Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records

Kugathasan, Pirathiv; Wu, Honghan; Gaughran, Fiona; Nielsen, René Ernst; Pritchard, Megan; Dobson, Richard; Stewart, Robert; Stubbs, Brendon

doi:10.1016/j.schres.2019.10.061

Cited by 24 publications

(38 citation statements)

References 45 publications

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“…The large sample size of this study, and representativeness of data from CPRD(34, 35), suggests the results of this study are generalisable to the UK population. The prevalence of multimorbidity in the SMI cohort was similar to previous studies(16, 18, 56), however prevalence of multimorbidity depends on the conditions studied and therefore other studies have found substantially different(15, 17) estimates. As with all studies using electronic health records, a limitation of this study is potential biases in recording variables.…”

Section: Discussionsupporting

confidence: 86%

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Launders¹,

Hayes

Price

et al. 2021

Preprint

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Objective: To investigate the clustering of physical health multimorbidity in people with severe mental illness (SMI) compared to matched comparators. Design: A cohort-nested analysis of lifetime diagnoses of physical health conditions. Setting: Over 1,800 UK general practices (GP) contributing to Clinical Practice Research DataLink (CPRD) Gold or Aurum databases. Participants: 68,392 adult patients with a diagnosis of SMI between 2000 and 2018, with at least one year of follow up data, matched 1:4 to patients without an SMI diagnosis, on age, sex, GP, and year of GP registration. Main outcome measures: Odds ratios for 24 physical health conditions derived using Elixhauser and Charlson comorbidity indices. We controlled for age, sex, region, and ethnicity; and then additionally for smoking status, alcohol and drug misuse and body mass index. We defined multimorbidity clusters using Multiple Correspondence Analysis and K-Means cluster analysis and described them based on the observed/expected ratio. Results: Patients with a diagnosis of SMI had an increased odds of 19 of 24 physical health conditions and had a higher prevalence of multimorbidity at a younger age compared to comparators (aOR: 2.47; 95%CI: 2.25 to 2.72 in patients aged 20-29). Smoking, obesity, alcohol, and drug misuse were more prevalent in the SMI group and adjusting for these reduced the odds ratio of all comorbid conditions. In patients with multimorbidity (SMI cohort: n=22,843, comparators: n=68,856), we identified six multimorbidity clusters in the SMI cohort, and five in the comparator cohort. Five profiles were common to both. The "hypertension and varied multimorbidity" cluster was most common: 49.8% in the SMI cohort, and 56.7% in comparators. 41.5% of the SMI cohort were in a "respiratory and neurological disease" cluster, compared to 28.7% of comparators. Conclusions: Physical health multimorbidity clusters similarly in people with and without SMI, though patients with SMI develop multimorbidity earlier and a greater proportion fall into a "respiratory and neurological disease" cluster. There is a need for interventions aimed at younger-age multimorbidity in those with SMI.

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Section: Discussionsupporting

confidence: 86%

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Launders¹,

Hayes

Price

et al. 2021

Preprint

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“…However, due to the small numbers included in the affective psychotic disorder group, results pertaining to this group should be interpreted with caution. A recent report had found that cardiovascular, neurological, or skin-related diseases, each combined with respiratory diseases, had the highest impact on mortality rates [ 50 ]. As respiratory and skin conditions were reported in a sizable proportion of individuals, and as respiratory and skin conditions were significantly correlated locally, our findings, together with other evidences found overseas, would warrant a thorough examination of local data of these combinations in psychotic disorders.…”

Section: Discussionmentioning

confidence: 99%

Comorbid physical illnesses in adult outpatients with psychotic disorders: risk factors, psychological functioning, and quality of life outcomes

Teh

Cetty

Jeyagurunathan

et al. 2021

Soc Psychiatry Psychiatr Epidemiol

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Purpose In contrast to global research, where physical comorbidity in psychotic disorders is established, only a few studies have been conducted in Southeast Asia. With a concerning trend of chronic physical illnesses emerging in adults below the age of 65, an investigation into comorbid chronic physical illnesses in adults diagnosed with psychotic disorders is necessary. This study aims to explore the risk factors, psychological functioning, and quality of life outcomes associated with comorbidity in adults below the age of 65, diagnosed with psychotic disorders, in a multi-ethnic non-Western setting. Methods Electronic medical records of 364 patients with psychotic disorders who had provided written consent to participate were screened for co-occurring physical conditions. The majority of participants were female (53.7%), Chinese (69%), single (74.5%), and had tertiary and above education (43%). They were approximately 35 years old on average and the mean age of onset for psychosis was 26.7 years old. Results Comorbid physical illnesses were present in approximately a third of adults with psychotic disorders (28%). They typically reported cardiovascular-related diseases, respiratory, and skin conditions. Comorbidity was significantly related to lower physical quality of life. As compared to other types of psychotic disorders, schizophrenia was significantly related to a greater frequency of comorbid physical conditions. Multinomial regression analyses revealed that age, age of onset, Malay and Indian ethnicities were significant factors. Conclusion Physical comorbidity in adults below the age of 65 is common, signifying an emerging need to place greater attention into the screening and emphasis on the physical care needs of this age group. Finally, more research is needed to understand the impact of common co-occurring acute and chronic cardiovascular, skin, and respiratory diseases locally.

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“…Unnatural causes of death, i.e., suicide, accidents, and homicide, considerably contribute to this disparity [3], yet chronic somatic health conditions account for the majority of lost life years among people with SMI [4]. The majority of deaths are due to cardiovascular disease, respiratory disease, and cancer [5][6][7][8][9]. People with SMI are at higher risk of several chronic somatic conditions, particularly cardiovascular diseases [10], diabetes mellitus type II [11], metabolic syndrome [12], respiratory diseases, and liver abnormalities [13] as well as the risk of somatic multimorbidity [9].…”

Section: Background and Rationalementioning

confidence: 99%

“…The majority of deaths are due to cardiovascular disease, respiratory disease, and cancer [5][6][7][8][9]. People with SMI are at higher risk of several chronic somatic conditions, particularly cardiovascular diseases [10], diabetes mellitus type II [11], metabolic syndrome [12], respiratory diseases, and liver abnormalities [13] as well as the risk of somatic multimorbidity [9]. The mechanisms connecting SMI and somatic conditions are complex.…”

Section: Background and Rationalementioning

confidence: 99%

The SOFIA pilot trial: a cluster-randomized trial of coordinated, co-produced care to reduce mortality and improve quality of life in people with severe mental illness in the general practice setting

Rozing

Jønsson

Køster-Rasmussen

et al. 2021

Pilot Feasibility Stud

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Background People with severe mental illness (SMI) have an increased risk of premature mortality, predominantly due to somatic health conditions. Evidence indicates that primary and tertiary prevention and improved treatment of somatic conditions in patients with SMI could reduce this excess mortality. This paper reports a protocol designed to evaluate the feasibility of a coordinated co-produced care program (SOFIA model, a Danish acronym for Severe Mental Illness and Physical Health in General Practice) in the general practice setting to reduce mortality and improve quality of life in patients with severe mental illness. Methods The SOFIA pilot trial is designed as a cluster randomized controlled trial targeting general practices in two regions in Denmark. We aim to include 12 practices, each of which is instructed to recruit up to 15 community-dwelling patients aged 18 and older with SMI. Practices will be randomized by a computer in a ratio of 2:1 to deliver a coordinated care program or usual care during a 6-month study period. A randomized algorithm is used to perform randomization. The coordinated care program includes educational training of general practitioners and their clinical staff educational training of general practitioners and their clinical staff, which covers clinical and diagnostic management and focus on patient-centered care of this patient group, after which general practitioners will provide a prolonged consultation focusing on individual needs and preferences of the patient with SMI and a follow-up plan if indicated. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Assessments of the outcome parameters will be administered at baseline, throughout, and at end of the study period. Discussion If necessary the intervention will be revised based on results from this study. If delivery of the intervention, either in its current form or after revision, is considered feasible, a future, definitive trial to determine the effectiveness of the intervention in reducing mortality and improving quality of life in patients with SMI can take place. Successful implementation of the intervention would imply preliminary promise for addressing health inequities in patients with SMI. Trial registration The trial was registered in Clinical Trials as of November 5, 2020, with registration number NCT04618250. Protocol version: January 22, 2021; original version

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Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records

Abstract: Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records

Cited by 24 publications

References 45 publications

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Comorbid physical illnesses in adult outpatients with psychotic disorders: risk factors, psychological functioning, and quality of life outcomes

The SOFIA pilot trial: a cluster-randomized trial of coordinated, co-produced care to reduce mortality and improve quality of life in people with severe mental illness in the general practice setting

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