An Association of Socio-Demographic and Lifestyle Factors with Diabetes and Hypertension in Patients with Schizophrenia and Related Disorders

[摘要] Background:Diabetes and hypertension are implicated in the shortened lifespan of patients with schizophrenia. While obesity and atypical antipsychotics are well-established risk factors, the roles of socio-demographic and lifestyle factors have not been examined systematically.Design:A systematic review examining socio-demographic and lifestyle factors in diabetes and hypertension was carried out.A cross-sectional study examined the associations between socio-demographic and lifestyle factors, and diabetes and hypertension in patients with schizophrenia, their non-psychiatric first degree relatives, and non-psychiatric controls.Methods:The systematic review was carried out using established guidelines.Cross-sectional data from the Diagnostic Interview for Genetic Studies were analyzed to examine associations between socio-demographic and lifestyle risk factors, and diabetes and hypertension in the three groups. Results:The systematic review based on 26 studies showed a strong effect of age and African-American race on the prevalence of diabetes.Age was also associated with the metabolic syndrome, although the effect of race was equivocal.Sex was an effect modifier for diabetes and the metabolic syndrome in some, but not all studies, with higher rates in females.Patients with schizophrenia had higher rates of diabetes and hypertension compared to controls.Multivariate analyses that included age, race, sex, years of schooling, marital status, occupational status, and living arrangement showed that only increasing age and African-American race were significant risk factors for diabetes and hypertension.Patients with schizophrenia had higher rates of smoking, alcohol and marijuana use compared to controls.The rates of smoking and marijuana use in patients were also higher than the rates in their 1st degree relatives.Multivariate analyses that included age, race, sex and years of schooling, failed to show any significant associations for smoking, alcohol or marijuana use with diabetes or hypertension.Conclusions:Only established non-modifiable factors, namely age and race, were confirmed as risk factors for diabetes and hypertension in the systematic review and cross-sectional study.Public Health Significance:The dissertation confirms the need for developing services for minority, mainly African-American, patients with schizophrenia in order to reduce the disease burden and mortality associated with diabetes and hypertension.

[发布机构] the University of Pittsburgh