Mortality among psychiatric patients in Taiwan—Results from a universal National Health Insurance programme Yi-Hua Chen a , Hsin-Chien Lee b,c , Herng-Ching Lin d, ⁎ a School of Public Health, Taipei Medical University, Taipei, Taiwan b Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan c School of Medicine, Department of Psychiatry, Taipei Medical University, Taipei, Taiwan d School of Health Care Administration, Taipei Medical University, Taipei, Taiwan abstract article info Article history: Received 21 February 2008 Received in revised form 24 July 2008 Accepted 31 July 2008 Keywords: Mortality National Health Insurance Psychiatric inpatient This study investigated 6-year follow-up mortality rates and cause of death for persons younger than 45 years old with a history of hospitalisation for major psychiatric disorders after the introduction of the National Health Insurance (NHI). Linkage data combining death certificates with Taiwan NHI research claims data were used. The study cohort was comprised all patients under the age of 45 years, who had been hospitalised for major psychiatric disorders in 1998. Patients aged b 45 years undergoing an appendectomy were selected as a control group. Cox proportional hazard regressions were performed to compute the adjusted 6-year hazard ratios. For patients with schizophrenia, major depression, or bipolar disorder, the adjusted risks of dying during the follow-up period were significantly 4.614, 3.707 and 3.866, respectively, times higher than that for appendectomy patients. The adjusted hazard ratios of non-natural dying during the follow-up period were significantly 16.316, 14.626 and 8.481 times for female patients with schizophrenia, major depression, and bipolar disorder, respectively, as high as for female appendectomy patients. The continuing excess mortality among psychiatric patients, from both natural and unnatural causes, still remains even after implementation of a NHI. © 2008 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Over the years, studies have consistently reported higher mortality rates among psychiatric patients of both genders, in various countries and ethnic groups, especially among younger patients and specifically during the first year after admission (Black et al., 1985; Casadebaig and Quemada, 1991; Chen et al., 1996; Räsänen et al., 2003). Despite some studies reporting a distinct decline in excess mortality (Sims, 1987; Casadebaig and Quemada, 1991), others have observed a persistent or even widening disparity in health outcomes between the general population and psychiatric patients (Lawrence et al., 2003; Räsänen et al., 2003). Compared with the general population, excess mortality among psychiatric patients is attributed to both natural and unnatural causes of death (e.g., suicide and accidents). Higher risk of suicide was reported for schizophrenic, manic, and depressive patients, especially among male patients with affective disorders during the first decade after a psychiatric hospitalisation (Tsuang, 1978). Although similar patterns of death from natural causes (e.g., cardiovascular diseases and lung diseases) were reported comparing psychiatric groups and the general population, an elevated risk of mortality was documented among mentally ill people (Tsuang and Woolson, 1978; Corten et al., 1988; Mortensen and Juel, 1990, 1993). Consistent with this picture, higher mortality, both natural and unnatural deaths, among psychiatric inpatients in Taiwan has likewise been reported (Chen et al., 1996). Using a nationwide cohort of Taiwanese psychiatric inpatients admitted between 1987 and 1988, inclusive, Chen et al. (1996) reported a higher 6-year mortality rate for psychiatric inpatients (i.e., standardized mortality ratios of 3.1 for men and 4.8 for women) compared with the general population. Mortality studies have contributed considerably as indicators of health-care quality for inpatient and outpatient services (Tsuang and Simpson,1985; Hewer et al.,1995). It is often asked whether equal access to health services including specialised medical procedures has been achieved for a population in general (Corten et al., 1991). Many countries with advanced economies provide universal health insurance coverage to achieve more equal health-care access and to improve the health of the general population. In Taiwan, before 1995, about 57% of the people were insured through three separate programmes, the Labor, the Government Employee, and the Farmers' Insurance Programs. In March Psychiatry Research 178 (2010) 160–165 ⁎ Corresponding author. School of Health Care Administration, College of Medicine, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan. Tel.: +886 2 2736 1661x3613; fax: +886 2 2738 4831. E-mail address: henry11111@tmu.edu.tw (H.-C. Lin). 0165-1781/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2008.07.023 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres