Abstract
PurposePeople with severe mental illnesses (SMI) experience a 17- to 20-year reduction in life expectancy. One-third of deaths are due to cardiovascular disease. This study will establish the relationship of SMI with cardiovascular disease in ethnic minority groups (Indian, Pakistani, Bangladeshi, black Caribbean, black African and Irish), in the UK.MethodsE-CHASM is a mixed methods study utilising data from 1.25 million electronic patient records. Secondary analysis of routine patient records will establish if differences in cause-specific mortality, cardiovascular disease prevalence and disparities in accessing healthcare for ethnic minority people living with SMI exist. A nested qualitative study will be used to assess barriers to accessing healthcare, both from the perspectives of service users and providers.ResultsIn primary care, 993,116 individuals, aged 18+, provided data from 186/189 (98 %) practices in four inner-city boroughs (local government areas) in London. Prevalence of SMI according to primary care records, ranged from 1.3–1.7 %, across boroughs. The primary care sample included Bangladeshi [n = 94,643 (10 %)], Indian [n = 6086 (6 %)], Pakistani [n = 35,596 (4 %)], black Caribbean [n = 45,013 (5 %)], black African [n = 75,454 (8 %)] and Irish people [n = 13,745 (1 %)]. In the secondary care database, 12,432 individuals with SMI over 2007–2013 contributed information; prevalent diagnoses were schizophrenia [n = 6805 (55 %)], schizoaffective disorders [n = 1438 (12 %)] and bipolar affective disorder [n = 4112 (33 %)]. Largest ethnic minority groups in this sample were black Caribbean [1432 (12 %)] and black African (1393 (11 %)).ConclusionsThere is a dearth of research examining cardiovascular disease in minority ethnic groups with severe mental illnesses. The E-CHASM study will address this knowledge gap.
Highlights
People living with severe mental illnesses such as schizophrenia have a reduced life expectancy relative to the general population which is up to 20 years earlier in men and 17 years in women, in high income countries [1, 2]
Self-ascribed ethnicity according to Office for National Statistics (ONS) census categories is available for 80–90 % of patients, following local schemes to improve the recording of ethnicity [28,29,30, 56]
People registered to general practitioners/family doctors within the primary care database are more likely to reside in areas which are deprived and a high proportion of residents in each of the boroughs report their ethnicity as being of minority status (Table 2)
Summary
People living with severe mental illnesses such as schizophrenia have a reduced life expectancy relative to the general population which is up to 20 years earlier in men and 17 years in women, in high income countries [1, 2]. Increased mortality may be related to people with severe mental illnesses receiving poorer quality physical healthcare [4,5,6]. Anti-psychotic medications, especially at higher doses, are associated with death from stroke and coronary heart disease [11]. People with severe mental illnesses experience barriers to seeking timely help for co-morbid medical problems [12]. There may be shared factors underlying premature mortality and severe mental illness, such as social disadvantage [12]
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