Ethnic inequities in multimorbidity among people with psychosis: a retrospective cohort study

Abstract

Aims Research shows persistent ethnic inequities in mental health experiences and outcomes, with a higher incidence of illnesses among minoritised ethnic groups. People with psychosis have an increased risk of multiple long-term conditions (MLTC; multimorbidity). However, there is limited research regarding ethnic inequities in multimorbidity in people with psychosis. This study investigates ethnic inequities in physical health multimorbidity in a cohort of people with psychosis. Methods In this retrospective cohort study, using the Clinical Records Interactive Search (CRIS) system, we identified service-users of the South London and Maudsley NHS Trust with a schizophrenia spectrum disorder, and then additional diagnoses of diabetes, hypertension, low blood pressure, overweight or obesity and rheumatoid arthritis. Logistic and multinomial logistic regressions were used to investigate ethnic inequities in odds of multimorbidity (psychosis plus one physical health condition), and multimorbidity severity (having one or two physical health conditions, or three or more conditions), compared with no additional health conditions (no multimorbidity), respectively. The regression models adjusted for age and duration of care and investigated the influence of gender and area-level deprivation. Results On a sample of 20 800 service-users with psychosis, aged 13–65, ethnic differences were observed in the odds for multimorbidity. Controlling for sociodemographic factors and duration of care, compared to White British people, higher odds of multimorbidity were found for people of Black African [adjusted Odds Ratio = 1.41, 95% Confidence Intervals (1.23–1.56)], Black Caribbean [aOR = 1.79, 95% CI (1.58–2.03)] and Black British [aOR = 1.64, 95% CI (1.49–1.81)] ethnicity. Reduced odds were observed among people of Chinese [aOR = 0.61, 95% CI (0.43–0.88)] and Other ethnic [aOR = 0.67, 95% CI (0.59–0.76)] backgrounds. Increased odds of severe multimorbidity (three or more physical health conditions) were also observed for people of any Black background. Conclusions Ethnic inequities are observed for multimorbidity among people with psychosis. Further research is needed to understand the aetiology and impact of these inequities. These findings support the provision of integrated health care interventions and public health preventive policies and actions.

Managing medical and psychiatric multimorbidity in older patients

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Relationship between severe mental illness and physical multimorbidity: a meta-analysis and call for action

“…Of the 42 full-text articles, 23 articles were excluded due to lack of relevant outcomes, not including analysis on the association between severe mental illness and physical multimorbidity, and mental health diagnoses were not obtained. This left 19 articles to be included in the systematic review 25–41…”

Ethnic inequalities in age‐related patterns of multiple long‐term conditions in England: Analysis of primary care and nationally representative survey data

“…A recent analysis of ethnic inequalities in physical health MLTCs among people with psychosis living in the UK found that Black people were at higher risk of psychosis compared to white people (Fonseca de Freitas et al., 2022). The differences between our findings and those of Fonseca de Freitas and colleagues could be attributed to the fact that their study included people below 18 years (age range 13–65 years) and focused on people with a particular type of severe mental illness: psychosis.…”