CVD screening, treatment disparities prominent among people with mental disorders
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Individuals with mental disorders, particularly those with schizophrenia, received less screening and lower-quality treatment for cardiovascular disease, according to results of a systematic review and meta-analysis.
“A rigorous synthesis of the available evidence is paramount to determine whether disparities of this kind exist and to assess their type and extent,” Marco Solmi, MD, PhD, of the department of neuroscience at the Padua Neuroscience Center in Italy, and colleagues wrote in American Journal of Psychiatry. “However, no recent comprehensive meta-analysis, without restriction in types of CVDs or types of mental disorders, has investigated disparities in CVD screening and treatment.”
To address this research gap, the investigators searched two databases through July 31, 2020, and included 47 studies with a total of 24,400,452 individuals, of whom 1,283,602 had mental disorders, in the meta-analysis. Specifically, they conducted a random-effect meta-analysis of observational studies that compared CVD screening and treatment among individuals with and without mental disorders. ORs for CVD screening and treatment served as the primary outcome. Further, they ran sensitivity analyses on screening and treatment separately and by specific procedures, subgroup analyses by country and by controlling for confounding by indication, as well as meta-regressions, and they assessed publication bias and quality.
Results showed individuals with mental disorders had lower rates of screening or treatment for any CVD (OR = 0.773; 95% CI, 0.742-0.804), coronary artery disease (OR = 0.734; 95% CI, 0.69-0.781), cerebrovascular disease (OR = 0.81; 95% CI, 0.779-0.842) and other mixed CVDs (OR = 0.839; 95% CI, 0.761-0.924). The researchers noted the emergence of significant disparities for any screening, any intervention, catherization or revascularization in coronary artery disease, intravenous thrombolysis for stroke and treatment with any and with certain CVD medications across all mental disorders, aside from for CVD medications in mood disorders. Schizophrenia exhibited the largest disparities, which differed across countries. Solmi and colleagues reported high median study quality. They noted higher-quality studies found larger disparities and publication bias did not affect results.
“Targeted efforts to address this public health disparity are urgent,” Solmi and colleagues wrote. “Given the persistent mortality gap, seen over several decades, affecting people with mental disorders compared with the general population, and largely attributed to CVDs, a collaborative model of care involving preventive screening and collaboration among primary care clinicians, medical specialists and mental health care providers should be tested and implemented widely after efficacy is demonstrated.”