Multimorbidity in bipolar disorder and under-treatment of cardiovascular disease: a cross sectional study

Smith, D. , Martin, D., McLean, G., Langan-Martin, J. , Guthrie, B. and Mercer, S. (2013) Multimorbidity in bipolar disorder and under-treatment of cardiovascular disease: a cross sectional study. BMC Medicine, 11, p. 263. (doi: 10.1186/1741-7015-11-263)

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Background: Individuals with serious mental disorders experience poor physical health, especially increased rates of cardiometabolic morbidity and premature morbidity. Recent evidence suggests that individuals with schizophrenia have numerous comorbid physical conditions which may be under-recorded and under-treated but to date very few studies have explored this issue for bipolar disorder. Methods:We conducted a cross-sectional analysis of a dataset of 1,751,841 registered patients within 314 primary-care practices in Scotland, U.K. Bipolar disorder was identified using Read Codes recorded within electronic medical records. Data on 32 common chronic physical conditions were also assessed. Potential prescribing inequalities were evaluated by analyzing prescribing data for coronary heart disease (CHD) and hypertension. Results: Compared to controls, individuals with bipolar disorder were significantly less likely to have no recorded physical conditions (OR 0.59, 95% CI 0.54-0.63) and significantly more likely to have one physical condition (OR 1.27, 95% CI 1.16-1.39), two physical conditions (OR 1.45, 95% CI 1.30-1.62) and three or more physical conditions (OR 1.44, 95% CI 1.30-1.64). People with bipolar disorder also had higher rates of thyroid disorders, chronic kidney disease, chronic pain, chronic obstructive airways disease and diabetes but, surprisingly, lower recorded rates of hypertension and atrial fibrillation. People with bipolar disorder and comorbid CHD or hypertension were significantly more likely to be prescribed no antihypertensive or cholesterol-lowering medications compared to controls, and bipolar individuals with CHD or hypertension were significantly less likely to be on 2 or more antihypertensive agents. Conclusions: Individuals with bipolar disorder are similar to individuals with schizophrenia in having a wide range of comorbid and multiple physical health conditions. They are also less likely than controls to have a primary-care record of cardiovascular conditions such as hypertension and atrial fibrillation. Those with a recorded diagnosis of CHD or hypertension were less likely to be treated with cardiovascular medications and were treated less intensively. This study highlights the high physical healthcare needs of people with bipolar disorder, and provides evidence for a systematic under-recognition and under-treatment of cardiovascular disease in this group.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Martin, Dr Daniel and Smith, Professor Daniel and Mercer, Professor Stewart and Langan-Martin, Dr Julie and Guthrie, Prof Bruce and McLean, Dr Gary
Authors: Smith, D., Martin, D., McLean, G., Langan-Martin, J., Guthrie, B., and Mercer, S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
Journal Name:BMC Medicine
ISSN (Online):1741-7015
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in BMC Medicine 11:263
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
477971Living Well with Multiple MorbidityStewart MercerScottish Executive Health Department (SEHHD-CSO)ARPG/07/01IHW - GENERAL PRACTICE & PRIMARY CARE