Association of Borderline Personality Disorder with Physical Diseases and Mortality: A 16-Year Population-Based Electronic Health-Record Cohort Study in Hong Kong.

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.