Mortality Rates in Users of Typical and Atypical Antipsychotics: A Database Study in Poland

BACKGROUND The role of antipsychotics in influencing mortality of patients with mental disorders is still unexplained. OBJECTIVE The aim of this study was to determine mortality rates of patients treated with atypical and typical antipsychotics and to compare these data with the mortality rates for the general population. METHODS The study was based on the 2008-2012 prescription drug reimbursement data from the Polish National Health Fund in Gdansk and mortality data from the death registry. Age-standardized death rates (SDRs) and 95 % confidence intervals (CIs) were calculated for individuals prescribed solely atypical or typical antipsychotics, patients prescribed both atypical and typical antipsychotics, and patients prescribed clozapine. RESULTS Between 2008 and 2012, typical and/or atypical antipsychotics and clozapine were prescribed to a total of 81,313 patients. The SDR for typical antipsychotic users (69.6 per 1000, 95 % CI 67.64-71.56) was higher than for those treated with both typical and atypical antipsychotics (53.25 per 1000, 95 % CI 50.8-55.69) or clozapine (65.11 per 1000, 95 % CI 58.63-71.58). The lowest mortality was documented in the case of patients treated exclusively with atypical antipsychotics (SDR = 48.38 per 1000, 95 % CI, 44.78-51.98). The SDRs for patients treated with antipsychotics were more than tenfold higher than the respective SDRs for the general population in 2008, but later in 2012, the differences dropped to threefold. CONCLUSION Although the study was based on administrative record linkage and therefore could not be adjusted for potential confounders, its results suggest that mortality in atypical antipsychotic users is lower than in typical antipsychotic users.