Excess mortality and life-years lost in older adults with schizophrenia-spectrum disorders: A 6-year follow-up case-control study

The prevalence of older adults with schizophrenia is growing, yet age-specific mortality estimates and quantifying metrics remain scarce, limiting evidence-based healthcare management. We followed 2665 older adults (≥65 years) with schizophrenia-spectrum disorder (SSD) and 18,298 matched comparison group utilising Hong Kong electronic health records from 2005 to 2011. We estimated the mortality hazard ratios with Cox regression and competing risk analyses. We also quantified the mortality risks with life-years lost (LYLs) metric for enhanced clinical interpretation. Compared to the comparison group, older adults with SSD had 4-fold elevated all-cause mortality (HR4.39, 95 %CI: 4.02-4.80) and had 5.28 excess LYLs (95 %CI: 4.77-5.87). Natural causes accounted for 5.53 life-years lost, while unnatural causes contributed minimally despite an 8-fold elevated hazard ratio. Natural causes account the majority of excess mortality in older SSD patients. Our findings highlight the importance of prioritising physical health monitoring alongside psychiatric management for this vulnerable population.