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Health care disparities among persons with comorbid schizophrenia and cardiovascular disease: a case–control epidemiological study

Published online by Cambridge University Press:  01 October 2015

G. Gal ,
H. Munitz  and
I. Levav
G. Gal*
Affiliation:
School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Israel
H. Munitz
Affiliation:
Clalit Health Services, Tel Aviv, Israel
I. Levav
Affiliation:
Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
*
*Address for correspondence: G. Gal, School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Rabenu Yeruham St, Tel Aviv, Israel. (Email: giladgal@mta.ac.il)
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Abstract

Aims.

Studies showed health care disparities among persons with comorbid schizophrenia and cardiovascular disease (CVD), including in countries with universal health care. However, the potential positive effect of specific mental health legislation has not been reported. This study aimed to investigate the health care of persons with comorbid schizophrenia and CVD in a country with both a national health insurance and a comprehensive rehabilitation law for persons with mental disabilities.

Method.

This study builds on a large case–control epidemiological sample (N = 52 189) of service users. Within the sample we identified a sub-group of persons with CVD diagnoses (n = 8208) and compared service users with and without schizophrenia on drug utilisation, laboratory tests, visits to specialists and surgical interventions.

Results.

Service users with schizophrenia were less likely to meet similar indexes of care as their counterparts: 91% cholesterol tests (p < 0.001), 60% stress tests (p < 0.001), 93% visits to specialists (p = 0.001), 93% drug utilisation (p < 0.001) and 55% CVD surgical interventions (odds ratio 0.55, 95% confidence intervals 0.49–0.61).

Conclusions.

In Israel, a country with a national health insurance and a rehabilitation law specific for persons with mental disabilities, service users with schizophrenia still fail to receive equitable levels of health care for CVD. However, the disparities appear to be smaller than in other countries with universal health insurance.

Keywords

Epidemiologyhealth service researchquality of careschizophrenia
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 25 , Issue 6 , December 2016 , pp. 541 - 547
Copyright
Copyright © Cambridge University Press 2015 

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References

Ajetunmobi, O, Taylor, M, Stockton, D, Wood, R (2013). Early death in those previously hospitalised for mental healthcare in Scotland: a nationwide cohort study, 1986–2010. BMJ Open 30. doi: 10.1136/bmjopen-2013-002768.Google Scholar
Aviram, U, Ginath, Y, Roe, D (2012). Mental health reforms in Europe: Israel's rehabilitation in the community of persons with mental disabilities law: challenges and opportunities. Psychiatric Services 63, 110–112.CrossRefGoogle ScholarPubMed
Björkenstam, E, Ljung, R, Burström, B, Mittendorfer-Rutz, E, Hallqvist, J, Weitoft, GR (2012). Quality of medical care and excess mortality in psychiatric patients–a nationwide register-based study in Sweden. BMJ Open doi: 10.1136/bmjopen-2011-000778.CrossRefGoogle ScholarPubMed
Crump, C, Winkleby, MA, Sundquist, K, Sundquist, J (2013). Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. American Journal of Psychiatry 170, 324–333.CrossRefGoogle ScholarPubMed
De Hert, M, Dekker, JM, Wood, D, Kahl, KG, Holt, RI, Möller, HJ (2009). Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry 24, 412–424.Google Scholar
De Hert, M, Cohen, D, Bobes, J, Cetkovich-Bakmas, M, Leucht, S, Ndetei, DM, Newcomer, JW, Uwakwe, R, Asai, I, Möller, HJ, Gautam, S, Detraux, J, Correll, CU (2011 a). Physical illness in patients with severe mental disorders. II Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 10, 138–151.CrossRefGoogle ScholarPubMed
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 (2011 b). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10, 52–57.CrossRefGoogle ScholarPubMed
Druss, BG, Bradford, WD, Rosenheck, RA, Radford, MJ, Krumholz, HM (2000). Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA 283, 506–511.CrossRefGoogle ScholarPubMed
Druss, BG, Bradford, WD, Rosenheck, RA, Radford, MJ, Krumholz, HM (2001). Quality of medical care and excess mortality in older patients with mental disorders. Archives of General Psychiatry 58, 565–572.CrossRefGoogle ScholarPubMed
Gardner-Sood, P, Lally, J, Smith, S, Atakan, Z, Ismail, K, Greenwood, KE, Keen, A, O'Brien, C, Onagbesan, O, Fung, C, Papanastasiou, E, Eberherd, J, Patel, A, Ohlsen, R, Stahl, D, David, A, Hopkins, D, Murray, RM, Gaughran, F (2015). Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial. Psychological Medicine 45, 2619–2629.CrossRefGoogle ScholarPubMed
Haklai, Z, Godberger, N, Stein, N, Pugachova, I, Levav, I (2011). The mortality risk among persons with psychiatric hospitalizations. Israeli Journal of Psychiatry and Related Disorders 48, 230–239.Google ScholarPubMed
Hoang, U, Goldacre, MJ, Stewart, R (2013). Avoidable mortality in people with schizophrenia and bipolar disorder in England. Acta Psychiatrica Scandinavica 127, 195–201.CrossRefGoogle ScholarPubMed
Hornik-Lurie, T, Zilber, N, Lerner, Y (2012). Trends in the use of rehabilitation services in the community by people with mental disabilities in Israel; the factors involved. Israeli Journal of Health Policy Research 1, 24.CrossRefGoogle ScholarPubMed
Insel, TR, Landis, SC (2005). Twenty-five years of progress: the view from NIMH and NINDS. Neuron 80, 561–567.CrossRefGoogle Scholar
Jones, LE, Carney, CP (2005). Mental disorders and revascularization procedures in a commercially insured sample. Psychosomatic Medicine 67, 568–576.CrossRefGoogle Scholar
Kisely, S, Campbell, LA, Wang, Y (2009). Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare. British Journal of Psychiatry 195, 545–550.CrossRefGoogle ScholarPubMed
Laursen, TM, Munk-Olsen, T, Agerbo, E, Gasse, C, Mortensen, PB (2009). Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Archives of General Psychiatry 66, 713–720.CrossRefGoogle ScholarPubMed
Lawrence, DM, Holman, CD, Jablensky, AV, Hobbs, MS (2003). Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998. British Journal of Psychiatry 182, 31–36.CrossRefGoogle ScholarPubMed
Levav, I, Grinshpoon, A (2004). Mental health services in Israel. International Psychiatry 4, 10–14.CrossRefGoogle Scholar
Lichtenberg, P, Kaplan, Z, Grinshpoon, A, Feldman, D, Nahon, D (1999). The goals and limitations of Israel's psychiatric case register. Psychiatric Services 50, 1043–1048.CrossRefGoogle ScholarPubMed
Mental health in Israel (2008). Department of Information and Evaluation, Ministry of Health. Statistical Annual. Retrieved 25 May 2015 from http://www.old.health.gov.il/download/forms/mentalReport2008.pdf Google Scholar
Mitchell, AJ, Lawrence, D (2011). Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis. British Journal of Psychiatry 198, 434–441.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Vancampfort, D, Sweers, K, van Winkel, R, Yu, W, De Hert, M (2013). Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders: a systematic review and meta-analysis. Schizophrenia Bulletin 39, 306–318.CrossRefGoogle ScholarPubMed
Osborn, DP, Levy, G, Nazareth, I, Petersen, I, Islam, A, King, MB (2007). Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's General Practice Research Database. Archives of General Psychiatry 64, 242–249.CrossRefGoogle Scholar
Petersen, LA, Normand, SL, Druss, BG, Rosenheck, RA (2003). Process of care and outcome after acute myocardial infarction for patients with mental illness in the VA health care system: are there disparities? Health Services Research 38, 41–63.CrossRefGoogle ScholarPubMed
Rabinowitz, J, Slyuzberg, M, Ritsner, M, Mark, M, Popper, M, Ginath, Y (1994). Changes in diagnosis in a 9-year national longitudinal sample. Comprehensive Psychiatry 35, 361–365.CrossRefGoogle Scholar
Rehabilitation of the Mentally Disabled in the Community Law (2000). Ministry of Justice. Retrieved 2 March 2015 from www.old.health.gov.il/Download/pages/lawENG040409_2.pdf Google Scholar
Roe, D, Werbeloff, N, Gelkopf, M (2010). Do persons with severe mental illness who consume the psychiatric rehabilitation basket of services in Israel have better outcomes than those who do not? Israeli Journal Psychiatry Related Science 47, 166–170.Google Scholar
Sartorius, N (2002). Fighting stigma: theory and practice. World Psychiatry 1, 26–27.Google ScholarPubMed
Tabbane, K, Joober, R, Spadone, C, Poirier, MF, Olié, JP (1993). Mortality and cause of death in schizophrenia. Review of the literature. Encephale 19, 23–29.Google ScholarPubMed
Thornicroft, G (2011). Physical health disparities and mental illness: the scandal of premature mortality. British Journal of Psychiatry 199, 441–442.CrossRefGoogle ScholarPubMed
United Nations (2006). Convention on the Rights of Persons with Disabilities. Retrieved 25 May 2015 from http://www.un.org/disabilities/convention/conventionfull.shtml Google Scholar
van Hasselt, FM, Oud, MJ, Loonen, AJ (2015). Practical recommendations for improvement of the physical health care of patients with severe mental illness. Acta Psychiatrica Scandinavica 131, 387–396.CrossRefGoogle ScholarPubMed
Weiser, M, Harvey, PD, Glick, I, Goetz, D, Karni, O, Yakir, A, Turetsky, N, Fennig, S, Nahon, D, Lerer, B, Davidson, M (2005). Sensitivity of ICD-10 diagnosis of psychotic disorders in the Israeli National Hospitalization Registry compared with RDC diagnoses based on SADS-L. Comprehensive Psychiatry 46, 38–42.CrossRefGoogle ScholarPubMed
World Health Organization (1992). International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD–10).Google Scholar
Wu, SI, Chen, SC, Juang, JJ, Fang, CK, Liu, SI, Sun, FJ, Kao, KL, Dewey, M, Prince, MJ, Stewart, R (2013). Diagnostic procedures, revascularization, and inpatient mortality after acute myocardial infarction in patients with schizophrenia and bipolar disorder. Psychosomatic Medicine 75, 52–59.CrossRefGoogle ScholarPubMed
Young, JK, Foster, DA (2000). Cardiovascular procedures in patients with mental disorders. JAMA 283, 3198.Google ScholarPubMed