Disparities in Emergency Care Among Patients with Mental Illness

Mackenhauer, Julie

doi:10.54337/aau499829720

Cited by 1 publication

(8 citation statements)

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“…Proportion of Patients with Mental Illness. We found that one in three patients had a history of mental illness; however, one in twelve patients had history of moderate or major mental illness [25]. The proportion of patients with a history of mental illness is comparable to other studies [4,18] but may depend on the definition of mental illness [5].…”

Section: Discussionsupporting

confidence: 82%

“…However, to our knowledge, disparities in timing of imaging, mobilization, therapy, etc., were not described in subgroups of patients with comorbid mental illness. This fact was also discussed in the thesis defended by the corresponding author of the paper in 2022, including the finding from this paper [25]. While Denmark-like the other Nordic countries-is a welfare state providing equal access to healthcare to all citizens, equal care nor equal outcomes are provided [11,25,34].…”

Section: Discussionmentioning

confidence: 61%

“…Most likely, the proportion of patients with a history of major mental illness should be greater in the stroke population compared to the general population due to the higher prevalence of risk factors in this groups. However, system-and patient-related factors may complicate or obstruct hospital admission with time-critical diseases like ischemic stroke [6][7][8][9][10][11][12][13][14]25] .9 1 1.1 .8 .9 6 Acta Neurologica Scandinavica performance across measures of in-hospital stroke care in the Danish is comparable to other European settings [32,33]. However, the reperfusion rate is higher in Denmark [17] compared to the US [18].…”

Section: Discussionmentioning

confidence: 99%

“…However, the reperfusion rate is higher in Denmark [17] compared to the US [18]. Disparities in stroke care in patients with comorbid mental illness has been investigated in terms of reperfusion therapy [17,18,25] and hospital length of stay [15]. However, to our knowledge, disparities in timing of imaging, mobilization, therapy, etc., were not described in subgroups of patients with comorbid mental illness.…”

Section: Discussionmentioning

confidence: 99%

“…The authors of this paper have previously published a paper investigating disparities in reperfusion therapy based on this cohort [17]. Please find detailed description of study setting and the data sources in this paper [17] as well as other sources (the Danish CPR-number [25], the Danish Stroke Registry, and the Danish Clinical Registries [26]). Methods and results from this paper were included in the PhD thesis defended by the corresponding author at Aalborg University, Denmark, in 2022 [25].…”

Section: Study Design Andmentioning

confidence: 99%

See 4 more Smart Citations

High Quality of Early Ischemic Stroke Care but Poorer Clinical Outcomes among Patients with a History of Mental Illness

Mackenhauer,

Christensen,

Andersen

et al. 2023

Acta Neurologica Scandinavica

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Objectives. The aim of this study was to compare early stroke care and clinical outcomes among patients with and without a history of mental illness. Materials/Methods. A nationwide registry-based cohort study of patients with acute ischemic stroke treated in a tax-financed healthcare system. We used process and outcome measures from the Danish Stroke Registry 2007-2018 combined with the data from multiple Danish registries. We combined the process measures in two composite measures: an opportunity-based score (the proportion of all relevant process measures fulfilled for each patient) and an all-or-none score (the proportion of patients fulfilling all relevant process measures). Patients were categorized according to severity of mental health history. Results. We included 117 548 admissions with acute ischemic stroke: 20.8%, 3.5%, and 3.4% of admissions concerned patients with a history of minor, moderate, or major mental illness, respectively. Patients received a median of 85.7% (IQR, 66.7; 100.0) of the relevant processes (opportunity-based score). Patients with a history of mental illness were less likely to receive guideline-recommended acute stroke care within the defined time frames; however, differences were not clinically relevant. Patients with a history of mental illness were significantly more likely to die within 30 days, compared to patients with no history of mental illness: Risk ratios (RR) for 30-day mortality adjusted for age, sex, and country of origin were 1.31 (CI, 1.25; 1.37) for minor, 1.18 (CI, 1.05; 1.33) for moderate, and 1.44 (CI, 1.30; 1.60) for major mental illness. The corresponding adjusted RRs for recurrent stroke/TIA were 1.69 (CI, 1.58; 1.80) for minor, 1.39 (CI, 1.19; 1.61) for moderate, and 1.36 (CI, 1.17; 1.59) for major mental illness. The associations were weakened for 30-day mortality but not recurrent stroke/TIA after additional adjustment for potential mediating factors (comorbidity and stroke severity). Conclusion. More than one-quarter of patients with ischemic stroke had a history of mental illness. The overall performance of acute stroke care was high in all groups. Mental illness was associated with a higher risk of death and recurrent stroke compared to patients without a history of mental illness which may at least partly be due to a more adverse prognostic profile at the time of admission, including a higher stroke severity.

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