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Association of Borderline Personality Disorder with Physical Diseases and Mortality: A 16-Year Population-Based Electronic Health-Record Cohort Study in Hong Kong
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DOI：10.1159/000551534.png)
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Abstract
En 中文
Introduction: Borderline personality disorder (BPD) research is scarce. This study quantified risks of physical-diseases and assessed mortality patterns in individuals with BPD. Methods: This retrospective population-based cohort study investigated individuals with a first-recorded diagnosis of BPD in 2006-2021, utilizing a medical-record database of public healthcare services in Hong Kong. Individuals without mental-disorders attending primary care clinics in the study period served as unexposed comparison (i.e., primary care clinics [PCCs] cohort). We estimated risks of physical-diseases and all-cause and cause-specific mortality using Cox-proportional hazards-regression models, and calculated excess life-years lost (LYLs). Results: This analysis included 3,092 patients with BPD and 902,927 individuals in the PCC cohort. BPD was associated with increased risks of a wide-spectrum of physical diseases, with the highest hazards ratio (HR) for epilepsy (7.58 [95% confidence intervals: 5.33-10.79]). HRs for other physical-diseases ranged from 1- to 3-fold higher than the PCC cohort. Individuals with BPD experienced elevated risk of all-cause (5.65 [4.83-6.61]), natural-cause (2.02 [1.56-2.62]) and external-cause mortality (30.35 [23.52-39.17]), with suicide and cardiovascular diseases as the leading contributors. External causes accounted for 40.4% of deaths in BPD, while natural-causes explained 37.3%. The excess LYL for BPD was 13.01 years (9.35-15.52). The association between BPD and physical-diseases generally became statistically nonsignificant among males but remained significantly elevated among females. BPD-associated all-cause mortality risk was higher in females than males. Statistically significant associations between BPD and physical-diseases were predominantly observed in individuals with BPD diagnoses at younger-ages. Conclusion: BPD is associated with increased risk of physical-diseases, excess mortality and reduced life expectancy. Suicide-prevention strategies and physical-health monitoring are urgently warranted to reduce physical-health disparities and premature-mortality in BPD. Borderline personality disorder (BPD) is a serious mental disorder that remains understudied. This study examined whether people with BPD have an increased risk of physical diseases and premature death compared to people without mental disorders. We used electronic health-record database in Hong Kong to include 3092 people with BPD, and compared them to those who used primary-care services but without recorded mental disorders. The results showed that people with BPD had a higher risk of a broad range of physical diseases. The risk of epilepsy was approximately seven times higher, while the risks of other physical diseases were one to three times higher than in those without mental disorders. People with BPD also had an elevated risk of all-cause mortality, and deaths from both natural and external causes. Suicide and cardiovascular diseases were the leading death causes. On average, people with BPD died 13 years earlier than the general population. Exploratory analyses suggested that the excess risks of physical diseases and premature death related to BPD may be greater in females than in males, and that those diagnosed with BPD at younger ages may be at particularly higher risk of physical diseases. However, these subgroup findings were limited by small sample sizes, which precluded firm conclusions about sex- and age-specific differences. Overall, our findings indicate that BPD is related to increased physical disease burden, excess mortality, and shortened lifespan. These results underscore the need for integrated care models that prioritise suicide prevention and physical health monitoring in people with BPD.
Keywords:
Borderline personality disorder
Physical diseases
Mortality
Life years lost
Life expectancy
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