Abstract
BACKGROUND: Few studies investigate cause-specific mortality in individuals with tic disorders. We aimed to examine all-cause, natural-cause, and unnatural-cause mortality in individuals with tic disorders. METHODS: Using the nationwide database of Taiwan from 2003 to 2017, we identified 50,018 patients with tic disorders and, using a ratio of 1:4, matched unaffected controls based on birth year and sex. Cause-specific mortality (i.e., natural cause, accident, and suicide mortality) and all-cause mortality were assessed between the two cohorts using time-dependent Cox regression models. RESULTS: After adjusting for demographics, individuals with tic disorders had increased likelihoods (reported as adjusted hazard ratio [aHR] with 95% confidence interval [CI]) of all-cause (1.14, 1.03-1.26), unnatural-cause (including accidents and suicides; 1.78, 1.43-2.23), and suicide mortality (3.09, 2.07-4.59) compared to controls. With additional adjustments for psychiatric comorbidities, the likelihood of all-cause, unnatural-cause, and suicide mortality remained significant. However, we did not find a higher natural cause mortality in patients with tic disorders compared to controls (1.02, 0.91-1.15). CONCLUSION: Individuals with tic disorders have a higher likelihood of unnatural causes and suicide mortality after adjusting for demographics, clinical characteristics, and psychiatric comorbidities. Our findings suggest that clinicians should routinely monitor both the physical and mental conditions of patients with tic disorders.