Schizophrenia is a chronic psychiatric disorder associated with substantially increased mortality. Although antipsychotic medications are central to treatment, their long-term associations with survival in routine practice remain unclear in many non-Western populations. This registry cohort study from Guangdong Province, China, evaluated real-world antipsychotic prescribing patterns and the relationship between treatment regimens and all-cause mortality among adults with schizophrenia.
The analysis used the Community Schizophrenia Registry System of Guangdong Province and included 435,816 adults diagnosed with schizophrenia. Patients were followed over a median of 7.2 years. During follow-up there were 73,527 deaths, representing 16.9% of the cohort.
Patients were classified into four mutually exclusive groups for analysis:
In this real-world population, antipsychotic polytherapy was the predominant prescribing pattern (57.6% of patients), while monotherapy accounted for 27.6%.
Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for all-cause mortality comparing treatment groups. The models produced point estimates with 95% confidence intervals to quantify relative mortality risk across regimens versus the non-drug group.
Compared with the non-drug group, all-cause mortality risks were significantly lower for the treated groups:
These findings indicate that, in this cohort, receiving antipsychotic medication was associated with large relative reductions in all-cause mortality compared with no pharmacologic treatment recorded in the registry.
The study reports that first- and second-generation antipsychotics demonstrated comparable mortality benefits in this population. The abstract does not provide separate aHR values for each generation; it states the mortality associations were similar across generations.
Overall, most polytherapy regimens performed similarly to or better than monotherapy with respect to mortality associations. However, the authors identified specific combinations associated with higher mortality; the risperidone–sulpiride combination is highlighted in the abstract as linked to increased mortality risk relative to other regimens.
Subgroup analyses suggested that the magnitude of the mortality benefit associated with antipsychotic treatment varied across patient characteristics. Stronger associations with reduced mortality were observed among:
The abstract does not provide numerical subgroup-specific aHRs in the text presented, only that benefits were more pronounced in these subgroups.
In this large Chinese registry cohort of adults with schizophrenia, antipsychotic treatment—particularly when used in routine polytherapy—was associated with substantially lower all-cause mortality compared with no drug treatment. Both generations of antipsychotics showed comparable associations with reduced mortality. While most polytherapy regimens were as good as or better than monotherapy, certain combinations (for example, risperidone–sulpiride) were associated with higher mortality, highlighting the need to evaluate specific drug pairings in clinical decision-making. Observed variation by sex, age, residence and illness severity suggests patient characteristics modify the association between treatment and survival.
The abstract summarizes aims, methods, key results and subgroup patterns but does not provide full details on several elements often reported in full manuscripts. Specifically, the abstract does not report detailed covariates included in the adjusted models, absolute mortality rates by treatment group, duration or dosing of specific medications, how illness severity was defined or measured in the registry, or cause-specific mortality breakdowns. Details on potential biases inherent to registry data and sensitivity analyses are not reported in the abstract. For complete methodological detail and fuller numerical results, the full article should be consulted.