Health equity
Do people with bipolar disorder get less heart-disease treatment?
Open access · cc by · source: Europe PMC
People with bipolar disorder in Scottish general practice had more physical illnesses overall, but those with heart disease or high blood pressure were less likely to be prescribed statins and blood-pressure drugs than other patients.
Study at a glance
- Design
- Cross-sectional — Cross-sectional analysis of routine electronic primary-care records from 314 Scottish general practices, comparing adults with a bipolar Read code against all other adults using age- and sex-standardised odds ratios.
- N
- No single analytic N: the source dataset held 1,751,841 registered patients; the adult comparison was 2,582 people with a bipolar code versus 1,421,796 without, and prescribing analyses used the subsets with coronary heart disease or hypertension.
- Population
- Adults (18 and over) permanently registered with Scottish general practices in 2007, with bipolar disorder identified from primary-care diagnostic codes.
- Outcome
- Recorded prevalence of 32 chronic physical conditions and of multimorbidity; among those with coronary heart disease or hypertension, smoking, blood pressure and cholesterol targets, and prescribing of statins, antiplatelets and antihypertensives.
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Key findings
People with bipolar disorder were more likely to have several physical conditions (odds ratio 1.44 for three or more) and had higher recorded rates of 15 of the 32 conditions, including viral hepatitis, constipation, Parkinson's disease, chronic kidney disease and thyroid disease. Yet recorded hypertension and atrial fibrillation were lower and heart disease was not raised, despite more smoking and diabetes, suggesting under-recording. Among those with coronary heart disease, 70.0% of bipolar patients were on a statin versus 74.4% of others, 29.4% were on no antihypertensive versus 15.8%, and they were more often current smokers; a similar undertreatment pattern appeared for hypertension, although blood-pressure and cholesterol target attainment did not differ.
Methodology
The researchers used anonymised records from 314 Scottish general practices covering about a third of the population and identified 2,582 adults with a bipolar disorder code. They compared them with 1,421,796 other adults on 32 common chronic physical conditions, standardising for age and sex. Among patients with coronary heart disease or hypertension, they also compared smoking, whether blood-pressure and cholesterol targets were met, and what cardiovascular drugs were prescribed.
Limitations
Because the data are cross-sectional, the study cannot show whether lower prescribing leads to worse outcomes, and the authors note that undertreated patients with poor control may already have died and dropped out of the sample. Diagnoses come from routine codes rather than structured interviews, the recorded bipolar rate of 0.2% is well below the roughly 1% expected (so the group is skewed to more severe cases), and a small number of people coded with psychotic depression could not be separated out. Higher rates of conditions like hepatitis or thyroid disease may partly reflect more blood testing in this group rather than more disease.
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