In the Journals

Bipolar disorder linked to premature mortality

Adults with bipolar disorder were at twice the risk for all-cause mortality, according to the findings of a study published in JAMA Psychiatry.

“We found that bipolar disorder patients died prematurely from multiple causes, including cardiovascular disease and diabetes,” study researcher Casey Crump, MD, PhD, clinical assistant professor of medicine at Stanford University, said in an interview.

Casey Crump, MD, PhD 

Casey Crump

Researchers examined data from a Swedish national cohort study of 6.5 million adults, 6,618 of whom had bipolar disorder. Sixty percent of the study population with bipolar disorder was aged 40 to 69 years and 59.2% was women. In contrast to the general population, those with bipolar disorder were less likely to be employed (30.5% vs. 59.7%; P<.001) and more likely to have an alcohol (12.2% vs. 1.8%; P<.001) or substance use disorder (9.8% vs. 1.1%; P<.001).

Increased rates for comorbidities in adults with bipolar disorder were found in influenza or pneumonia (women, 2.4-fold; men, 1.9-fold); chronic obstructive pulmonary disease (women, 2.1-fold; men, 1.7-fold); diabetes (women, 1.7-fold; men, 1.6-fold); cardiovascular disease (women, 1.3-fold; men, 1.2-fold); and stroke (women, 1.6-fold; men, 1.3-fold). Analyses were adjusted for age and sociodemographic factors. However, when adjusted for substance use disorders, associations with stroke and chronic obstructive pulmonary disease were no longer statistically significant in men.

During the 7 years of follow-up, 9.5% of the population died. All-cause mortality was 2.3 times higher in women and two times higher in men with bipolar disorder. Women with bipolar disorder died an average of 9 years earlier (mean age, 73.4 vs. 82.4 years), and men died 8.5 years earlier (mean age, 68.9 vs. 77.4 years).

The most statistically significant causes of death were from influenza or pneumonia (women, 3.7-fold; men, 4.4-fold), diabetes (women, 3.6-fold; men, 2.6-fold) and chronic obstructive pulmonary disease (women, 2.9 fold; men, 2.6-fold).  Women also had increased risk for death from stroke (2.6-fold) and cancer (1.4-fold). After adjusting for age and sociodemographic factors, bipolar disorder was less significantly associated with mortality from previously diagnosed ischemic heart disease, diabetes, chronic obstructive pulmonary disease and cancer (HR=1.40; 95% CI, 1.26-1.56) than without a prior diagnosis (HR=2.38; 95% CI, 1.95-2.90).

Mortality from suicide was 10 times more prevalent in women and eight times more prevalent in men with bipolar disorder, according to adjusted analyses. Unmedicated bipolar participants were more likely to die of suicide (HR=2.06; 95% CI, 1.11-3.83).

Researchers noted that bipolar disorder may be linked to premature mortality due to a less likelihood to seek primary care and higher prevalence of smoking, substance abuse and obesity.

“However, survival among those with timely medical diagnosis approached that of the general population. Better provision of primary health care is needed to reduce early mortality among people with bipolar disorder.”

Disclosure: The researchers report no relevant financial disclosures.

Adults with bipolar disorder were at twice the risk for all-cause mortality, according to the findings of a study published in JAMA Psychiatry.

“We found that bipolar disorder patients died prematurely from multiple causes, including cardiovascular disease and diabetes,” study researcher Casey Crump, MD, PhD, clinical assistant professor of medicine at Stanford University, said in an interview.

Casey Crump, MD, PhD 

Casey Crump

Researchers examined data from a Swedish national cohort study of 6.5 million adults, 6,618 of whom had bipolar disorder. Sixty percent of the study population with bipolar disorder was aged 40 to 69 years and 59.2% was women. In contrast to the general population, those with bipolar disorder were less likely to be employed (30.5% vs. 59.7%; P<.001) and more likely to have an alcohol (12.2% vs. 1.8%; P<.001) or substance use disorder (9.8% vs. 1.1%; P<.001).

Increased rates for comorbidities in adults with bipolar disorder were found in influenza or pneumonia (women, 2.4-fold; men, 1.9-fold); chronic obstructive pulmonary disease (women, 2.1-fold; men, 1.7-fold); diabetes (women, 1.7-fold; men, 1.6-fold); cardiovascular disease (women, 1.3-fold; men, 1.2-fold); and stroke (women, 1.6-fold; men, 1.3-fold). Analyses were adjusted for age and sociodemographic factors. However, when adjusted for substance use disorders, associations with stroke and chronic obstructive pulmonary disease were no longer statistically significant in men.

During the 7 years of follow-up, 9.5% of the population died. All-cause mortality was 2.3 times higher in women and two times higher in men with bipolar disorder. Women with bipolar disorder died an average of 9 years earlier (mean age, 73.4 vs. 82.4 years), and men died 8.5 years earlier (mean age, 68.9 vs. 77.4 years).

The most statistically significant causes of death were from influenza or pneumonia (women, 3.7-fold; men, 4.4-fold), diabetes (women, 3.6-fold; men, 2.6-fold) and chronic obstructive pulmonary disease (women, 2.9 fold; men, 2.6-fold).  Women also had increased risk for death from stroke (2.6-fold) and cancer (1.4-fold). After adjusting for age and sociodemographic factors, bipolar disorder was less significantly associated with mortality from previously diagnosed ischemic heart disease, diabetes, chronic obstructive pulmonary disease and cancer (HR=1.40; 95% CI, 1.26-1.56) than without a prior diagnosis (HR=2.38; 95% CI, 1.95-2.90).

Mortality from suicide was 10 times more prevalent in women and eight times more prevalent in men with bipolar disorder, according to adjusted analyses. Unmedicated bipolar participants were more likely to die of suicide (HR=2.06; 95% CI, 1.11-3.83).

Researchers noted that bipolar disorder may be linked to premature mortality due to a less likelihood to seek primary care and higher prevalence of smoking, substance abuse and obesity.

“However, survival among those with timely medical diagnosis approached that of the general population. Better provision of primary health care is needed to reduce early mortality among people with bipolar disorder.”

Disclosure: The researchers report no relevant financial disclosures.