Characterizing Infectious Disease Mortality in Severe Mental Illness: A Retrospective Matched Cohort Study

People with severe mental illness (SMI) are at an increased risk of infection mortality compared to the general population. Little is known about how this risk might differ across infection types, and the potential impact of sociodemographic and clinical factors. We investigated associations between SMI and infection mortality in a population-based cohort, examining variation by infection type and potential moderating factors.

This retrospective matched cohort study (January 1, 2000 to December 31, 2019) used national primary care data from the UK Clinical Practice Research Datalink linked with Office of National Statistics mortality data. Competing risks regression and cause-specific hazard models assessed risk of infection mortality in people with SMI versus non-SMI controls. We examined risk across different infection types and assessed the impact of sociodemographic and clinical factors.

Our cohort comprised 84 494 people with SMI matched on age, gender, and GP practice with 84 494 non-SMI controls. Fully adjusted models showed that people with SMI were more likely to die from any infection compared to non-SMI controls (adjusted hazards ratio (aHR) = 1.58, 95% CI, 1.44-1.74). Infection-specific analyses revealed increased risk of death from respiratory (aHR = 1.69, 95% CI, 1.51-1.89), gastrointestinal (aHR = 2.01, 95% CI, 1.16-3.48), and renal/urinary (aHR = 1.70, 95% CI, 1.32-2.19) infections in the SMI group.

People with SMI are at increased risk of infection mortality, especially from respiratory, gastrointestinal, and renal/urinary infections. We recommend prioritizing this group for preventative measures including influenza and pneumococcal vaccines.