However, it is unclear whether these associations differ by socioeconomic position (SEP). The aim of this study was to explore comprehensively the role of individual-level SEP in the associations between specific types of mental disorders and mortality (due to all causes, and to natural or external causes), presenting both relative and absolute measures. This was a cohort study including all residents in Denmark on January 1, 2000, following them up until December 31, 2020. Information on mental disorders, SEP (income percentile, categorized into low, <20%; medium, 20-79%; and high, ≥80%), and mortality was obtained from nationwide registers. We computed the average reduction in life expectancy for those with mental disorders, relative and absolute differences in mortality rates, and proportional attributable fractions. Subgroup analyses by sex and age groups were performed. Overall, 5,316,626 individuals (2,689,749 females and 2,626,877 males) were followed up for 95.2 million person-years. People with mental disorders had a shorter average life expectancy than the general population regardless of SEP (70.9-77.0 vs. 77.2-85.1 years, depending on income percentile). Among individuals with a mental disorder, the subgroup in the top 3% of the income distribution had the longest average life expectancy (77.0 years), and this estimate was lower than the shortest life expectancy in the general Danish population (77.2 years for individuals in the bottom 6% income distribution). The mortality rate differences were larger in the low-income than the high-income group (19.6 vs. 13.3 per 1,000 person-years). For natural causes of death, a socioeconomic gradient for differences in life expectancy and mortality rates was observed across most diagnoses, both sexes, and all age groups. For external causes, no such gradient was observed. In the low-SEP group, 10.1% of all deaths and 23.7% of those related to external causes were attributable to mental disorders, compared with 3.5% and 8.7% in the high-SEP group. Thus, our data indicate that people with mental disorders have a shorter life expectancy even than people with the lowest SEP in the general population. The socioeconomic gradients in mortality rates due to natural causes highlight a greater need for coordinated care of physical diseases in people with mental disorders and low SEP.
精神障碍与死亡率升高和预期寿命缩短有关。然而，目前尚不清楚这些关联是否因社会经济地位（SEP）而异。本研究的目的是全面探讨个体层面的SEP在特定类型精神障碍与死亡率（全因死亡率、自然原因或外部原因导致的死亡率）之间关联中的作用，同时呈现相对和绝对指标。这是一项队列研究，纳入了2000年1月1日丹麦的所有居民，并随访至2020年12月31日。关于精神障碍、SEP（收入百分位数，分为低，<20%；中，20 - 79%；高，≥80%）和死亡率的信息来自全国性登记册。我们计算了患有精神障碍者预期寿命的平均缩短情况、死亡率的相对和绝对差异以及比例归因分数。按性别和年龄组进行了亚组分析。总体而言，5316626人（2689749名女性和2626877名男性）被随访了9520万人年。无论SEP如何，患有精神障碍的人的平均预期寿命均短于普通人群（70.9 - 77.0岁与77.2 - 85.1岁，取决于收入百分位数）。在患有精神障碍的个体中，收入分布前3%的亚组平均预期寿命最长（77.0岁），而这一估计低于丹麦普通人群中最短的预期寿命（收入分布后6%的个体为77.2岁）。低收入组的死亡率差异高于高收入组（每1000人年分别为19.6和13.3）。对于自然死亡原因，在大多数诊断、男女及所有年龄组中，均观察到预期寿命和死亡率差异的社会经济梯度。对于外部原因，未观察到此类梯度。在低SEP组中，所有死亡中有10.1%以及与外部原因相关的死亡中有23.7%可归因于精神障碍，而在高SEP组中这一比例分别为3.5%和8.7%。因此，我们的数据表明，患有精神障碍的人的预期寿命甚至比普通人群中SEP最低的人还要短。自然原因导致的死亡率的社会经济梯度凸显了对患有精神障碍且SEP较低的人群进行身体疾病协调护理的更大需求。
