Socio-economic position as a moderator of cardiometabolic outcomes in patients receiving psychotropic treatment associated with weight gain: results from a prospective 12-month inception cohort study and a large population-based cohort

Abstract

Weight gain and metabolic complications are major adverse effects of many psychotropic drugs. We aimed to understand how socio-economic status (SES), defined as the Swiss socio-economic position (SSEP), is associated with cardiometabolic parameters after initiation of psychotropic medications known to induce weight gain. Cardiometabolic parameters were collected in two Swiss cohorts following the prescription of psychotropic medications. The SSEP integrated neighborhood-based income, education, occupation, and housing condition. The results were then validated in an independent replication sample (UKBiobank), using educational attainment (EA) as a proxy for SES. Adult patients with a low SSEP had a higher risk of developing metabolic syndrome over one year versus patients with a high SSEP (Hazard ratio (95% CI) = 3.1 (1.5–6.5), n = 366). During the first 6 months of follow-up, a significant negative association between SSEP and body mass index (BMI), weight change, and waist circumference change was observed (25 ≤ age < 65, n = 526), which was particularly important in adults receiving medications with the highest risk of weight gain, with a BMI difference of 0.86 kg/m2 between patients with low versus high SSEP (95% CI: 0.03–1.70, n = 99). Eventually, a causal effect of EA on BMI was revealed using Mendelian randomization in the UKBiobank, which was notably strong in high-risk medication users (beta: −0.47 SD EA per 1 SD BMI; 95% CI: −0.46 to −0.27, n = 11,314). An additional aspect of personalized medicine was highlighted, suggesting the patients’ SES represents a significant risk factor. Particular attention should be paid to patients with low SES when initiating high cardiometabolic risk psychotropic medications.

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

“…This study shows that Black people with psychosis are at higher risk of multimorbidity. Although this study is not focused on aetiology, the findings are consistent with adversity-related onset of disease, where marginalised ethnic groups face higher rates of psychosis and other health conditions when living with this severe mental illness (Dubath et al, 2021; Jongsma et al, 2021; Watkinson et al, 2021). The observed ethnic inequities in health show the need for integrated care and multi-disease prevention among minoritised ethnic groups.…”

“…Moreover, only the conditions relevant to the aetiology and management of psychosis may be reported in SLaM electronic records, so we may have less information on other conditions. We did not adjust for the type of pharmacological treatment for psychosis, which could be related to the presence of the included physical conditions (Baxter et al, 2016; Dubath et al, 2021). Finally, we could not investigate the timing of the onset of the different health conditions.…”

“…Also, health related quality of life and self-rated health, a predictor of mortality, is poorer in several minoritised ethnic groups (Evandrou et al, 2016; Watkinson et al, 2021). Ethnic health inequities have been largely associated with differences in socioeconomic status (income, education, occupation) (Dubath et al, 2021; James Y. Nazroo & Williams, 2006). However, evidence suggests that ethnic inequities persist after controlling for socioeconomic factors, though such models may contain residual confounding (Evandrou et al, 2016; Larsen et al, 2017; James Y. Nazroo, 1998; James Y. Nazroo & Williams, 2006; Verest et al, 2019; Watkinson et al, 2021).…”

“…This study aims to investigate ethnic inequities in multimorbidity, and multimorbidity severity, among a cohort of people with psychosis. Acknowledging differences in multimorbidity related to gender (Gaughran et al, 2019; Head et al, 2021; Larsen et al, 2017; Watkinson et al, 2021) and socioeconomic deprivation (Dubath et al, 2021; Head et al, 2021; Marmot et al, 2020), we investigate interaction effects. We hypothesise that people of a minoritised ethnic background present higher multimorbidity than White British people and that this is amplified for minoritised ethnic women and minoritised ethnic people living in more deprived areas.…”

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

“…Also, health-related quality of life and self-rated health, a predictor of mortality, is poorer in several minoritised ethnic groups (Evandrou et al, 2016;Watkinson et al, 2021). Ethnic health inequities have been largely associated with differences in socioeconomic status (income, education, occupation) (Nazroo and Williams, 2006;Dubath et al, 2021). However, evidence suggests that ethnic inequities persist after controlling for socioeconomic factors, though such models may contain residual confounding (Nazroo, 1998;Nazroo and Williams, 2006;Evandrou et al, 2016;Larsen et al, 2017;Ashworth et al, 2019;Verest et al, 2019;Watkinson et al, 2021).…”