Diabetes underlying-cause subtypes and age at death among individuals with schizophrenia: a decedent-based registry study in Jiangsu Province, China, 2014–2022

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Diabetes is a common comorbidity in schizophrenia, yet the characteristics of schizophrenia decedents with diabetes recorded as the underlying cause of death remain insufficiently described. Using data from the Jiangsu Province Management Information System for patients with severe mental illness (SMI) and the Mortality Registration System, we conducted a retrospective analysis of schizophrenia patients who died from diabetes (ICD-10: E10–E14) between 2014 and 2022 in Jiangsu. A total of 1,335 decedents were identified, with an average age at death of 63.72 years (SD = 12.34). Premature death (< 60 years) accounted for 34.1%,with males dying at a younger age (t =-5.750, P <0.001) and having a higher proportion of premature death (< 60 years) (χ²=23.906, P <0.001) than females. In multivariable analyses, male sex and the acute metabolic subtype were associated with slightly younger age at death and higher odds of being younger than 60 years at death among decedents. The chronic renal subtype was associated with a modestly younger age at death in the linear model, but was not statistically significantly associated with age at death < 60 years in the logistic model. The adjusted differences in age at death were modest, approximately 3.05 years for the acute metabolic subtype and 2.28 years for the chronic renal subtype compared with the no complications subtype. Among schizophrenia decedents with diabetes recorded as the underlying cause of death, male sex and the acute metabolic subtype were associated with slightly younger age at death and higher odds of being younger than 60 years at death. These findings should be interpreted as descriptive epidemiological differences within the selected decedent cohort, rather than as evidence of clinically established differences in prognosis or mortality risk.