11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study)

• Published in: The Lancet (British edition) 2009-08, Vol.374 (9690), p.620-627
• Main Authors: Tiihonen, Jari, Prof, Lönnqvist, Jouko, Prof, Wahlbeck, Kristian, Prof, Klaukka, Timo, Prof, Niskanen, Leo, Prof, Tanskanen, Antti, PhLic, Haukka, Jari, PhD
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Age Distribution; Aged; Antipsychotic Agents - adverse effects; Antipsychotics; Biological and medical sciences; Cardiovascular disease; Case-Control Studies; Cause of Death; Clozapine - adverse effects; Dibenzothiazepines - adverse effects; Drug Utilization - trends; Drugs; Epidemiology; Female; Finland - epidemiology; Follow-Up Studies; General aspects; Health Status Disparities; Hospitals; Humans; Internal Medicine; Life Expectancy; Male; Medical sciences; Mental disorders; Middle Aged; Mortality; Patient Readmission - statistics & numerical data; Perphenazine - adverse effects; Proportional Hazards Models; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotropic drugs; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quetiapine Fumarate; Registries; Risk Factors; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - mortality; Sex Distribution; Time Factors
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(09)60742-X

Summary Background The introduction of second-generation antipsychotic drugs during the 1990s is widely believed to have adversely affected mortality of patients with schizophrenia. Our aim was to establish the long-term contribution of antipsychotic drugs to mortality in such patients. Methods Nationwide registers in Finland were used to compare the cause-specific mortality in 66 881 patients versus the total population (5·2 million) between 1996, and 2006, and to link these data with the use of antipsychotic drugs. We measured the all-cause mortality of patients with schizophrenia in outpatient care during current and cumulative exposure to any antipsychotic drug versus no use of these drugs, and exposure to the six most frequently used antipsychotic drugs compared with perphenazine use. Findings Although the proportional use of second-generation antipsychotic drugs rose from 13% to 64% during follow-up, the gap in life expectancy between patients with schizophrenia and the general population did not widen between 1996 (25 years), and 2006 (22·5 years). Compared with current use of perphenazine, the highest risk for overall mortality was recorded for quetiapine (adjusted hazard ratio [HR] 1·41, 95% CI 1·09–1·82), and the lowest risk for clozapine (0·74, 0·60–0·91; p=0·0045 for the difference between clozapine vs perphenazine, and p