Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study

(a) Summary of prospective cohort studies addressing the association between various indications of cardiovascular disease and risk of psychiatric disorders/psychiatric symptoms. (b) International Classification of Diseases (ICD) codes for exposure, outcome, and covariates identifications. (c) Crude incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psychiatric disorder among CVD patients compared with their full siblings or matched population controls, by patient characteristics. CVD: cardiovascular disease. ^aCox regression models, stratified by family identifier for sibling comparison or matching identifier (birth year and sex) for population comparison, adjusting for sex, birth year, educational level, individualized family income, cohabitation status, history of somatic disease, and family history of psychiatric disorder. Time since index date was used as underlying time scale. (d) Crude incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psychiatric disorders among CVD patients compared with their full siblings or matched population controls, by time of follow-up (<1 or ≥ 1 year from CVD diagnosis). CVD: cardiovascular disease. ^aCox regression models, stratified by family identifier for sibling comparison or matching identifier (birth year and sex) for population comparison. Time since index date was used as underlying time scale. (e) Crude incidence rates (IRs) of different types of psychiatric disorder among CVD patients, their full siblings, and matched population controls, by time of follow-up (<1 or ≥ 1 year from CVD diagnosis). CVD: cardiovascular disease. (f) Crude incidence rates (IRs) for psychiatric disorders among different groups of CVD patients, their full siblings and matched population controls, by time of follow-up (<1 or ≥ 1 year from CVD diagnosis)^a. CVD: cardiovascular disease. ^aWe identified all cardiovascular diagnoses during follow-up and considered CVD comorbidity as a time-varying variable by grouping the person-time according to each diagnosis. (g) Crude incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) for psychiatric disorders among CVD patients compared with their full siblings or matched population controls, excluding CVD patients medicated with psychotropic drugs, by time of follow-up (<1 or ≥1 year from CVD diagnosis)^a. CVD: cardiovascular disease. ^aCVD patients diagnosed during 2006–2016 were included in this analysis due to the availability of data on prescribed drug. In sibling comparison, 27.8% CVD patients and 23.5% siblings were excuded due to prior medicaiton of psychotropic drugs before index date. In population comparison, 30.6% CVD patients and 25.0% population controls were excluded due to prior medicated with psychotropic drugs before index date. ^bCox regression models, stratified by family identifier for sibling comparison or matching identifier (birth year and sex) for population comparison. Time since index date was used as underlying time scale. Definition of psychiatric disorder included hospital visits as well as use of psychotropic drugs during follow-up. (h) Crude incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psychiatric disorder among CVD patients compared with their full siblings or matched population controls, restricting study period to 2001–2016 and excluding individuals with a history of alcoholic cirrhosis of liver or COPD, by time of follow-up (<1 or ≥1 year from CVD diagnosis). COPD, chronic obstructive pulmonary disease. ^§In sibling comparison, 1.14% exposed patients and 0.55% siblings were excluded due to a history of alcoholic cirrhosis or COPD before index date. In population comparison, 1.44% exposed patients and 1.01% population controls were excluded due to having a history of alcoholic cirrhosis or COPD before index date. *Cox regression models, stratified by family identifier for sibling comparison or matching identifier (birth year and sex) for population comparison. Time since index date was used as underlying time scale. Definition of psychiatric disorder included hospital visits as well as use of psychotropic drugs during follow-up.

CVD: cardiovascular disease. *67,745 families had more than one sibling affected by CVD.