Mortality Trends From Medical Comorbidities Among Patients With Psychiatric Disorders in the U.S. (CDC WONDER 1999–2020)
Authors: Ijaz MT, Zaheer I, Khurshid MLR, Motasim N, Zahoor A, Ijaz N, Mukhtar H, Farooq RMU, Niazi A
Journal: American Journal of Emergency Medicine, February 2026
Conclusions:
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Mortality among patients with psychiatric disorders rose dramatically from 1999 to 2020, driven largely by cardiovascular, respiratory, and endocrine/metabolic comorbidities.
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There are major disparities by sex (higher in males) and state/geography, suggesting that local systems of care, access, and comorbidity burden matter.
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For ED practice: “psych” patients are a high medical-risk population—the signal here is not suicide/overdose alone, but medical comorbidity mortality, especially cardiometabolic and pulmonary disease.
ED practice takeaways:
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Treat psychiatric history as a risk flag for silent medical disease: lower threshold for ECG/troponin when appropriate, aggressive evaluation of dyspnea, and attention to diabetes/thyroid/nutrition issues (and medication effects).
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When dispositioning, consider whether “psychiatric” presentation is masking hypoxia, infection, ACS, PE, arrhythmia, DKA/HHS, thyroid storm/myxedema, or med side effects (antipsychotics → metabolic syndrome/QTc; sedatives → respiratory risk).
Results:
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Overall age-adjusted mortality rate (AAMR) associated with psychiatric illnesses increased from 72.1 (1999) to 237.6 (2020) per 100,000.
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Top mortality contributors:
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Cardiovascular disease
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Respiratory disease
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Endocrine/metabolic/nutritional disease
All showed sustained increases with periods of accelerated rise on Joinpoint analysis. -
Sex differences:
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Males: AAMR 116.8 vs females: 77.8 (per 100,000).
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Geographic variation:
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Overall AAMRs ranged from 90.7 (California) to 294.4 (Oregon).
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Vermont had the highest cause-specific mortality rates reported for: CV 167.7, respiratory 124.7, endocrine/metabolic 71.9.
Methods:
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Retrospective trend analysis using CDC WONDER mortality data (1999–2020).
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Calculated age-adjusted mortality rates and used Joinpoint regression to identify trend inflection points and average annual percentage change (AAPC).
Ijaz, M.T., Zaheer, I., Khurshid, M.L.R., Motasim, N., Zahoor, A., Ijaz, N., Mukhtar, H., Farooq, R.M.U. and Niazi, A., 2026. Mortality trends from medical comorbidities among patients with psychiatric disorders in the United States from 1999 to 2020: Insights from CDC Wonder database. The American Journal of Emergency Medicine.