Risk factors for mortality due to natural causes and suicide among people with severe mental illness in western China

•Compared to the studies of most high-income country, the mortality due to natural causes and suicide among people with severe mental illness in western China were much higher.•Risk factors were not shared across natural deaths and suicide among people with severe mental illness in western China. Risk management and interventions for people with SMI should be tailored for specific causes of death.•To reduce natural deaths, we should pay more attention to the SMI patiets who lack care and treatment, especially the poor elderly. For the prevention of suicide, more concern should be given to the highly educated SMI patiets, especially those who have attempted suicide. Excess mortality in people with severe mental illness (SMI) has been extensively reported. However, little is known about mortality due to natural causes and suicide and their risk factors among people with SMI in western China. The study was conducted to determine the risk factors of natural death and suicide among people with SMI in western China. A totoal of 20,195 SMI patients in western China derived from severe mental illness information system in Sichuan province (January 1, 2006, through July 31, 2018) were included in the cohort study. Mortality rates per 10,000 person-years of natural causes and suicide for patients were calculated with different characteristics. Fine-Gray competing risk model was used to identify risk factors of natural death and suicide. The mortality was 132.8 per 10,000 person-years for natural death and 13.6 per 10,000 person-years for suicide. Males, older age, divorced/widowed, poverty and no anti-psychotic treatment were significantly associated with natural death. Higher education and suicide attempt were strong risk factors of suicide. Risk factors were not shared across natural death and suicide among people with SMI in western China. Risk management and interventions for people with SMI should be tailored for specific causes of death.