Abstract P109: Access to Mental Health Care Services as a Risk Factor for Cardiovascular and Cerebrovascular Disease Mortality

Abstract

Introduction: Poor access to mental health care is a national epidemic. Individuals with unmet mental health care needs are at increased risk for poor CVH outcomes. Research examining the relationship between mental health care access and CVD/CVA mortality is scarce. Hypothesis and Research Question: We hypothesized that lack of mental health care access would be associated with increased CVD and CVA mortality. Additionally, we examined whether the relationship between mental health care access and CVD/CVA mortality differed by race and ethnicity. Methods: We analyzed data from the National Health Interview Surveys (NHIS) from the years 1999-2018. NHIS data were linked to mortality data from the National Death Index records up to 2018. The main predictor variable was access to mental healthcare services. The primary outcome was mortality due to CVD/CVA. Cox proportional hazards models were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between mental healthcare access and mortality. The model was adjusted for known confounders. Models were stratified by race and ethnicity. Results: A total of 1,824,334 individuals were included in the study. Participants mean age was (±SD) 43.2 (±.17). Nearly 23% of individuals reported an inability to afford needed mental healthcare services. Mortality due to CVD/CVA was higher among individuals who were unable to afford needed mental healthcare services, however this association was only significant for NH Black (aHR: 1.39 [95% CI 1.05-1.84]) and White adults (aHR: 1.53 [95% CI 1.30-1.81]). Mortality from CVD/CVA due to lack of access to mental health services differed by race and ethnicity. After adjustment, mortality due to CVD or CVA was highest among NH White persons and lowest among NH Black persons. Conclusion: We observed higher CVD/CVA mortality rates among individuals who were unable to afford needed mental healthcare services and their counterparts who obtained needed services. These results differed by race and ethnicity.