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. 2022 May;145(5):481-493.
doi: 10.1111/acps.13407. Epub 2022 Feb 18.

Educational attainment and mortality in schizophrenia

Martin Tesli  1   2 , Eirik Degerud  3 , Oleguer Plana-Ripoll  4   5 , Kristin Gustavson  1   6 , Fartein Ask Torvik  1   6 , Eivind Ystrom  1   6   7 , Helga Ask  1 , Natalia Tesli  2 , Anne Høye  8   9 , Camilla Stoltenberg  1   10 , Ted Reichborn-Kjennerud  1   11 , Ragnar Nesvåg  1 , Øyvind Naess  1   12
Affiliations

Educational attainment and mortality in schizophrenia

Martin Tesli et al. Acta Psychiatr Scand. 2022 May.

Abstract

Background: Individuals suffering from schizophrenia have a reduced life expectancy with cardiovascular disease (CVD) as a major contributor. Low educational attainment is associated with schizophrenia, as well as with all-cause and CVD mortality. However, it is unknown to what extent low educational attainment can explain the increased mortality in individuals with schizophrenia.

Aim: Here, we quantify associations between educational attainment and all-cause and CVD mortality in individuals with schizophrenia, and compare them with the corresponding associations in the general population.

Method: All Norwegian citizens born between January 1, 1925, and December 31, 1959, were followed up from January 1, 1990, to December 31, 2014. The total sample included 1,852,113 individuals, of which 6548 were registered with schizophrenia. We estimated hazard ratios (HR) for all-cause and CVD mortality with Cox models, in addition to life years lost. Educational attainment for index persons and their parents were included in the models.

Results: In the general population individuals with low educational attainment had higher risk of all-cause (HR: 1.48 [95% CI: 1.47-1.49]) and CVD (HR: 1.59 [95% CI: 1.57-1.61]) mortality. In individuals with schizophrenia these estimates were substantially lower (all-cause: HR: 1.13 [95% CI: 1.05-1.21] and CVD: HR: 1.12 [95% CI: 0.98-1.27]). Low educational attainment accounted for 3.28 (3.21-3.35) life years lost in males and 2.48 (2.42-2.55) years in females in the general population, but was not significantly associated with life years lost in individuals with schizophrenia. Results were similar for parental educational attainment.

Conclusions: Our results indicate that while individuals with schizophrenia in general have lower educational attainment and higher mortality rates compared with the general population, the association between educational attainment and mortality is smaller in schizophrenia subjects than in the general population.

Keywords: cardiovascular disease; education; mortality; schizophrenia; socioeconomic.

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Conflict of interest statement

We declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier curves. Survival probability (y axis) for all‐cause and cardiovascular disease (CVD) death, divided by sex, from the Norwegian population (Total N = 1,852,113, N schizophrenia patients = 6548). Survival time x axis = years. Abbreviations: Edu, educational attainment; Low education, primary school or less; SCZ, schizophrenia
FIGURE 2
FIGURE 2
Excess life years lost for the Norwegian population aged 30–65 on January 1, 1990, with follow‐up to December 31, 2014 (total N = 1,852,113, N individuals with schizophrenia = 6548). Survival time x axis = years. CVD = life years lost due to cardiovascular related disease. Other = life years lost due all other causes of death. (A) Males with schizophrenia compared with males without schizophrenia. (B) Females with schizophrenia compared with females without schizophrenia
See this image and copyright information in PMC

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