Many studies have observed a link between mortality and mental illness, although the contribution of violence exposure to mortality in people with mental illness remains under-researched.

To examine the association of violence exposure, such as being physically assaulted, with general and cause-specific mortality in a population using mental health services.

We assembled a cohort study using electronic health records from a mental health and substance use treatment provider in south-east London. Records were linked to acute medical admission and emergency department presentation data, as well as to a national mortality register with death certificates for deaths registered in England and Wales. Cox regressions estimated the associations of binary and cumulative violence exposure, as indicated by assault admission and presentation to emergency departments for violence-related reasons. Mortality was adjusted for sociodemographic and clinical potential confounders.

The hazard ratio for assault admission with all-cause mortality was 2.14 (95% CI: 1.93–2.36) following covariate adjustment. Adjusted associations were also found with mortality from the following causes: internal (natural) (hazard ratio 1.72, 95% CI: 1.50–1.98), external (hazard ratio 1.94, 95% CI: 1.51–2.48), suicide (hazard ratio 2.20, 95% CI: 1.38–3.52), respiratory (hazard ratio 2.01, 95% CI: 1.41–2.85), circulatory (hazard ratio 1.71, 95% CI: 1.27–2.28), diabetes-related (hazard ratio 2.86, 95% CI: 1.20–6.86) and alcohol-related (hazard ratio 1.56, 95% CI: 1.10–2.22). Results for cumulative assault were consistent with these in both direction and magnitude. There was evidence for an association of weapon-related assault admission with all-cause mortality (hazard ratio 1.58, 95% CI: 1.14–2.18).

People with mental illness, who are exposed to assault, experience greater mortality than those who are not exposed. Excess mortality attributable to violence exposure in people with mental illness was related to deaths from natural and external causes.

Dynamic, data-driven predictors of perioperative mortality risks in preterm/early-term neonates with CHD undergoing cardiac surgery in the first 24 months of life are limited.

To identify risk factors of mortality in the first 24 months of life for pre/early-term neonates with CHD.

Retrospective cohort study of patients <39 weeks of gestation undergoing cardiac surgery within 24 months of life from 2013–2020 at a tertiary care centre. Independent risk factors of mortality within 24 months of life were determined by multivariable Cox regression analysis.

Among the 205 neonates, 33 (16.1%) died within 24 months. Multivariable analysis revealed that high-frequency ventilation (hazard ratio = 5.15; 95% confidence interval): 2.51, 10.6; p < 0.001), extracorporeal membrane oxygenation support (hazard ratio = 5.77; 95% confidence interval: 2.67, 12.5; p < 0.001), and CHD with a palliated circulation (hazard ratio = 6.07; 95% confidence interval: 2.84, 13; p < 0.001) were significant independent risk factors of mortality at any time during the index hospitalisation or the first 24 months of life.

Identifying and re-evaluating risk factors of mortality for preterm/early-term neonates with CHD at any time during the index hospitalisation or the first 24 months of life may guide resource allocation and therapeutic interventions.

Trial registration number and date of registration: IRB P00028833 5/2/2018. Retrospectively registered.

In-hospital strokes comprise a small but high-risk subgroup of patients and are associated with worse outcomes compared to community-onset strokes. We compared clinical characteristics, workflow metrics and clinical outcomes of adult patients with in-hospital strokes and those with community-onset strokes in Alberta.

We conducted a retrospective cohort study (INPATIENTS: IN-hosPitAl sTrokes InAlbErta iNcidence and ouTcomeS) from Jan 1, 2018–Dec 31, 2022 using provincial administrative data and chart review to compare in-hospital and community-onset acute ischemic and hemorrhagic strokes. We performed multivariable logistic regression to determine the association of stroke onset location (in-hospital vs community-onset) with the following outcomes: in-hospital mortality, prolonged hospital stay and in-hospital complications. Negative binomial regression was conducted to compare workflow metrics between cohorts. All models were adjusted for age, sex, comorbidities, facility type and admission year.

Among 24,039 stroke admissions, 2,545 (10.6%) were in-hospital strokes and 20,895 (86.9%) were ischemic. In-hospital strokes had higher rates of comorbidities and were associated with higher in-hospital mortality (adjusted OR [aOR] 3.09; 95% CI 2.80–3.41), prolonged hospital stays (aOR 5.47; 95% CI 4.89–6.112) and increased in-hospital complications. In-hospital ischemic stroke patients receiving thrombectomy showed lower odds of in-hospital mortality (aOR 0.46; 95% CI, 0.28–0.75) and pneumonia (aOR 0.38; 95% CI, 0.20–0.71) compared to non-treated patients. Workflow times were significantly longer in in-hospital ischemic strokes compared to community-onset strokes.

Patients with in-hospital stroke experience higher rates of mortality, poorer clinical outcomes and significant delays in management. Targeted quality improvement efforts are needed to address care gaps and improve outcomes in this population.

People with severe mental illness (SMI) (schizophrenia-spectrum and bipolar disorders) experience a 15–20-year reduction in life expectancy. The role of social determinants, including that of social exclusion, in contributing to excess mortality in SMI remains underexplored.

Retrospective cohort study, comprising 8098 people with clinician-diagnosed SMI, matched to 581,209 population controls, followed for 5.7 years using person-level linked health/ census records. A social exclusion index was derived from census indicators: marital status, social isolation, economic inactivity, education, tenure, housing stability, and material assets.

Social exclusion was more common in SMI than in controls and strongly associated with higher mortality. Relative to the least socially excluded controls, adjusted hazard ratios (aHR) for mortality in SMI were: 16–44 years: aHR 7.58 (95% CI: 2.75–20.86) in the least socially excluded, increasing to 12.34 (7.92–19.24) in the most excluded; 45–64 years: 3.34 (1.98–5.64) [least excluded] increasing to 6.58 (5.32–8.14) [most excluded]; 65+ years: 2.71 (1.90–3.86) [least excluded], increasing to 3.07 (2.48–3.80)[most excluded]. Excess mortality among those with SMI was pronounced at younger ages if never married; by mid-life if living alone or economically inactive; and at 65+ years in those with SMI living alone, renting, or with no car ownership. Economic inactivity and lack of qualifications accounted for 16–35% of SMI mortality.

Social exclusion is an under-recognized contributor to premature mortality in SMI. Targeting social determinants through novel socially-focused interventions could improve survival in people with SMI.

To characterise hospital-treated multimorbidity patterns in people who subsequently died a drug-related death in Scotland, and to identify clinically meaningful associations among conditions and decedent to inform prevention and care.

A register-based retrospective cohort study using nationally linked hospital admission (1996–2019) and mortality (2008–2019) records for 5,749 decedents. We identified hospital admissions for Elixhauser comorbidities using ICD-10 codes. Correlation analysis, network analysis, and Bayesian clustering were used to describe co-occurring conditions and identify patient clusters with distinct comorbidity profiles.

Over half (50.9%) of decedents had at least one admission for an Elixhauser comorbidity. The most frequent were related to alcohol use (38.2%), drug use (29.1%), other neurological disorders (18.0%, mainly epilepsy/seizures/anoxic brain injury), depression (15.2%), and psychoses (12.5%). Network analysis highlighted drug use, alcohol use, psychoses, depression, and neurological disorders as central conditions. Bayesian clustering identified seven distinct patient clusters, including groups characterised by: high psychiatric and drug-use admissions; extensive physical comorbidities; alcohol and liver disease; dominant neurological issues and depression.

Individuals experiencing drug-related deaths exhibit substantial multimorbidity with distinct patterns often dominated by substance use and mental ill-health but also including significant physical health clusters. These distinct profiles underscore the need for integrated, tailored care strategies addressing substance use, psychiatric, and physical health needs to mitigate mortality risk.

The population with a serious mental illness (SMI) shows a high risk of premature mortality. Overexposed to multiple health risks throughout life, their main threat is physical illness, which starts earlier and is not diagnosed in time. Developing preventive actions is a public health priority.

This longitudinal prospective study evaluated the predictive value of lung function on all-cause mortality in patients with schizophrenia (SCHIZ) or bipolar disorder. Patients aged 40–70 years, active smokers, and without preexisting respiratory disease underwent spirometry following American Thoracic Society/European Respiratory Society 2021 standards. Mortality data were collected through December 2022. Cox proportional hazards models and Kaplan–Meier survival curves analyzed the association between lung function, specifically forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and mortality, adjusting for relevant confounders (age, gender, abdominal circumference, and comorbidities).

Of 107 participants (mean age 49.3 years, 63.3% male) with SMI (72% SCHIZ) and active smokers, 8 (7.5%) died during the 6-year follow-up (5 cardiovascular and 3 cancer). Mean z-scores were −1.41 (SD = 1.22) for FEV1 and −0.99 (SD = 1.16) for FVC. Lower FEV1 and FVC z-scores were significantly associated with increased mortality risk (p = 0.002 and p = 0.009, respectively). Kaplan–Meier analysis confirmed this association for FEV1 (p = 0.039) and FVC (p = 0.007) but not for gender, comorbidities (hypertension, diabetes, and dyslipidemia), or FEV1/FVC. A multivariate Cox regression model, adjusting for age and abdominal circumference, confirmed the independent predictive value of lower FEV1 z-score for mortality (hazard regression = 0.473, 95% confidence interval: 0.220–0.979, p = 0.044).

Poorer lung function, especially lower FEV1, was independently associated with all-cause mortality in SMI. Spirometry, an easily implementable technique, could help to detect at-risk individuals and favor prevention initiatives.

The COVID-19 pandemic significantly impacted Saskatchewan, resulting in high per capita case counts and COVID-19-related deaths. While vaccination mandates have been a key strategy to control the pandemic, their impact in Saskatchewan remains poorly documented. This study assessed the effect of COVID-19 vaccine mandates on the incidence of COVID-19 cases and deaths in Saskatchewan during the first year following vaccine rollout.

A single-group interrupted time series analysis with multiple intervention points was conducted using aggregated daily COVID-19 incidence and mortality rates as outcome variables. The models accounted for confounding effects of daily total vaccine doses administered and public health countermeasures, including the stringency index and economic support index, from April 1, 2020 to January 20, 2022. Average daily COVID-19 incidence and mortality rates were estimated for the pre-vaccine rollout period (April 1 to December 14, 2020), and the post-rollout period (December 15, 2020 to January 20, 2022). In addition, nine supplementary initiatives were introduced during the implementation phase. All estimated effects reflected cumulative changes in trend relative to the pre-vaccination period.

Cumulatively, COVID-19 incidence increased faster than the pre-vaccination trend, likely driven by successive variant surges from wild-type to Omicron, while COVID-19–related deaths remained stable across the same period. The implementation of vaccine rollout, prioritization of vaccines for high-risk populations, and proof-of-vaccination policy were effective in reducing daily COVID-19 incidence and deaths in Saskatchewan. Economic support and an increased number of daily vaccine doses administered were also associated with an improved provincial COVID-19 response. Conversely, surges in COVID-19 incidence and deaths occurred following the introduction of the centralized virtual booking system and booster doses. These surges may reflect accessibility challenges, increased testing, emergence of immune-escape variants, relaxation of public health measures before achieving herd immunity, and waning immunity over time.

Economic support, policy measures, and vaccination efforts played important roles in managing public health crises, hence the need for an integrated approach to managing public health crises. However, temporary surges following certain interventions underscore the need for accessible, adaptable strategies that account for variant emergence, immunity waning and public adherence.

Understanding how suicide rates vary across age, sex, and geography is essential to designing effective prevention strategies. We examined long-term trends in suicide mortality across European countries over three decades, with a focus on age-specific trajectories.

Using the WHO mortality database, we computed annual sex- and age-specific suicide rates (10–14 to 85+ age groups) from 1990 to 2022, for the most populous European countries, and aggregated rates for the EU-27 and four geographical areas (North, West, South, and Centre-East Europe). We also calculated percentage differences across four time periods (1990–1994, 2000–2004, 2010–2014, and 2020–2022), according to data availability.

Suicide rates increased with age, peaking in older individuals (85+) in most countries (e.g., 82.0/100,000 in France in 2020–2022, 77.1/100,000 in Germany among males, in 2020), except in the UK and Northern Europe, where rates peaked at middle age (∼22/100,000 at 45–49, in 2020). EU-27 suicide rates in 2020 ranged from 5.5/100,000 (age 15–19) to 58.2/100,000 (85+) among males, and from 2.6 (15–19) to 8.6/100,000 (85+) among females. Male suicide rates were 3 to 8 times higher than female rates across all ages. While overall rates declined since 1990 in most countries, youth suicide increased after 2010 in Western (e.g., +12%, girls 15–19), Southern (+24.5%, girls 15–19), and Northern (+44%, girls 15–19 and 20–24) Europe. Rates among young and middle-aged adults recently rose in Spain, the UK, and Northern Europe, while they declined in Eastern Europe after the 1990s.

Despite overall declines, our findings highlight marked heterogeneity in sex- and age-specific trends in suicide mortality across Europe. These patterns call for age-tailored prevention strategies that address evolving psychosocial stressors and structural determinants across the lifespan.

Individuals with first-episode psychosis (FEP) face markedly increased excess mortality, yet the long-term trends and key contributing factors remain insufficiently characterized. This study aimed to examine long-term mortality patterns, standardized mortality ratios (SMRs), and associated factors in a FEP cohort.

This population-based cohort study included 1,389 individuals diagnosed with FEP, followed for up to 25 years. Mortality outcomes were obtained from Hong Kong’s centralized hospital database (CMS) and coroner’s court reports, with SMRs calculated. Baseline sociodemographic and clinical, as well as long-term treatment-related factors of all-cause, natural, and unnatural mortality were analyzed.

Among 1,389 participants, 137 deaths (9.86%) occurred during the follow-up period with the overall SMR of 6.56 (95% CI, 5.50–7.71). The cumulative incidence rate of unnatural mortality increased sharply over the first 10 years and that of the natural cause of death started to increase after the first decade of the illness. Male gender and poorer social functioning were associated with increased all-cause mortality risk, while male gender, lower education, and baseline hospitalization raised unnatural mortality risk. Greater monthly antipsychotic variability during the first 10 years increased all-cause mortality risk in the period after the initial 10 years.

This 25-year follow-up study of FEP highlighted the changes in the long-term mortality pattern of FEP and thus the phase-specific needs of individuals with FEP. Therefore, it is important to integrate physical care into mental health services, as well as stage-specific and individualized care for patients with psychotic disorders to reduce long-term excess mortality.