English summary: Mortality of patients with schizophrenia in health care districts

Mortality in patients with schizophrenia is higher than in the general population. Mortality can be used as a criterion of effectiveness of care.

From the National Finnish Hospital Discharge register, we identified all 18 006 patients aged between 15 and 64 years admitted for the first time with schizophrenia diagnosis to hospital in Finland between 1987 and 2002. The patients' family backgrounds were identified from the Population Register, as were their deaths to the end of 2003 from the Register of Causes of Deaths. The causes of death were classified as natural, unnatural or suicide. Separately, deaths during psychiatric hospitalization were identified. Associations between mortality and patients' backgrounds or health care districts were analysed by the Cox regression analysis.

In all 2202 deaths or 12.2% of the whole sample were registered. Mortality was higher in men, the elderly, widows, and in those without children. Female gender and having children were two factors that protected from unnatural deaths and, as a separate issue, from suicides. Total mortality and natural or unnatural deaths varied significantly between health care districts although the effect of patients' backgrounds had been taken into account. 13.6% of natural deaths, 22.6% of suicides and 7.1% of other unnatural deaths occurred during psychiatric hospital care. Natural deaths during outpatient care varied significantly between health care districts.

Male gender and a lack of a close network of people increased the risk of mortality in patients with schizophrenia. Differences in mortality between health care districts may be due to differences in treatment practices and their effect on mortality in patients with schizophrenia.