Relative risk of acute myocardial infarction in people with schizophrenia and bipolar disorder: A population-based cohort study

Shu I. Wu, Su Chiu Chen, Shen Ing Liu, Fang Ju Sun, Jimmy J M Juang, Hsin Chien Lee, Kai Liang Kao, Michael E. Dewey, Martin Prince, Robert Stewart, Ruud Van Winkel

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. Method: Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. Results: A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01∼1.32) for schizophrenia and 1.37 (1.08∼1.73) for bipolar disorder, and in women, 1.85 (1.58∼2.18) and 1.88(1.47∼2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. Conclusions In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.

Original languageEnglish
Article numbere0134763
JournalPLoS One
Volume10
Issue number8
DOIs
Publication statusPublished - Aug 13 2015

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myocardial infarction
relative risk
cohort studies
Bipolar Disorder
Schizophrenia
Hazards
Cohort Studies
Myocardial Infarction
behavior disorders
Population
Medical problems
Age Groups
Urbanization
gender
hyperlipidemia
schizophrenia
Hyperlipidemias
Proportional Hazards Models
urbanization
sampling

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Relative risk of acute myocardial infarction in people with schizophrenia and bipolar disorder : A population-based cohort study. / Wu, Shu I.; Chen, Su Chiu; Liu, Shen Ing; Sun, Fang Ju; Juang, Jimmy J M; Lee, Hsin Chien; Kao, Kai Liang; Dewey, Michael E.; Prince, Martin; Stewart, Robert; Van Winkel, Ruud.

In: PLoS One, Vol. 10, No. 8, e0134763, 13.08.2015.

Research output: Contribution to journalArticle

Wu, SI, Chen, SC, Liu, SI, Sun, FJ, Juang, JJM, Lee, HC, Kao, KL, Dewey, ME, Prince, M, Stewart, R & Van Winkel, R 2015, 'Relative risk of acute myocardial infarction in people with schizophrenia and bipolar disorder: A population-based cohort study', PLoS One, vol. 10, no. 8, e0134763. https://doi.org/10.1371/journal.pone.0134763
Wu, Shu I. ; Chen, Su Chiu ; Liu, Shen Ing ; Sun, Fang Ju ; Juang, Jimmy J M ; Lee, Hsin Chien ; Kao, Kai Liang ; Dewey, Michael E. ; Prince, Martin ; Stewart, Robert ; Van Winkel, Ruud. / Relative risk of acute myocardial infarction in people with schizophrenia and bipolar disorder : A population-based cohort study. In: PLoS One. 2015 ; Vol. 10, No. 8.
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abstract = "Objective: Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. Method: Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. Results: A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95{\%} CI 1.01∼1.32) for schizophrenia and 1.37 (1.08∼1.73) for bipolar disorder, and in women, 1.85 (1.58∼2.18) and 1.88(1.47∼2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. Conclusions In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.",
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AU - Lee, Hsin Chien

AU - Kao, Kai Liang

AU - Dewey, Michael E.

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AU - Stewart, Robert

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N2 - Objective: Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. Method: Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. Results: A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01∼1.32) for schizophrenia and 1.37 (1.08∼1.73) for bipolar disorder, and in women, 1.85 (1.58∼2.18) and 1.88(1.47∼2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. Conclusions In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.

AB - Objective: Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. Method: Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. Results: A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01∼1.32) for schizophrenia and 1.37 (1.08∼1.73) for bipolar disorder, and in women, 1.85 (1.58∼2.18) and 1.88(1.47∼2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. Conclusions In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.

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