Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study

Abstract

BackgroundHealth care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs) and non-MHCs.MethodsThis was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA) from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharmaceutical benefits claims. Diabetes was identified from hospital diagnoses, prescriptions and diabetes-specific primary care claims (17,045 MHCs, 26,626 non-MHCs). Both univariate and multivariate analyses adjusted for socio-demographic factors and case mix were performed to compare the outcome measures among MHCs, category of mental disorders and non-MHCs.ResultsThe prevalence of diabetes was significantly higher in MHCs than in non-MHCs (crude age-sex-standardised point-prevalence of diabetes on 30 June 2006 in those aged ≥20 years, 9.3% vs 6.1%, respectively, P < 0.001; adjusted odds ratio (OR) 1.40, 95% CI 1.36 to 1.43). Receipt of recommended pathology tests (HbA1c, microalbuminuria, blood lipids) was suboptimal in both groups, but was lower in MHCs (for all tests combined; adjusted OR 0.81, 95% CI 0.78 to 0.85, at one year; and adjusted rate ratio (RR) 0.86, 95% CI 0.84 to 0.88, during the study period). MHCs also had increased risks of hospitalisation for diabetes complications (adjusted RR 1.20, 95% CI 1.17 to 1.24), diabetes-related mortality (1.43, 1.35 to 1.52) and all-cause mortality (1.47, 1.42 to 1.53). The disparities were most marked for alcohol/drug disorders, schizophrenia, affective disorders, other psychoses and personality disorders.ConclusionsMHCs warrant special attention for primary and secondary prevention of diabetes, especially at the primary care level.

Physical Health Inequities in People with Severe Mental Illness: Identifying Initiatives for Practice Change

“…Diagnostic overshadowing may lead to existing physical conditions being untreated until more severe symptoms present, requiring emergency treatment. This is supported by Mai et al (2011) who claim that medical hospital admissions for patients with SMI would be greatly reduced if this group received preventative physical care of quality equal to that afforded to people without a mental illness.…”

“…Poor organisational skills and impaired social cognition associated with schizophrenia may contribute to reduced access to primary health care services, and result in limited capacity to understand health information that is given (Hyland, Judd, Davidson, Jolley, & Hocking, 2003;Lawrence & Kisley, 2010). However given the higher rates of admissions to emergency departments and visits to general practitioners, Mai et al (2011) argue that the disparities in physical health care for people with SMI are less likely to be a result of poor access, but rather a result of poorer quality care provided by primary health care providers.…”

Healthcare, self-care, and health status of immigrants and non-immigrants with type 2 diabetes in the Canadian Community Health Surveys

“…Income and education have been inversely associated with the prevalence of mental illness in surveys of North Americans; however, individuals with lower income and education are less likely to receive adequate treatment [24,25]. Since diabetes and mental health conditions aggregate together and increase the risk of T2DM-related complications [26], the relationship between socioeconomic factors and mental health among individuals with diabetes warrants further research. Immigrants with T2DM were less likely to perform weekly feet self-checking than non-immigrants in the CCHS.…”

Improving the diagnosis of physical illness in patients with mental illness who present in Emergency Departments: Consensus study

“…Inadequate or less thorough procedures when the patients had mental illness were reported in hospitalisation and pathology tests for diabetes [2,3], in coronary re-vascularisation procedures and in basic health assessments such as blood pressure monitoring [4][5][6] as well as in screening for cancer [7]. It has been suggested [8,9] that such disparities and their resulting delayed or wrong diagnosis might have contributed to the considerable shorter life expectancy and quicker deterioration of physical illnesses among people with mental illness compared to the general population [10][11][12][13].…”