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All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-6851-3297
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2024 (English)In: BMJ (Clinical Research Edition), ISSN 0959-8138, Vol. 384, article id e077564Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN: Population based matched cohort and sibling cohort study. SETTING: Register linkage in Sweden.

PARTICIPANTS: Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES: All cause and cause specific mortality.

RESULTS: 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding.

CONCLUSIONS: Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024. Vol. 384, article id e077564
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-111022DOI: 10.1136/bmj-2023-077564ISI: 001352409900001PubMedID: 38233033Scopus ID: 2-s2.0-85182795484OAI: oai:DiVA.org:oru-111022DiVA, id: diva2:1832692
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00569Region Stockholm, 20160143; 20180078Swedish Society of Medicine, SLS-879801Karolinska Institute, FS-2018:0007Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-11-28Bibliographically approved

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Larsson, Henrik

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