TY - JOUR
T1 - Disparities in Screening and Treatment of Cardiovascular Diseases in Patients With Mental Disorders Across the World
T2 - Systematic Review and Meta-Analysis of 47 Observational Studies
AU - Solmi, Marco
AU - Fiedorowicz, Jess
AU - Poddighe, Laura
AU - Delogu, Marco
AU - Miola, Alessandro
AU - Høye, Anne
AU - Heiberg, Ina H.
AU - Stubbs, Brendon
AU - Smith, Lee
AU - Larsson, Henrik
AU - Attar, Rubina
AU - Nielsen, René E.
AU - Cortese, Samuele
AU - Shin, Jae Il
AU - Fusar-Poli, Paolo
AU - Firth, Joseph
AU - Yatham, Lakshmi N.
AU - Carvalho, Andre F.
AU - Castle, David J.
AU - Seeman, Mary V.
AU - Correll, Christoph U.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - OBJECTIVE: This study used meta-analysis to assess disparities in cardiovascular disease (CVD) screening and treatment in people with mental disorders, a group that has elevated CVD incidence and mortality. METHODS: The authors searched PubMed and PsycInfo through July 31, 2020, and conducted a random-effect meta-analysis of observational studies comparing CVD screening and treatment in people with and without mental disorders. The primary outcome was odds ratios for CVD screening and treatment. Sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, and by controlling for confounding by indication, as well as meta-regressions, were also run, and publication bias and quality were assessed. RESULTS: Forty-seven studies (N=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening or treatment in patients with mental disorders emerged for any CVD (k=47, odds ratio=0.773, 95% CI=0.742, 0.804), coronary artery disease (k=34, odds ratio=0.734, 95% CI=0.690, 0.781), cerebrovascular disease (k=8, odds ratio=0.810, 95% CI=0.779, 0.842), and other mixed CVDs (k=11, odds ratio=0.839, 95% CI=0.761, 0.924). Significant disparities emerged for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and they differed across countries. Median study quality was high (Newcastle-Ottawa Scale score, 8); higher-quality studies found larger disparities, and publication bias did not affect results. CONCLUSIONS: People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.
AB - OBJECTIVE: This study used meta-analysis to assess disparities in cardiovascular disease (CVD) screening and treatment in people with mental disorders, a group that has elevated CVD incidence and mortality. METHODS: The authors searched PubMed and PsycInfo through July 31, 2020, and conducted a random-effect meta-analysis of observational studies comparing CVD screening and treatment in people with and without mental disorders. The primary outcome was odds ratios for CVD screening and treatment. Sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, and by controlling for confounding by indication, as well as meta-regressions, were also run, and publication bias and quality were assessed. RESULTS: Forty-seven studies (N=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening or treatment in patients with mental disorders emerged for any CVD (k=47, odds ratio=0.773, 95% CI=0.742, 0.804), coronary artery disease (k=34, odds ratio=0.734, 95% CI=0.690, 0.781), cerebrovascular disease (k=8, odds ratio=0.810, 95% CI=0.779, 0.842), and other mixed CVDs (k=11, odds ratio=0.839, 95% CI=0.761, 0.924). Significant disparities emerged for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and they differed across countries. Median study quality was high (Newcastle-Ottawa Scale score, 8); higher-quality studies found larger disparities, and publication bias did not affect results. CONCLUSIONS: People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.
KW - Bipolar and Related Disorders
KW - Cardiovascular Disease
KW - Mental Health Care/Service Delivery Systems
KW - Physical Health
KW - Schizophrenia Spectrum and Other Psychotic Disorders
KW - Screening
UR - http://www.scopus.com/inward/record.url?scp=85116956761&partnerID=8YFLogxK
U2 - 10.1176/appi.ajp.2021.21010031
DO - 10.1176/appi.ajp.2021.21010031
M3 - Article
C2 - 34256605
AN - SCOPUS:85116956761
SN - 0002-953X
VL - 178
SP - 793
EP - 803
JO - The American Journal of Psychiatry
JF - The American Journal of Psychiatry
IS - 9
ER -
