Abstract
ObjectivesThe primary aim of this study was to describe the geography of serious mental illness (SMI)–type 2 diabetes comorbidity (T2D) in the Illawarra-Shoalhaven region of NSW, Australia. The Secondary objective was to determine the geographic concordance if any, between the comorbidity and the single diagnosis of SMI and diabetes.MethodsSpatial analytical techniques were applied to clinical data to explore the above objectives. The geographic variation in comorbidity was determined by Moran’s I at the global level and the local clusters of significance were determined by Local Moran’s I and spatial scan statistic. Choropleth hotspot maps and spatial scan statistics were generated to assess the geographic convergence of SMI, diabetes and their comorbidity. Additionally, we used bivariate LISA (Local Indicators of Spatial Association) and multivariate spatial scan to identify coincident areas with higher rates of both SMI and T2D.ResultsThe study identified significant geographic variation in the distribution of SMI–T2D comorbidity in Illawarra Shoalhaven. Consistently higher burden of comorbidity was observed in some urban suburbs surrounding the major metropolitan city. Comparison of comorbidity hotspots with the hotspots of single diagnosis SMI and T2D further revealed a geographic concordance of high-risk areas again in the urban areas outside the major metropolitan city.ConclusionThe identified comorbidity hotspots in our study may serve as a basis for future prioritisation and targeted interventions. Further investigation is required to determine whether contextual environmental factors, such as neighbourhood socioeconomic disadvantage, may be explanatory.Implications for public healthOurs is the first study to explore the geographic variations in the distribution of SMI and T2D comorbidity. Findings highlight the importance of considering the role of neighbourhood environments in influencing the T2D risk in people with SMI.
Highlights
Research has established that type 2 diabetes (T2D) often co-occurs with serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depression[1]
In this study we combined spatial analytical methods and clinical data to analyse the spatial distribution of SMI -T2D comorbidity in Illawarra Shoalhaven
Our results revealed evidence of spatial variations in the distribution of SMI -T2D comorbidity
Summary
Research has established that type 2 diabetes (T2D) often co-occurs with serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depression[1]. Several lines of evidence suggest that a diagnosis of T2D can increase the risk of mental disorders such as depression[4]. For people with SMI, a comorbid diabetic diagnosis confers a higher cardiovascular risk and increased risk of premature mortality, but is associated with greater cognitive decline, worse prognosis, increased hospitalisations, greater number of emergency department visits, non-adherence to treatments, higher healthcare utilisation costs and decreased quality of life for people experiencing mentally illhealth[3,5,6,7,8,9]. Describing the geography may assist public health authorities to cost-effectively target local resources and preventive interventions to reduce the regional disparities and public health burden imposed by the comorbidity
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