Impact of socioeconomic deprivation on rate and cause of death in severe mental illness

BMC Psychiatry

Daniel J Smith¹  Stewart W Mercer⁴  Moira Connolly³  Daniel J Martin¹  John Park²  Gary McLean¹  Julie Langan Martin¹ 

[1] Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK;Lead Research Nurse PsyCIS Team, Stobhill Hospital, 300 Balgrayhill Road, Glasgow G21 3UR, UK;Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK;Institute of Health and Wellbeing, University of Glasgow, General Practice & Primary Care, 1 Horselethill Road, Glasgow G12 9LX, UK

关键词: Deprivation;    Mortality;    Bipolar disorder;    Schizophrenia;    Severe mental illness (SMI);   

Others  :  1123341
DOI  :  10.1186/s12888-014-0261-4

 received in 2014-02-07, accepted in 2014-09-04,  发布年份 2014

【 摘 要 】

Background

Socioeconomic status has important associations with disease-specific mortality in the general population. Although individuals with Severe Mental Illnesses (SMI) experience significant premature mortality, the relationship between socioeconomic status and mortality in this group remains under investigated. We aimed to assess the impact of socioeconomic status on rate and cause of death in individuals with SMI (schizophrenia and bipolar disorder) relative to the local (Glasgow) and wider (Scottish) populations.

Methods

Cause and age of death during 2006-2010 inclusive for individuals with schizophrenia or bipolar disorder registered on the Glasgow Psychosis Clinical Information System (PsyCIS) were obtained by linkage to the Scottish General Register Office (GRO). Rate and cause of death by socioeconomic status, measured by Scottish Index of Multiple Deprivation (SIMD), were compared to the Glasgow and Scottish populations.

Results

Death rates were higher in people with SMI across all socioeconomic quintiles compared to the Glasgow and Scottish populations, and persisted when suicide was excluded. Differences were largest in the most deprived quintile (794.6 per 10,000 population vs. 274.7 and 252.4 for Glasgow and Scotland respectively). Cause of death varied by socioeconomic status. For those living in the most deprived quintile, higher drug-related deaths occurred in those with SMI compared to local Glasgow and wider Scottish population rates (12.3% vs. 5.9%, p = <0.001 and 5.1% p = 0.002 respectively). A lower proportion of deaths due to cancer in those with SMI living in the most deprived quintile were also observed, relative to the local Glasgow and wider Scottish populations (12.3% vs. 25.1% p = 0.013 and 26.3% p = <0.001). The proportion of suicides was significantly higher in those with SMI living in the more affluent quintiles relative to Glasgow and Scotland (54.6% vs. 5.8%, p = <0.001 and 5.5%, p = <0.001).

Conclusions

Excess mortality in those with SMI occurred across all socioeconomic quintiles compared to the Glasgow and Scottish populations but was most marked in the most deprived quintiles when suicide was excluded as a cause of death. Further work assessing the impact of socioeconomic status on specific causes of premature mortality in SMI is needed.

【 授权许可】

   
2014 Martin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Strickland S, Shetty P, MacIntyre S: Social inequalities and health in the contemporary world: comparative overview. In Human biology and social inequality (39th symposium volume of the Society for the Study of Human Biology). Cambridge University Press, Cambridge; 1998:20-35.
• [2]Stirbu I, Kunst A, Mielck A, Mackenbach J: Inequalities in utilisation of general practitioner and specialist services in 9 European countries. BMC Health Serv Res 2011, 11:288. BioMed Central Full Text
• [3]Van Doorslaer E, Masseria C, Koolman X: Inequalities in access to medical care by income in developed countries. CMAJ 2006, 174:177-183.
• [4][http:/ / www.gcph.co.uk/ assets/ 0000/ 3606/ Scottish_Mortality_in_a_European_Co ntext_2012_v11_FINAL_bw.pdf] webcite Whyte B, Ajetunmobi T, Glasgow Centre for Population Health (GCPH): Still the Sick Man of Europe? Scottish Mortality in a European Context 1950 – 2010 An analysis of comparative mortality trends. 2012, .
• [5]Health in Scotland 2004. Scottish Executive, Edinburgh; 2005.
• [6]Choosing health; making healthy choices easier. The Stationery Office, London; 2004.
• [7][http://www.scotpho.org.uk/] webcite ScotPHO Public Health Information for Scotland: .
• [8]Crump C, Sundquist K, Winkleby MA, Sundquist J: Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. Am J Psychiatry 2013, 170:324-333.
• [9]Hoang U, Stewart R, Goldacre MJ: Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study. BMJ 2011, 343:d5422.
• [10]Laursen TM, Munk-Olsen T, Gasses C: Chronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder. PLoS ONE 2011, 6:e24597.
• [11]Wahlbeck K, Westman J, Nordentoft M, Gissler M, Munk LT: Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry 2011, 199(6):453-458.
• [12]Chang C-K, Hayes RD, Perera G, Broadbent MTM, Fernandes AC, Lee WE, Hotopf M, Stewart R: Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS ONE 2011, 6(5):e19590. doi:10.1371/journal.pone.0019590
• [13]Morden NE, Lai Z, Goodrich DE, Mackenzie T, McCarthy JF, Austin K, Welsh DE, Bartels S, Kilbourne AM: Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia. Gen Hosp Psychiatry 2012, 34:368-379.
• [14]Lawrence D, Hancock K, Kisley S: The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013, 346:f2539. doi:10.1136/bmj.f2539
• [15]Smith DJ, Langan J, McLean G, Guthrie B, Mercer SW: Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ Open 2013, 3:e002808. doi:10.1136/ bmjopen-2013-002808
• [16]Smith DJ, Martin DJ, McLean G, Langan Martin J, Guthrie B, Mercer SW: Multimorbidity in bipolar disorder and under treatment of cardiovascular disease: cross sectional study. BMC Medicine 2013, 11:263-274. BioMed Central Full Text
• [17]Lambert TJ, Newcomer JW: Are the cardiometabolic complications of schizophrenia still neglected? Barriers to care. Med J Aust 2009, 190:S39-S42.
• [18]DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S: Physical illness in patients with severe mental disorders. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011, 10(1):52-77.
• [19]Frayne SM, Halanych JH, Miller DR, Wang F, Lin H, Pogach L, Sharkansky EJ, Keane TM, Skinner KM, Rosen CS, Berlowitz DR: Disparities in diabetes care: impact of mental illness. Arch Intern Med 2005, 165(22):2631-2638.
• [20]Weiss AP, Henderson DC, Weilburg JB, Goff DC, Meigs JB, Cagliero E, Grant RW: Treatment of cardiac risk factors among patients with schizophrenia and diabetes. Psychiatr Serv 2006, 57(8):1145-1152.
• [21]Laursen TM, Munk-Olsen T, Agerbo E, Gasse C, Mortensen PB: Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry 2009, 66(7):713-720.
• [22]Aro S, Aro H, Keskimäki I: Socio-economic mobility among patients with schizophrenia or major affective disorder. A 17-year retrospective follow-up. Br J Psychiatry 1995, 166(6):759-767.
• [23]Park J, McAlaney C, Connolly M: Improving patient care and clinical governance through utilisation of a clinical information system. Clin Govern 2008, 13(4):254-259.
• [24][http://www.isdscotland.org/Products-and-Services/eDRIS/] webcite eDRIS Produucts & Services ISD Scotland. Accessible at .
• [25][http://www.gro-scotland.gov.uk/files2/stats/ve-reftables-2011/ve2011-t5-1.pdf] webcite Sources of Information for Coding the Causes of Death GRO for Scotland. Available at: .
• [26][http:/ / www.gro-scotland.gov.uk/ statistics/ theme/ vital-events/ deaths/ suicides/ definition-of-stats/ index.html] webcite Definition of Statistics: Probable Suicides: Deaths which are the Result of Intentional Self-harm or Events of Undetermined Intent. Available at .
• [27][http:/ / simd.scotland.gov.uk/ publication-2012/ introduction-to-simd-2012/ overview-of-the-simd/ what-is-the-simd/ ] webcite Overview of the Scottish Index of Multiple Deprivation. Available at: .
• [28]Baxter DN: The mortality experience of individuals on the Salford Psychiatric Case Register. All-cause mortality. Br J Psychiatry 1996, 168:772-779.
• [29]Colton CW, Manderscheid RW: Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006, 3:A42.
• [30]Osborn DP, Levy G, Nazareth I, Petersen I, Islam A, King MB: Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s General Practice Research Database. Arch Gen Psychiatry 2007, 64:242-249.
• [31]Tran E, Rouillon F, Loze JY, Casadebaig F, Philippe A, Vitry F, Limosin F: Cancer mortality in patients with schizophrenia: an 11-year prospective cohort study. Cancer 2009, 1(15):3555-3562.
• [32]Oksbjerg Dalton S, Munk Laursen T, Mellemkjaer L, Johansen C, Mortensen PB: Schizophrenia and the risk for breast cancer. Schizophr Res 2003, 62:89-92.
• [33]Catts VS, Catts SV, O'Toole BI, Frost ADJ: Cancer incidence in patients with schizophrenia and their first-degree relatives—a meta-analysis. Acta Psychiatr Scand 2008, 117:323-336.
• [34]Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990, 264(19):2511-2518.
• [35]Rosenberg SD, Drake RE, Wolford GI, Mueser KT, Oxman TE, Vidaver RM, Carrieri KL, Luckoor R: Dartmouth assessment of lifestyle instrument (DALI): a substance use disorder screen for people with severe mental illness. Am J Psychiatry 1998, 155(2):232-238.
• [36][http:/ / www.ias.org.uk/ Alcohol-knowledge-centre/ Health-impacts/ Factsheets/ Alcohol-related-mortality-rates.asp x] webcite Alcohol related Mortality Institute of Alcohol Studies. .
• [37]Taylor R, Morrell S, Slaytor E, Ford P: Suicide in Urban New South Wales, Australia 1985-1994. Socio-economic and Migrant Interactions. Soc Sci Med 1998, 47:1677-1686.
• [38]Kposowa AJ: Unemployment and suicide: a cohort analysis of social factor predicting suicide in the US: National Longitudinal Mortality Study. Psychol Med 1999, 31:127-138.
• [39]Hawton K, Harris L, Simkin S, Bale E, Bond A: Social class and suicidal behaviour: the associations between social class and the characteristics of deliberate self-harm patients and the treatment they are offered. Soc Psychiatry Psychiatr Epidemiol 2001, 36:437-443.
• [40]Osborn D, Levy G, Nazareth I, King M: Suicide and severe mental illnesses. Cohort study within the UK general practice research database. Schizophr Res 2008, 99(1-3):134-138. Epub 2007 Dec 26
• [41]Payne RA, Abel GA, Guthrie B, Mercer SW: The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. CMAJ 2013, 185(5):E221-E228. doi:10.1503 /cmaj.121349
• [42]Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012, 380:37-43.
• [43]Gunnell DJ, Peters TJ, Kammerling RM, Brooks J: Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. BMJ 1995, 311(6999):226-230.
• [44]Congdon P: Assessing the Impact of Socioeconomic variables on small area variations in suicide outcomes in England. Int J Environ Res Public Health 2013, 10(1):158-177.
• [45]Surtees PG, Wainwright NW, Luben RN, Wareham NJ, Bingham SA, Khaw KT: Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom prospective cohort study. Am J Psychiatry 2008, 165(4):515-523. doi:10.1176/appi.ajp.2007.07061018. Epub 2008 Feb 1
• [46]Scafato E, Galluzzo L, Ghirini S, Gandin C, Rossi A, Solfrizzi V, Panza F, Di Carlo A, Maggi S, Farchi G: Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging. Psychol Med 2012, 42(12):2619-2629. doi:10.1017/S0033291712000645. Epub 2012 Apr 11
• [47]Phillips AC, Batty GD, Gale CR, Deary IJ, Osborn D, MacIntyre K, Carroll D: Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study. Psychosom Med 2009, 71(4):395-403. doi:10.1097/PSY.0b013e31819e6706. Epub 2009 Mar 25
• [48]Singh GK, Hoyert DL: Social epidemiology of chronic liver disease and cirrhosis mortality in the United States, 1935-1997: trends and differentials by ethnicity, socioeconomic status, and alcohol consumption. Hum Biol 2000, 72(5):801-820.
• [49]Schneider B, Müller MJ, Philipp M: Mortality in affective disorders. J Affect Disord 2001, 65(3):263-274.
• [50][http://www.sphsu.mrc.ac.uk/] webcite Inequalities in mortality in Scotland 1981-2001. Available at .
• [51][http:/ / www.gro-scotland.gov.uk/ statistics/ theme/ life-expectancy/ scottish-areas/ index.html] webcite Life Expectancy in Scottish Areas GRO for Scotland. Available at .
• [52]McCartney G, Shipley M, Hart C, Davey Smith G, Kivimaki M, Walsh D, Watt G, Batty GD: Why do males in Scotland die younger than those in England? Evidence from three prospective cohort studies. PLoS ONE 2012, 7:7-18. ISSN 1932-6203
• [53][http:/ / www.gcph.co.uk/ assets/ 0000/ 0087/ Investigating_a_Glasgow_Effect_for_ web.pdf] webcite Walsh D, Bendel N, Jones N, Hanlon P: Investigating a Glasgow Effect. Why do equally deprived UK cities experience difference health outcomes? In Glasgow Centre for Population Health; .