Avoidable Mortality among Long-stay Patients with Schizophrenia under Different Smoking-restriction Settings

Objective: Patients with schizophrenia are at a greater risk of avoidable death. Although smoking is a modifiable factor to reduce the mortality gap, the rate of quitting smoking in these inpatients is still lower than that in the general population. We examined avoidable mortality among long-stay patients with schizophrenia under different smoking-restriction environments. Methods: A total of 1998 male and 459 female patients with schizophrenia who was admitted to Taipei Veterans General Hospital, Yuli Branch, in Taiwan, received follow-ups for 11 years to be estimated for the standardized mortality ratios (SMRs) of avoidable causes of death. During that period, all the male patients had stayed in smoking-allowed wards, but all the female patients had not. Results: The mean ± standard deviation age of the patients was 57.8 ± 17.0 years. Of the 993 decedents in total, 411 died of avoidable causes (41.4%). Compared with the general population, male patients had significantly higher mortality due to avoidable causes (SMR = 1.96, 95% confidence interval [CI] = 1.77-2.16, p ＜ 0.05) and in terms of indicators of medical care (SMR = 2.41, 95% CI = 2.17-2.67, p ＜ 0.05); however, the female patients did not (SMR = 1.22, 95% CI = 0.67-2.05; SMR = 1.57, 95% CI = 0.86-2.64, respectively). Conclusion: Male patients had higher mortality gaps due to avoidable causes and in terms of indicators of medical care. But female patients who all had stayed in tobacco-free settings did not. Environmental smoking restriction might be related to the diminished avoidable mortality gaps in patients with schizophrenia.