The relationship of mental and behavioral disorders to all-cause mortality in a 27-year follow-up of 4 epidemiologic catchment area samples - PubMed (original) (raw)

. 2013 Nov 1;178(9):1366-77.

doi: 10.1093/aje/kwt219. Epub 2013 Oct 3.

Kimberly B Roth, Martha Bruce, Linda Cottler, Litzy Wu, Gerald Nestadt, Dan Ford, O Joseph Bienvenu, Rosa M Crum, George Rebok, James C Anthony, Alvaro Muñoz

The relationship of mental and behavioral disorders to all-cause mortality in a 27-year follow-up of 4 epidemiologic catchment area samples

William W Eaton et al. Am J Epidemiol. 2013.

Abstract

Subjects from the Epidemiologic Catchment Area Program, interviewed during 1979-1983, were linked to data in the National Death Index through 2007 to estimate the association of mental and behavioral disorders with death. There were more than 25 years of follow-up for 15,440 individuals, with 6,924 deaths amounting to 307,881 person-years of observation. Data were analyzed by using age as the time scale and parametric approaches to quantify the years of life lost due to disorders. Alcohol, drug use, and antisocial personality disorders were associated with increased risk of death, but there was no strong association with mood and anxiety disorders. Results of high- and low-quality matches with the National Death Index were similar. The 3 behavioral disorders were associated with 5-15 years of life lost, estimated along the life course via the generalized gamma model. Regression tree analyses showed that risk of death was associated with alcohol use disorders in nonblacks and with drug disorders in blacks. Phobia interacted with alcohol use disorders in nonblack women, and obsessive-compulsive disorder interacted with drug use disorders in black men. Both of these anxiety disorders were associated with lower risk of death early in life and higher risk of death later in life.

Keywords: anxiety disorders; generalized gamma distribution; mental disorder; mood disorders; mortality; personality disorders; proportional hazards model; substance-related disorders.

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Figures

Figure 1.

Figure 1.

Survival curves for 4 sex/race strata in 4 sites of the Epidemiologic Catchment Area Study, 1979–1983 through 2007. Nonparametric Kaplan-Meier curves as step functions and smoothed curves for the generalized gamma (GG) distribution for cumulative proportion deceased in g groups according to nonblack/black race and female/male sex. The estimated parameters of GG models were: GG(4.10, 0.16, 1.86) for nonblack women, GG(3.99, 0.21, 1.53) for nonblack men, GG(4.11, 0.19, 2.23) for black women, and GG(3.97, 0.28, 1.87) for black men.

Figure 2.

Figure 2.

Survival curves and estimates of years of life lost due to alcohol, phobia, and antisocial personality disorders, among nonblack women and men in 4 sites of the Epidemiologic Catchment Area Study, 1979–1983 through 2007. Kaplan-Meier and generalized gamma survival curves for nonblack women and men, showing the estimated effects of alcohol use disorder and simple phobia and alcohol use disorder and antisocial personality disorder. B and D show the years of life lost compared with individuals in the general population who do not have a history of the disorders (age at death in those without disorders is displayed on right-hand axes) with 95% confidence intervals from bootstrapping procedures represented by horizontal bars. For women (A and B), black lines denote no alcohol use disorder (2,891 of 6,090), light purple lines denote alcohol use disorder and no simple phobia disorder (44 of 166), and dark purple lines denote alcohol use and simple phobia disorders (15 of 52). For men (C and D), black lines denote no antisocial personality and no alcohol use disorders (1,761 of 3,546), red lines denote alcohol use disorder and no antisocial personality disorder (312 of 771), and burgundy lines denote antisocial personality disorder (54 of 159).

Figure 3.

Figure 3.

Survival curves and estimates of years of life lost due to drug use disorder and obsessive-compulsive disorder in black women and men in 4 sites of the Epidemiologic Catchment Area Study, 1979–1983 through 2007. Kaplan-Meier and generalized gamma survival curves for black women and men, showing the estimated effects of drug use disorder in black women and the combination of drug use disorder and obsessive-compulsive disorder in black men. B and D show the years of life lost compared with individuals in the general population who do not have a history of the disorders (age at death in those without disorders displayed on right-hand axes), with the 95% confidence intervals from bootstrapping procedures represented by horizontal bars. The confidence intervals for the 28 individuals with no drug use disorder or obsessive-compulsive disorder (D) were so large as to be uninformative and are not shown. For women (A and B), black lines denote no drug use disorder (825 of 2,553) and green lines denote drug use disorder (16 of 93). For men (C and D), black lines denote no obsessive-compulsive disorder and no drug use disorder (522 of 1,268), dark blue lines denote obsessive-compulsive disorder and no drug use disorder (11 of 28), and light blue lines denote drug use disorder (23 of 77).

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