Impact of severe mental illness on healthcare use and health outcomes for people with type 2 diabetes: A longitudinal observational study in England
Impact of severe mental illness on healthcare use and health outcomes for people with type 2 diabetes: A longitudinal observational study in England
Background People with severe mental illnesses (SMIs) have reduced life expectancy compared with the general population. Diabetes is a contributor to this disparity, with higher prevalence and poorer outcomes in people with SMI. Aim To determine the impact of SMI on healthcare processes and outcomes for people with type 2 diabetes (T2DM). Design and setting Retrospective, observational, matched, nested, case-control study conducted in England using patient records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics. Method A range of healthcare processes (primary care consultations, physical health checks, and metabolic measurements) and outcomes (prevalence and hospitalisation for cardiovascular disease [CVD], and mortality risk) were compared for 2192 people with SMI and T2DM (cases) with 7773 people who had diabetes alone (controls). Sociodemographics, comorbidity, and medication prescription were covariates in regression models. Results When compared with results for participants with T2DM only, SMI was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.919, 95% confidence interval [CI] = 1.602 to 2.300) and CVD-specific mortality (HR 2.242, 95% CI = 1.547 to 3.250), higher primary care physician consultation rates (incidence rate ratio [IRR] 1.149, 95% CI = 1.111 to 1.188), more-frequent checks of blood pressure (IRR 1.024, 95% CI = 1.003 to 1.046) and cholesterol (IRR 1.038, 95% CI = 1.019 to 1.058), lower prevalence of angina (odds ratio 0.671, 95% CI = 0.450 to 1.001), more emergency admissions for angina (IRR 1.532, 95% CI = 1.069 to 2.195), and fewer elective admissions for ischaemic heart disease (IRR 0.682, 95% CI = 0.508 to 0.915). Conclusion Monitoring of metabolic measurements was comparable for people with T2DM who did, and did not, have SMI. Increased mortality rates observed in people with SMI may be attributable to underdiagnosis of CVD and delays in treatment.
Cardiovascular diseases, Diabetes, Mortality, Primary care, Severe mental illness
E565-E573
Han, Lu
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Doran, Tim
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Holt, Richard
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Hewitt, Catherine
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Jacobs, Rowena
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Prady, Stephanie Louise
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Alderson, Sarah Louise
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Shiers, David
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Wang, Han
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Belfass, Sue
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Gilbody, Simon
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Wray Kitchen, Charlotte Emma
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Lister, Jennie
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Taylor, Johanna
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Siddiqi, Najma
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August 2021
Han, Lu
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Doran, Tim
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Holt, Richard
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Hewitt, Catherine
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Jacobs, Rowena
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Prady, Stephanie Louise
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Alderson, Sarah Louise
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Shiers, David
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Wang, Han
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Belfass, Sue
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Gilbody, Simon
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Wray Kitchen, Charlotte Emma
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Lister, Jennie
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Taylor, Johanna
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Siddiqi, Najma
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Han, Lu, Doran, Tim, Holt, Richard, Hewitt, Catherine, Jacobs, Rowena, Prady, Stephanie Louise, Alderson, Sarah Louise, Shiers, David, Wang, Han, Belfass, Sue, Gilbody, Simon, Wray Kitchen, Charlotte Emma, Lister, Jennie, Taylor, Johanna and Siddiqi, Najma
(2021)
Impact of severe mental illness on healthcare use and health outcomes for people with type 2 diabetes: A longitudinal observational study in England.
British Journal of General Practice, 71 (709), .
(doi:10.3399/BJGP.2020.0884).
Abstract
Background People with severe mental illnesses (SMIs) have reduced life expectancy compared with the general population. Diabetes is a contributor to this disparity, with higher prevalence and poorer outcomes in people with SMI. Aim To determine the impact of SMI on healthcare processes and outcomes for people with type 2 diabetes (T2DM). Design and setting Retrospective, observational, matched, nested, case-control study conducted in England using patient records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics. Method A range of healthcare processes (primary care consultations, physical health checks, and metabolic measurements) and outcomes (prevalence and hospitalisation for cardiovascular disease [CVD], and mortality risk) were compared for 2192 people with SMI and T2DM (cases) with 7773 people who had diabetes alone (controls). Sociodemographics, comorbidity, and medication prescription were covariates in regression models. Results When compared with results for participants with T2DM only, SMI was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.919, 95% confidence interval [CI] = 1.602 to 2.300) and CVD-specific mortality (HR 2.242, 95% CI = 1.547 to 3.250), higher primary care physician consultation rates (incidence rate ratio [IRR] 1.149, 95% CI = 1.111 to 1.188), more-frequent checks of blood pressure (IRR 1.024, 95% CI = 1.003 to 1.046) and cholesterol (IRR 1.038, 95% CI = 1.019 to 1.058), lower prevalence of angina (odds ratio 0.671, 95% CI = 0.450 to 1.001), more emergency admissions for angina (IRR 1.532, 95% CI = 1.069 to 2.195), and fewer elective admissions for ischaemic heart disease (IRR 0.682, 95% CI = 0.508 to 0.915). Conclusion Monitoring of metabolic measurements was comparable for people with T2DM who did, and did not, have SMI. Increased mortality rates observed in people with SMI may be attributable to underdiagnosis of CVD and delays in treatment.
Text
BJGP manuscript - revision R1
- Accepted Manuscript
More information
Accepted/In Press date: 5 February 2021
e-pub ahead of print date: 10 February 2021
Published date: August 2021
Additional Information:
Funding Information:
This research was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (reference: 15/70/26). In addition, Simon Gilbody, Najma Siddiqi, Stephanie Louise Prady, and Rowena Jacobs were funded by the NIHR Yorkshire and Humber Applied Research Collaboration; Sarah Louise Alderson has received funding from the Wellcome Institutional Strategic Support Fund and a NIHR Clinical Trials Fellowship; and Lu Han was funded by the UK Research and Innovation (UKRI) Closing the Gap network (reference: ES/S004459/1). The views expressed are those of the authors and not necessarily those of the HS&DR programme, the NHS, the NIHR, the Department of Health and Social Care, the Closing the Gap network, or UKRI.
Publisher Copyright:
© 2021 Royal College of General Practitioners. All rights reserved.
Keywords:
Cardiovascular diseases, Diabetes, Mortality, Primary care, Severe mental illness
Identifiers
Local EPrints ID: 446969
URI: http://eprints.soton.ac.uk/id/eprint/446969
ISSN: 0960-1643
PURE UUID: 20ca3b6d-bf08-4d72-a35c-4f1380cd6971
Catalogue record
Date deposited: 01 Mar 2021 17:30
Last modified: 17 Mar 2024 06:19
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Contributors
Author:
Lu Han
Author:
Tim Doran
Author:
Catherine Hewitt
Author:
Rowena Jacobs
Author:
Stephanie Louise Prady
Author:
Sarah Louise Alderson
Author:
David Shiers
Author:
Han Wang
Author:
Sue Belfass
Author:
Simon Gilbody
Author:
Charlotte Emma Wray Kitchen
Author:
Jennie Lister
Author:
Johanna Taylor
Author:
Najma Siddiqi
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