Regional differences in five-year mortality after a first episode of schizophrenia in Finland

Objective: This study analyzed gender-specific mortality of patients with a first episode of schizophrenic illness, particularly deaths from circulatory system diseases and suicide. Methods: This was a nationwide register-based five-year follow-up study of all patients with onset of schizophrenia between 1995 and 2001. Standardized mortality ratios (SMRs) were calculated by matching patients' data with the general Finnish population on age, gender, and place of residence. Results: During the five-year follow-up of 7,591 schizophrenia patients, 403 (5%) patients died. They had 4.45-fold higher mortality than the general population, and patients' mortality was significantly elevated in all age groups. The SMRs for all-cause mortality, circulatory system diseases, and suicides were higher for females than males in almost all age groups. The largest single unnatural cause of death was suicide. In natural causes of death, the SMR for ill-defined and unknown causes of death was almost 25. Total mortality, circulatory deaths, and suicides differed among the 20 hospital districts examined. Regional variations in SMRs were not associated with population characteristics or psychiatric health care resources of a hospital district. Conclusions: In this nationwide registerbased study, excess mortality among persons with schizophrenia was clearly observed. Regional differences in mortality were evident, indicating a need for further research to understand the mortality gap and why it might vary regionally.