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Disparities in screening and treatment of cardiovascular diseases in patients with mental disorders across the world: Systematic review and meta-analysis of 47 observational studies

Disparities in screening and treatment of cardiovascular diseases in patients with mental disorders across the world: Systematic review and meta-analysis of 47 observational studies
Disparities in screening and treatment of cardiovascular diseases in patients with mental disorders across the world: Systematic review and meta-analysis of 47 observational studies
Objective: This study used meta-analysis to assess disparities in cardiovascular disease (CVD) screening and treatment in people with mental disorders, a group that has elevated CVD incidence and mortality.

Methods: The authors searched PubMed and PsycInfo through July 31, 2020, and conducted a random-effect meta-analysis of observational studies comparing CVD screening and treatment in people with and without mental disorders. The primary outcome was odds ratios for CVD screening and treatment. Sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, and by controlling for confounding by indication, as well as meta-regressions, were also run, and publication bias and quality were assessed.

Results: Forty-seven studies (N=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening or treatment in patients with mental disorders emerged for any CVD (k=47, odds ratio=0.773, 95% CI=0.742, 0.804), coronary artery disease (k=34, odds ratio=0.734, 95% CI=0.690, 0.781), cerebrovascular disease (k=8, odds ratio=0.810, 95% CI=0.779, 0.842), and other mixed CVDs (k=11, odds ratio=0.839, 95% CI=0.761, 0.924). Significant disparities emerged for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and they differed across countries. Median study quality was high (Newcastle-Ottawa Scale score, 8); higher-quality studies found larger disparities, and publication bias did not affect results.

Conclusions: People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.

Keywords: Bipolar and Related Disorders; Cardiovascular Disease; Mental Health Care/Service Delivery Systems; Physical Health; Schizophrenia Spectrum and Other Psychotic Disorders; Screening.
Bipolar and Related Disorders, Cardiovascular Disease, Mental Health Care/Service Delivery Systems, Physical Health, Schizophrenia Spectrum and Other Psychotic Disorders, Screening
1535-7228
793-803
Solmi, Marco
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Cortese, Samuele
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Fiedorowicz, Jess
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Poddighe, Laura
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Delogu, Marco
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Miola, Alessandro
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Hoye, Anne
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Heiberg, Ina H.
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Stubbs, Brendon
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Smith, Lee
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Larsson, Henrik
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Attar, Rubina
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Nielsen, Rene E.
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Shin, Jae I.I.
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Fusar-Poli, Paolo
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Firth, Joseph
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Yatham, Lakshmi N.
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Carvalho, Andre F.
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Castle, David J.
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Seeman, Mary V.
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Correll, Christoph U.
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Solmi, Marco
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Cortese, Samuele
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Fiedorowicz, Jess
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Poddighe, Laura
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Delogu, Marco
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Miola, Alessandro
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Hoye, Anne
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Heiberg, Ina H.
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Stubbs, Brendon
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Smith, Lee
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Larsson, Henrik
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Attar, Rubina
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Nielsen, Rene E.
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Shin, Jae I.I.
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Fusar-Poli, Paolo
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Firth, Joseph
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Yatham, Lakshmi N.
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Carvalho, Andre F.
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Castle, David J.
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Seeman, Mary V.
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Correll, Christoph U.
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Solmi, Marco, Cortese, Samuele, Fiedorowicz, Jess, Poddighe, Laura, Delogu, Marco, Miola, Alessandro, Hoye, Anne, Heiberg, Ina H., Stubbs, Brendon, Smith, Lee, Larsson, Henrik, Attar, Rubina, Nielsen, Rene E., Shin, Jae I.I., Fusar-Poli, Paolo, Firth, Joseph, Yatham, Lakshmi N., Carvalho, Andre F., Castle, David J., Seeman, Mary V. and Correll, Christoph U. (2021) Disparities in screening and treatment of cardiovascular diseases in patients with mental disorders across the world: Systematic review and meta-analysis of 47 observational studies. American Journal of Psychiatry, 178 (9), 793-803. (doi:10.1176/appi.ajp.2021.21010031).

Record type: Article

Abstract

Objective: This study used meta-analysis to assess disparities in cardiovascular disease (CVD) screening and treatment in people with mental disorders, a group that has elevated CVD incidence and mortality.

Methods: The authors searched PubMed and PsycInfo through July 31, 2020, and conducted a random-effect meta-analysis of observational studies comparing CVD screening and treatment in people with and without mental disorders. The primary outcome was odds ratios for CVD screening and treatment. Sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, and by controlling for confounding by indication, as well as meta-regressions, were also run, and publication bias and quality were assessed.

Results: Forty-seven studies (N=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening or treatment in patients with mental disorders emerged for any CVD (k=47, odds ratio=0.773, 95% CI=0.742, 0.804), coronary artery disease (k=34, odds ratio=0.734, 95% CI=0.690, 0.781), cerebrovascular disease (k=8, odds ratio=0.810, 95% CI=0.779, 0.842), and other mixed CVDs (k=11, odds ratio=0.839, 95% CI=0.761, 0.924). Significant disparities emerged for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and they differed across countries. Median study quality was high (Newcastle-Ottawa Scale score, 8); higher-quality studies found larger disparities, and publication bias did not affect results.

Conclusions: People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.

Keywords: Bipolar and Related Disorders; Cardiovascular Disease; Mental Health Care/Service Delivery Systems; Physical Health; Schizophrenia Spectrum and Other Psychotic Disorders; Screening.

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Accepted/In Press date: 19 April 2021
e-pub ahead of print date: 14 July 2021
Published date: 1 September 2021
Keywords: Bipolar and Related Disorders, Cardiovascular Disease, Mental Health Care/Service Delivery Systems, Physical Health, Schizophrenia Spectrum and Other Psychotic Disorders, Screening

Identifiers

Local EPrints ID: 451246
URI: http://eprints.soton.ac.uk/id/eprint/451246
ISSN: 1535-7228
PURE UUID: 06e47540-54b9-46be-a4c1-ca4071106df3
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 14 Sep 2021 21:00
Last modified: 17 Mar 2024 06:48

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Contributors

Author: Marco Solmi
Author: Samuele Cortese ORCID iD
Author: Jess Fiedorowicz
Author: Laura Poddighe
Author: Marco Delogu
Author: Alessandro Miola
Author: Anne Hoye
Author: Ina H. Heiberg
Author: Brendon Stubbs
Author: Lee Smith
Author: Henrik Larsson
Author: Rubina Attar
Author: Rene E. Nielsen
Author: Jae I.I. Shin
Author: Paolo Fusar-Poli
Author: Joseph Firth
Author: Lakshmi N. Yatham
Author: Andre F. Carvalho
Author: David J. Castle
Author: Mary V. Seeman
Author: Christoph U. Correll

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