Launders, Naomi;
(2023)
Investigating physical health and related secondary care use in people with severe mental illness using electronic health records.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: People diagnosed with severe mental illness (SMI) have poorer physical health and higher mortality than those without SMI. In this thesis I investigate the physical health and planned and emergency physical health hospital use of people with SMI compared to people without SMI. Methods: I conducted a meta-analysis to quantify excess hospital use for non mental health causes in people with SMI and five physical long-term conditions (LTCs). I used primary care records to investigate the prevalence of 24 LTCs in those with and without SMI, to identify patterns of multimorbidity, and to investigate cancer incidence and mortality. I then linked primary and secondary care records to investigate planned and emergency physical health hospital admissions in people with SMI. Results: Patients with SMI had higher prevalence of 19 of 24 physical LTCs, and of multimorbidity (odds ratio:1.84, 95%CI:1.80-1.88) than those without SMI, with 13 LTCs elevated at or before SMI diagnosis. However, clusters of LTCs were similar between those with and without SMI. Patients with schizophrenia had a lower risk of cancer diagnosis (hazard ratio[HR]:0.83, 95%CI:0.78-0.89) but were at greater risk of cancer mortality (HR:1.93, 95%CI:1.54-2.41) and had fewer planned physical health admissions (incidence rate ratio [IRR]:0.80, 95%CI:0.72- 0.90) than those without SMI. Patients with SMI had more emergency physical health admissions, particularly avoidable admissions (IRR:2.88, 95%CI:2.60- 3.19). Conclusions: Interventions to improve physical health should focus on similar groups of conditions as for the general population, but at a younger age, and early in the course of SMI. The low incidence of cancer and of planned physical health admissions in people with schizophrenia suggest a need for interventions to improve access to preventative and planned services. The high rate of avoidable admissions in those with SMI suggests interventions are required to improve the management of existing physical LTCs.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Investigating physical health and related secondary care use in people with severe mental illness using electronic health records |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10166822 |
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