Understanding the pandemic’s effects on cardiovascular disease for people living with mental health disorders

The challenge

Previous research has shown that mental health disorders are associated with increased mortality, including through increased risk of cardiovascular disease (CVD). This is especially true for those living with severe mental illnesses such as bipolar disorder, schizophrenia and severe depression, where life expectancy can be reduced by up to 12 years according to previous research.

On top of this, the COVID-19 pandemic also significantly disrupted healthcare. With there already being a significant gap in life expectancy, understanding the impact of the pandemic was vital.

Researchers from the University of Edinburgh, supported by the BHF Data Science Centre, investigated whether disparities in cardiovascular disease for people with schizophrenia, bipolar disorder, and depression were exacerbated by the COVID-19 pandemic.

Investigating these disparities is timely, as the most recent estimates of healthcare disparities in CVD relating to mental health disorders are from 2015. Disruption to healthcare caused by the pandemic is expected to impact marginalised groups the most and might have altered the disparities for those with mental disorders.

The solution

The data for this study were derived from electronic health data from primary care records, inpatient hospital admissions data, and death registration data, accessed through NHS England’s Secure Data Environment (SDE). This enabled the analysis of a study population of about 65 million people, modelling disparities on a cohort of 32 million adults aged 40-100.

The researchers separately studied three cardiovascular diseases: myocardial infarction (heart attack), heart failure, and stroke events. Researchers used quasi-Poisson models to estimate rate ratios of CVD for people with mental disorders versus those without, adjusting for age, sex, deprivation and time. They then saw if adding an interaction between time and each mental disorder would improve the fit of the model to see if the pandemic widened disparities in health outcomes.

The impact

On average, people with the mental health disorders studied were diagnosed with CVD 3-10 years earlier than people without. This gap was largest for heart failure, where people with schizophrenia were on average 10 years younger at diagnosis than those without.

However, the study found that although disparities in CVD incidence based on mental health disorder diagnosis persist, they did not widen during or after the pandemic. This research adds to the understanding of inequalities in CVD which is vital to prevent these gaps from widening further.

The Impact committee’s comments

The impact committee commend this study for investigating this research question in a large population, using a prespecified protocol, and publishing codelists and analysis code to enhance the transparency and reproducibility of the study. It’s important to listen to people who have lived experience of mental disorders when carrying out research that impacts them. As part of the CVD-COVID-UK/COVID-IMPACT Consortium, this study was conducted with an advisory group which included people with lived experience of mental health disorders.

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