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Journal Article Epublish 9 citations

PubMed: 35844106 DOI: 10.1017/S2045796022000385

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

Epidemiol Psychiatr Sci 31:e52

Authors: D Fonseca de Freitas, M Pritchard, H Shetty, M Khondoker, J Nazroo, R D Hayes, K Bhui

Affiliations

  • Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
  • Department of Psychiatry, University of Oxford, Oxford, UK.
  • Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK.
  • Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK.
  • Norwich Medical School, University of East Anglia, Norwich, UK.
  • Sociology, School of Social Sciences, University of Manchester, Manchester, UK.
  • Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

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.

MeSH

Epidemiology, Psychotic Disorders, Comorbidity, Schizophrenia, Cohort Studies, Research, Multimorbidity

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