Article

Cigarette Smoking and Mortality Risk in People With Schizophrenia

Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 12/2009; 37(4):832-8. DOI: 10.1093/schbul/sbp152
Source: PubMed

ABSTRACT

This study examined effects of cigarette smoking on mortality risk in 1213 persons aged 19-69 years with schizophrenia-related psychotic disorders admitted to State of Maryland Hospitals between 1994 and 2000. Inpatient medical records from 7 hospitals were reviewed to obtain demographic information, diagnosis, medication use, as well as smoking and other substance use. Social Security Death Index data were used to identify deaths in the study group between 1994 and 2004. Death records were reviewed to obtain manner of death and underlying disorders. Of the 1213, 55% were smokers and 71% abused substances. There was an age × smoking interaction (χ(2) = 14.6, df = 1, P = .0001) for mortality, with estimated hazard ratios (HRs) for smokers vs nonsmokers of 2.1 among 35- to 54-year olds and HR of 0.7 among those aged 55-69 years. Five- and 10-year mortality rates for smokers aged 35-54 years were 7.0% and 14.2%, compared with 3.3% and 10.0% for nonsmokers, respectively (χ(2) = 5.53, df = 1, P = .019). Cardiac causes were identified in 43% of deaths in smokers but only 19% of deaths in nonsmokers (P < .006). For those aged 35-54 years, the odds of cardiac related death was increased by 12 fold in smokers relative to nonsmokers (HR = 12.4, χ(2) = 12.0, df = 1, P = .0005). Among people aged 35-54 years, those smoking greater than one pack daily have a significantly increased total mortality risk (HR = 2.7) vs nonsmokers. Cigarette smoking, particularly in people aged 35-54 years, contributes to an increased risk of death. Greater smoking severity significantly increases this risk. Smoking cessation in people with schizophrenia deserves significant attention.

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    • "Smoking is one of the major preventable causes of morbidity and premature mortality both in the general population and in schizophrenia (Kelly et al., 2011). In the past decades numerous studies examined smoking in schizophrenia patients in Western countries. "
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    • "reduction in life expectancy reported in this population [Kelly et al., 2011 [Kelly et al., , 2012. The adverse health consequences of smoking have been largely attributed to the abundance of reactive oxygen species (ROS) and reactive nitrogen species (RNS) that readily react with various biomolecules [Bar-Shai et al., 2006]. "

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    • "The T cells are also being associated with psychopathological symptoms and the outcome of neuroleptic treatment in schizophrenia (Muller et al. 1991; 1993). Cigarette smoking causes high mortality in schizophrenia patients (Kelly et al. 2011). Interestingly, cigarette smoking was found to be associated with increased T-cell proliferation in schizophrenia patients (Herberth et al. 2010). "
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