Inequitable access for mentally ill patients to some medically necessary procedures

Kisely, Stephen, Smith, Mark, Lawrence, David, Cox, Martha, Campbell, Leslie Anne and Maaten, Sarah (2007) Inequitable access for mentally ill patients to some medically necessary procedures. CMAJ: Canadian Medical Association Journal, 176 6: 779-784. doi:10.1503/cmaj.060482

Author Kisely, Stephen
Smith, Mark
Lawrence, David
Cox, Martha
Campbell, Leslie Anne
Maaten, Sarah
Title Inequitable access for mentally ill patients to some medically necessary procedures
Journal name CMAJ: Canadian Medical Association Journal   Check publisher's open access policy
ISSN 0008-4409
Publication date 2007-03-13
Sub-type Article (original research)
DOI 10.1503/cmaj.060482
Volume 176
Issue 6
Start page 779
End page 784
Total pages 6
Place of publication Ottawa, Ontario, Canada
Publisher Canadian Medical Association
Language eng
Subject 111714 Mental Health
111708 Health and Community Services
119999 Medical and Health Sciences not elsewhere classified
Formatted abstract
Background: Although universal health care aims for equity in service delivery, socioeconomic status still affects death rates from ischemic heart disease and stroke as well as access to revascularization procedures. We investigated whether psychiatric status is associated with a similar pattern of increased mortality but reduced access to procedures. We measured the associations between mental illness, death, hospital admissions and specialized or revascularization procedures for circulatory disease (including ischemic heart disease and stroke) for all patients in contact with psychiatric services and primary care across Nova Scotia.

Methods: We carried out a population-based record-linkage analysis of related data from 1995 through 2001 using an inception cohort to calculate rate ratios compared with the general public for each outcome (n = 215 889). Data came from Nova Scotia’s Mental Health Outpatient Information System, physician billings, hospital discharge abstracts and vital statistics. We estimated patients’ income levels from the median incomes of their residential neighbourhoods, as determined in Canada’s 1996 census.

Results: The rate ratio for death of psychiatric patients was significantly increased (1.34), even after adjusting for potential confounders, including income and comorbidity (95% confidence interval [CI] 1.29–1.40), which was reflected in the adjusted rate ratio for first admissions (1.70, 95% CI 1.67–1.72). Their chances of receiving a procedure, however, did not match this Increased risk. In some cases, psychiatric patients were significantly less likely to undergo specialized or revascularization procedures, especially those who had ever been psychiatric inpatients. In the latter case, adjusted rate ratios for cardiac catheterization, percutaneous transluminal coronary angioplasty and coronary artery bypass grafts were 0.41, 0.22 and 0.34, respectively, in spite of psychiatric inpatients’ increased risk of death.

Conclusions: Psychiatric status affects survival with and access to some procedures for circulatory disease, even in a universal health care system that is free at the point of delivery. Understanding how these disparities come about and how to reduce them should be a priority for future research.
Keyword Psychiatric-patients
Excess Mortality
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Health and Rehabilitation Sciences Publications
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Created: Wed, 18 Nov 2009, 12:21:28 EST