Study Suggests Veterans with Psychosis More Likely to Die from Heart Disease
Heart disease is one of the leading causes of death among persons with mental disorders and there are many reasons for increased risk of heart disease and subsequent premature death among this population. For example, a substantial percentage of those with schizophrenia have significantly higher rates of obesity, diabetes, and hypertension compared to the general population. This study assessed whether Veterans with mental disorders receiving care in the VA healthcare system were more likely to die from heart disease than Veterans without these disorders, and whether modifiable factors may explain mortality risks. Investigators analyzed data from the 1999 Large Health Survey of Veteran Enrollees (n=147,193), VA electronic medical record data (FY98-99), and the CDC's National Death Index Plus (FY00-06) to assess eight-year heart disease-related mortality risk by diagnosis. They also examined patient demographics, as well as clinical and behavioral factors.
Findings show that compared to Veterans without a mental health diagnosis, Veterans with psychosis (schizophrenia or other psychotic disorder diagnoses) were more likely to die from heart disease. Smoking and physical inactivity were the behavioral factors most strongly associated with mortality related to heart disease. Veterans with schizophrenia were the most likely to be current smokers, and those with bipolar disorder were the least likely to report adequate physical activity. Controlling for behavioral factors (e.g., smoking and physical inactivity) diminished but did not eliminate the impact of psychosis on mortality. The authors suggest that to reduce mortality related to heart disease, early interventions that promote smoking cessation and physical activity among Veterans with psychotic disorders are warranted.
Kilbourne A, Morden N, Austin K, Ilgen M, McCarthy J, Dalack G, and Blow F. Excess Heart Disease-related Mortality in a National Study of Patients with Mental Disorders: Identifying Modifiable Risk Factors. General Hospital Psychiatry Nov-Dec 2009;31(6):555-563.
This study was partly funded by HSR&D. Drs. Kilbourne, Ilgen, McCarthy, and Blow are part of HSR&D's Center for Clinical Management Research in Ann Arbor.