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BMJ Open 2:e000831 doi:10.1136/bmjopen-2012-000831
  • Health services research
    • Research

How does a history of psychiatric hospital care influence access to coronary care: a cohort study

  1. Kristian Wahlbeck1
  1. 1National Institute for Health and Welfare, Helsinki, Finland
  2. 2Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
  1. Correspondence to Dr Kristiina Manderbacka; kristiina.manderbacka{at}thl.fi
  • Received 10 January 2012
  • Accepted 7 March 2012
  • Published 5 April 2012

Abstract

Objectives Equity in physical health of patients with severe mental disorders is a major public health concern. The aim of this cohort study was to examine equity in access to coronary care among persons with a history of severe mental disorder in 1998–2009.

Design Nationwide register linkage cohort study.

Setting Hospital care in the Finnish healthcare system.

Population The study population consisted of all residents in Finland aged 40 years or older. All hospital discharges in 1998–2009 with a diagnosis of coronary heart disease or severe mental disorder were obtained from the Care Register.

Primary outcome measures Data on deaths, hospitalisations and coronary revascularisations were linked to the data set using unique personal identifiers.

Results Patients with severe mental disorders had increased likelihood of hospital care due to coronary heart disease (RR between 1.22, 95% CI 1.18 to 1.25 and 1.93, 1.84 to 2.03 in different age groups) and in 40–49-year-olds also increased likelihood of revascularisation (1.26, 1.16 to 1.38) compared with persons without mental disorders. Access to revascularisation was poorer among older persons with severe mental disorders in relation to need suggested by increased coronary mortality. In spite of excess coronary mortality (ranging from 0.95, 0.89 to 1.01 to 3.16, 2.82 to 3.54), worst off were people with a history of psychosis, who did not have increased use of hospital care and had lower likelihood of receiving revascularisations (ranging from 0.44, 0.37 to 0.51 to 0.74, 0.59 to 0.93) compared with persons without mental disorders.

Conclusions Selective mechanisms seem to be at work in access to care and revascularisations among people with severe mental disorders. Healthcare professionals need to be aware of the need for targeted measures to address challenges in provision of somatic care among people with severe mental health problems, especially among people with psychoses and old people.

Footnotes

  • To cite: Manderbacka K, Arffman M, Sund R, et al. How does a history of psychiatric hospital care influence access to coronary care: a cohort study. BMJ Open 2012;2:e000831. doi:10.1136/bmjopen-2012-000831

  • Contributors KM participated in the study conception and design, drafted the manuscript, participated in review and interpretation of the results and revision of the manuscript and has approved the final version. She is the guarantor of the manuscript. MA participated in the study conception and design, performed the data preparation and analysis and participated in drafting of the methods and findings sections of the manuscript, participated in review and interpretation of the results and has seen and approved the final version. RS participated in the study conception and design, guided the data analysis, participated in the interpretation of the results and preparation of the manuscript and in review and interpretation of the results and has seen and approved the final version. JH participated in the study conception and design, participated in the interpretation of the results and drafting of the manuscript and in the review and interpretation of results and has seen and approved the final version. IK participated in the study conception and design, participated in the interpretation of the results and drafting of the manuscript and in the review and interpretation of results and has seen and approved the final version. KW participated in the study conception and design, oversaw the data analysis, design and drafting of the manuscript and participated in the interpretation of the results and in the review and interpretation of results and has seen and approved the final version. He is the guarantor of the manuscript.

  • Funding This work was partly supported by the Academy of Finland (project number 133793) but it had no involvement in its design, data collection, findings or decision to publish.

  • Competing interests JH has been in research collaboration with Janssen-Cilag, Eli Lilly, Novartis, Novo Nordisk, Astra-Zeneca, Sanofi-Aventis and Nycomed and have been a member of the expert advisory group for Astellas. IK has received funding from the Academy of Finland for the study but the Academy had no involvement in its design, data collection, findings or decision to publish and is asked to advise the Finnish Ministry of Health and Social Affairs from time to time on matters relating to socioeconomic inequality and health: regardless of the findings of this study, the outputs of this research would form part of that advice. KM, RS, MA and KW declared no conflict of interest.

  • Ethics approval Ethics approval was provided by the Research Ethics Committee of the National Centre for Health and Welfare (§163/2010).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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