Trends and disparities in schizophrenia related mortality in the United States: An analysis of CDC WONDER database, 1999-2020

Asian J Psychiatr. 2025 Apr 14;108:104496. doi: 10.1016/j.ajp.2025.104496. Online ahead of print.

ABSTRACT

BACKGROUND: Schizophrenia is a mental health condition that typically begins between ages 18 and 25, significantly impairs daily functioning, ranks among the leading causes of disability worldwide, and is associated with a shortened lifespan. Mortality in schizophrenia is often linked to cardiovascular disease, driven by poor lifestyle choices, limited access to physical healthcare, frequent comorbidities, and non-compliance with antipsychotic medications. This article analyzes mortality trends among U.S. adults aged 35-85 + years with schizophrenia from 1999 to 2020 using CDC Wonder data, contributing valuable insights to the existing literature on this topic.

METHOD: Data from death certificates between 1999 and 2020 were obtained from the CDC WONDER database using ICD-10 code F20 to identify deaths where schizophrenia was listed as a primary or contributing cause, covering all 50 states and the District of Columbia. Demographic data, including race/ethnicity, age, and gender, and information on the place, year, and setting of death-residences, hospices, nursing homes/long-term care facilities, and medical institutions-were collected. We analyzed schizophrenia-related mortality trends in the U.S. from 1999 to 2020. We used the Joinpoint Regression Program (Version 5.1.0, National Cancer Institute) to calculate the annual percent change (APC) and Average Annual Percentage Change (AAPC) in AAMR, along with their 95 % CIs, to identify significant trends over time. Statistical significance was set at P < 0.05.

RESULTS: We identified 80,836 schizophrenia-related deaths, with the highest proportion occurring in nursing homes and long-term care facilities. The overall age-adjusted mortality rate (AAMR) rose from 23.9 in 1999-27.2 in 2020. Notably, the AAMR decreased between 1999 and 2015, with a significant increase from 2015 to 2020.

CONCLUSIONS: This study reveals an increase in the age-adjusted mortality rate (AAMR) for schizophrenia-related deaths among adults from 1999 to 2020, which highlights critical insights for healthcare professionals and policymakers. Further research is needed to identify modifiable factors to reduce morbidity and mortality, potentially easing the burden on healthcare resources and improving the quality of life for those with schizophrenia. Understanding these trends is essential for addressing gaps in the healthcare system and directing resources to areas of greatest need.

PMID:40250200 | DOI:10.1016/j.ajp.2025.104496