Inequitable access for mentally ill patients to some medically necessary procedures

Area of Science:

• Cardiovascular Health
• Mental Health Services Research
• Health Equity

Background:

• Socioeconomic status impacts outcomes for ischemic heart disease and stroke, despite universal healthcare.
• Previous research indicates disparities in access to revascularization procedures based on socioeconomic factors.
• This study investigates whether psychiatric status is similarly associated with mortality and procedural access for circulatory diseases.

Purpose of the Study:

• To determine if psychiatric status is linked to increased mortality from circulatory diseases.
• To assess if patients with mental illness have reduced access to specialized or revascularization procedures for circulatory conditions.
• To examine these associations within a universal healthcare system.

Main Methods:

• Population-based record-linkage analysis of data from 1995-2001 in Nova Scotia.
• Inclusion of patients in contact with psychiatric services and primary care.
• Calculation of rate ratios for death, hospital admissions, and procedures, adjusting for income and comorbidity.

Main Results:

• Psychiatric patients had a significantly increased rate ratio for death (1.34) and first admissions (1.70).
• Access to specialized or revascularization procedures was significantly lower for psychiatric patients, particularly inpatients.
• Adjusted rate ratios for cardiac catheterization, angioplasty, and bypass grafts were notably lower in psychiatric inpatients compared to their mortality risk.

Conclusions:

• Psychiatric status is a significant determinant of survival and procedural access for circulatory diseases.
• Disparities in care persist even within a universal healthcare system.
• Further research is crucial to understand and mitigate these inequities in healthcare delivery.