Patterns of physical co-/multi-morbidity among patients with serious mental illness: a London borough-based cross-sectional study

Abstract

BackgroundSerious mental illness (SMI) is associated with elevated mortality compared to the general population; the majority of this excess is attributable to co-occurring common physical health conditions. There may be variation within the SMI group in the distribution of physical co/multi-morbidity. This study aims to a) compare the pattern of physical co- and multi-morbidity between patients with and without SMI within a South London primary care population; and, b) to explore socio-demographic and health risk factors associated with excess physical morbidity among the SMI group.MethodsData were obtained from Lambeth DataNet, a database of electronic patient records derived from general practices in the London borough of Lambeth. The pattern of 12 co-morbid common physical conditions was compared by SMI status. Multivariate ordinal and logistic regression analyses were conducted to assess the strength of association between each condition and SMI status; adjustments were made for potentially confounding socio-demographic characteristics and for potentially mediating health risk factors.ResultsWhile SMI patients were more frequently recorded with all 12 physical conditions than non-SMI patients, the pattern of co-/multi-morbidity was similar between the two groups. Adjustment for socio-demographic characteristics – in particular age and, to a lesser extent ethnicity, considerably reduced effect sizes and accounted for some of the associations, though several conditions remained strongly associated with SMI status. Evidence for mediation by health risk factors, in particular BMI, was supported.ConclusionsSMI patients are at an elevated risk of a range of physical health conditions than non-SMI patients but they do not appear to experience a different pattern of co-/multimorbidity among those conditions considered. Socio-demographic differences between the two groups account for some of the excess in morbidity and known health risk factors are likely to mediate the association. Further work to examine a wider range of conditions and health risk factors would help determine the extent of excess mortality attributable to these factors.

The impact of exclusion criteria on a physician’s adenoma detection rate

“…Risk adjustment is the norm in quality measurement in other areas of medicine. 22–27 Third, using extensive exclusion criteria substantially reduces the number of colonoscopy reports used to generate a physician’s ADR. This results in wider confidence intervals around each physician’s ADR estimate, thus sacrificing precision.…”

Healthcare Costs for People with Serious Mental Illness in England: An Analysis of Costs Across Primary Care, Hospital Care, and Specialist Mental Healthcare

“…UK healthcare policy defines SMI as schizophrenia, bipolar disorder, and other nonorganic psychoses [2]; 0.72% of the population in England will receive a diagnosis of schizophrenia at some point in their lives [3], and 1-2% will receive a diagnosis of bipolar disorder [4]. People with SMI have poorer physical health compared to the general population, with a higher prevalence of common chronic disorders and multi-morbidity, and a lower life expectancy by around 20 years, and often die of preventable physical illnesses [5][6][7][8][9]. People with SMI have high rates of healthcare utilisation, including accident and emergency (A&E) attendances and hospital admissions, for both physical and mental health problems [10][11][12][13], and the multiplicity of co-morbid health conditions raises total healthcare costs [14].…”

“…7 The Mental Health Clustering Tool is an algorithm used to allocate patients to a cluster [39]. 8 Geographic information was derived by CPRD based on the patient residence and practice locations. These links were made by CPRD to avoid disclosing location information to the study team.…”

Increased cardiometabolic dysfunction in first-degree relatives of patients with psychotic disorders

“…Cardio-vascular and metabolic (hereinafter called cardio-metabolic) disorders (CMD) are known to be the leading medical cause of excess mortality in psychosis (Chwastiak et al, 2006; Laursen et al, 2009; Osborn et al, 2008; Woodhead et al, 2014). This is underscored by statistics reporting a 1.3 to 4.9 fold increase in morbidity and mortality resulting from coronary heart disease, diabetes and treatable risk factors such as hypertension and dyslipidemia (Jeste et al, 1996; Laursen et al, 2014a; McEvoy et al, 2005; Miller et al, 2008; Nordentoft et al, 2013).…”