A predisposition for allergies predicts subsequent hypertension, dyslipidemia, and diabetes mellitus among patients with schizophrenia or bipolar disorder: A nationwide longitudinal study

doi:10.1016/j.schres.2014.07.029

Schizophrenia Research

Volume 159, Issue 1, October 2014, Pages 171-175

https://doi.org/10.1016/j.schres.2014.07.029 Get rights and content

Abstract

Background

Previous studies have shown that both severe mental disorders (schizophrenia and bipolar disorder) and atopic diseases were associated with an increased risk of metabolic syndrome. However, the role of atopy/the predisposition for allergies in the development of metabolic syndrome is still unknown among those with severe mental disorders.

Methods

Using the Taiwan National Health Insurance Research Database, 5826 patients with schizophrenia or bipolar disorder (1908 with a predisposition for allergies and 3918 without) were enrolled between 1998 and 2008. Those who developed hypertension, dyslipidemia, and/or diabetes mellitus were identified during the follow-up to the end of 2011.

Results

A predisposition for allergies increased the risk of developing hypertension (HR: 1.67), dyslipidemia (HR: 1.82), and diabetes mellitus (HR: 1.37) in later life among those with severe mental disorders. A dose-dependent relationship was noted between having more atopic comorbidities and a greater likelihood of hypertension (1 atopic disease: HR: 1.60; ≧ 2 atopic comorbidities: HR: 1.87), dyslipidemia (HR: 1.73; HR: 2.12), and diabetes mellitus (HR: 1.26; HR: 1.69).

Conclusion

A predisposition for allergies was an independent risk factor for hypertension, dyslipidemia, and diabetes mellitus among patients with schizophrenia or bipolar disorder. Further studies would be required to elucidate the underlying pathophysiology among atopy, schizophrenia, bipolar disorder, and metabolic syndrome.

Introduction

The increased risk of metabolic syndrome/disorders in those with severe mental disorders, including schizophrenia and bipolar disorder, has gained much attention in both psychiatry and public health during the past decade because metabolic syndrome has been reported to elevate the risk of subsequent cardiovascular diseases that may contribute to excess mortality or premature mortality in these patients (Brown et al., 2000, Osby et al., 2001, Angst et al., 2002, Laursen et al., 2011). Previous evidence has shown that patients with severe mental disorders (schizophrenia or bipolar disorder) had a higher prevalence, ranging from 32% to 50%, of metabolic syndrome than the general population (Birkenaes et al., 2007, Malhotra et al., 2013, Vancampfort et al., 2013). The causes of increased metabolic syndrome/disorders are multifactorial, and include an unhealthy lifestyle, the adverse effects of pharmacological treatments, and poorer access to and quality of physical health care (Mitchell et al., 2009, M et al., 2011, Vancampfort et al., 2013).

Previous studies have reported the relationship of atopy or a predisposition for allergies with schizophrenia and bipolar disorder (Goodwin et al., 2003, Chen et al., 2009, Jerrell et al., 2010, Pedersen et al., 2012). Chen et al. surveyed the prevalence of atopic diseases among 44,187 patients with schizophrenia and found that more than 20% of them had experienced concurrent atopic diseases (Y. H. Chen et al., 2009). A Danish population-based study showed that atopic diseases, especially asthma, increased the rate ratio of schizophrenia by 1.45 (95% confidence interval [CI]: 1.31–1.90) (Pedersen et al., 2012). Jerrell et al. demonstrated a significantly higher prevalence of asthma among 1841 patients with bipolar disorder than among 4500 controls (25.7% vs. 22.7%, p < 0.01) (Jerrell et al., 2010). Goodwin et al. also revealed that lifetime severe asthma was associated with an increased likelihood of bipolar disorder (odds ratio [OR]: 5.64; 95%CI: 1.95–16.35) (Goodwin et al., 2003). Furthermore, some evidence has suggested an association between atopic diseases and metabolic syndrome/disorders (Del-Rio-Navarro et al., 2010, Agrawal et al., 2011, Singh et al., 2013, Garmendia et al., 2014). Assessing the prevalence of metabolic syndrome among 111 patients with asthma and 198 without, Del-Rio-Navarro et al. found that patients with asthma had a higher prevalence of metabolic syndrome than those without (Del-Rio-Navarro et al., 2010). In a study of 3609 adults, Husemoen et al. found an association between insulin resistance and asthma (OR: 1.52, 95%CI: 1.14–2.03) (Husemoen et al., 2008). An animal study further suggested that atopic dermatitis caused abnormal lipid accumulation in the liver of NC/Nga mice (Seino et al., 2012). Overall, some research evidence has suggested that both schizophrenia and bipolar disorder were associated with more atopic diseases, and other studies have suggested that atopic diseases were associated with a higher risk of metabolic syndrome in the general population. However, there has been no study investigating the role of atopic diseases in the development of metabolic syndrome/disorders among patients with schizophrenia and bipolar disorder.

In this study, using the Taiwan National Health Insurance Research Database (NHIRD) with a large sample size and a longitudinal follow-up study design, we investigated the association among atopic diseases/the predisposition for allergies and metabolic disorders (hypertension, dyslipidemia, and diabetes mellitus) among patients with schizophrenia or bipolar disorder. We hypothesized that atopic diseases/the predisposition for allergies increased the risk of developing metabolic disorders in later life among patients with schizophrenia or bipolar disorder.

Section snippets

Data source

The National Health Insurance (NHI) program was implemented in 1995 and covers up to 99% of the 23,000,000 residents of Taiwan (http://www.nhi.gov.tw/). The NHIRD was audited and released by the National Health Research Institute. Comprehensive information on insured subjects, such as demographic data, dates of clinical visits, and disease diagnoses, is included in the database. To guarantee privacy, all subjects included in the NHIRD are anonymous. The diagnostic codes used were based on the

Results

Of the 5826 enrolled subjects, 4269 with schizophrenia and 1557 with bipolar disorder, 1908 had a predisposition for allergies and 3918 did not (Table 1). Those with a predisposition for allergies were predominantly female (58.1% vs. 48.7%, p < 0.001) and had an earlier age of diagnosis of schizophrenia or bipolar disorder (32.77 ± 13.39 vs. 34.89 ± 12.60 years, p < 0.001) than those without a predisposition for allergies (Table 1). Among the atopic subjects, 1385 (72.6%) were diagnosed as having only

Discussion

Our results supported the study hypotheses that atopic diseases/a predisposition for allergies increased the risk of developing hypertension, dyslipidemia, and diabetes mellitus in later life in subjects with schizophrenia and in those with bipolar disorder, and that there was a dose-dependent relationship, in that those with more atopic comorbidities had a greater likelihood of hypertension, dyslipidemia, and diabetes mellitus.

From the clinical aspect, both schizophrenia/bipolar disorder and

Role of funding source

The study was supported by grant from Taipei Veterans General Hospital (V103E10-001). The funding has no role in any process of this study.

Contributors

Dr MHC, Dr TPS, and Dr YMB designed the study, and wrote the protocol and manuscripts, Dr YMB, Dr TPS, Dr CTL, Dr WCL, Dr HTW, and Prof TLP assisted with the preparation and proof-reading of the manuscript, and Dr YMB, Dr TJC, and Ms WHC provided advice on statistical analysis.

Conflicts of interest

All authors declare no conflict of interest.

Acknowledgment

We thank Dr MHC, Dr TPS, and Dr YMB, who designed the study, and wrote the protocol and manuscripts, Dr YMB, Dr TPS, Dr CTL, Dr WCL, Dr HTW, and Prof TLP, who assisted with the preparation and proof-reading of the manuscript, and Dr YMB, Dr TJC, and Ms WHC, who provided advice on statistical analysis.

We thank Mr I-Fan Hu's friendship and support.

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A predisposition for allergies predicts subsequent hypertension, dyslipidemia, and diabetes mellitus among patients with schizophrenia or bipolar disorder: A nationwide longitudinal study

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Data source

Results

Discussion

Role of funding source

Contributors

Conflicts of interest

Acknowledgment

J. Affect. Disord.

J. Affect. Disord.

Biol. Psychiatry

Schizophr. Res.

Neurosci. Lett.

Alcohol

J. Affect. Disord.

J. Psychiatr. Res.

J. Affect. Disord.

Schizophr. Res.

Biol. Psychiatry

Schizophr. Res.

Emerging interface between metabolic syndrome and asthma

Am. J. Respir. Cell Mol. Biol.

Genetic dissection of atypical antipsychotic-induced weight gain: novel preliminary data on the pharmacogenetic puzzle

J. Clin. Psychiatry

The level of cardiovascular risk factors in bipolar disorder equals that of schizophrenia: a comparative study

J. Clin. Psychiatry

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Br. J. Psychiatry

Generalized anxiety and major depressive disorders, their comorbidity and hypertension in middle-aged men

Psychosom. Med.

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PLoS ONE

Attention deficit hyperactivity disorder, tic disorder, and allergy: is there a link? A nationwide population-based study

J. Child Psychol. Psychiatry

Asthma and attention-deficit/hyperactivity disorder: a nationwide population-based prospective cohort study

J. Child Psychol. Psychiatry