Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study

AbstractBackgroundDepression is associated with increased mortality, however, little is known about its variation by ethnicity.MethodsWe conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007–2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures.ResultsData from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45–2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53–0.74) (Black Caribbean), 0.53(95% CI 0.39–0.72) (Black African) and 0.69(95% CI 0.52–0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68–2.24) and aHR:1.18 (95% CI 1.01–1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58–0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression.ConclusionsAlthough individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.

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Better understandings of ethnic variations: ethnicity, poverty and social exclusion

Poverty and Social Exclusion in the UK: Vol 1 ◽

10.1332/policypress/9781447332152.003.0006 ◽

2017 ◽

Author(s):

Saffron Karlsen ◽

Christina Pantazis

Keyword(s):

Ethnic Minority ◽

Social Exclusion ◽

Minority Groups ◽

Black African ◽

Ethnic Minority Population ◽

Polish People ◽

Black Caribbean ◽

White Majority ◽

The Uk ◽

Ethnic Variations

Previous assessments of poverty and social exclusion in the UK show variations in the social position of people with different ethnic backgrounds. While many minority groups experience significant disadvantage compared with the white majority, this is found to be particularly persistent among Pakistani and Bangladeshi people. However, this previous work is less than comprehensive in its coverage of the ethnic minority population. There are also concerns that standard measures of socioeconomic status fail to account for some of the specific experiences of ethnic minority groups and as a consequence underestimate the prevalence of socioeconomic disadvantage among them. The Poverty and Social Exclusion UK 2012 survey enables us to look at groups often ignored in analyses of ethnic inequalities, such as white minority groups and more recent migrants. Our findings therefore make a valuable contribution to this existing evidence, drawing attention to the particular disadvantage experienced by Black African and Polish people. The more detailed markers employed here reveal additional dimensions of disadvantage than have generally been explored previously and through this the significant disadvantage experienced by other groups – such as Black Caribbean people – as well as the heterogeneity within particular ethnic groups, which have been unappreciated in previous work.

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Ethnic Disproportionality in the Identification of High-Incidence Special Educational Needs: A National Longitudinal Study Ages 5 to 11

Council review ◽

10.1177/0014402921990895 ◽

2021 ◽

pp. 001440292199089

Author(s):

Steve Strand ◽

Ariel Lindorff

Keyword(s):

Ethnic Minority ◽

Minority Groups ◽

Educational Needs ◽

Special Educational Needs ◽

Social Emotional Development ◽

Ethnic Minority Groups ◽

Social Emotional ◽

Black African ◽

Level Data ◽

Black Caribbean

We used pupil-level data from the National Pupil Database in England to conduct a longitudinal analysis of the identification of moderate learning difficulties (MLD) and social, emotional, and mental health difficulties (SEMH) among 550,000 pupils ages 5 to 11 years. Survival analysis was used to determine the hazard ratios (HRs) for time to first identification, controlling for prior attainment and social-emotional development at age 5 as well as socioeconomic variables. For MLD, the overrepresentation of Black Caribbean and Pakistani pupils compared with White British pupils was eliminated following age 5 controls, and the predominant picture was of ethnic-minority underrepresentation. For SEMH, Black Caribbean and mixed White and Black Caribbean (MWBC) pupils continued to be overrepresented even after age 5 controls (HR = 1.36 and 1.44, respectively), although this was not true for the larger group of Black African pupils, who were underrepresented in the adjusted analyses (HR = 0.62), as were most other ethnic-minority groups. The results indicate most ethnic-minority groups are underrepresented for special educational needs after adjusting for pupil characteristics on entry to school, though this varies by ethnic group and type of need.

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Access to mental healthcare in the year after first fit note: a longitudinal study of linked clinical records

BMJ Open ◽

10.1136/bmjopen-2020-044725 ◽

2021 ◽

Vol 11 (11) ◽

pp. e044725

Author(s):

Sarah Dorrington ◽

Ewan Carr ◽

Sharon Stevelink ◽

Mark Ashworth ◽

Matthew Broadbent ◽

...

Keyword(s):

Mental Health ◽

Longitudinal Study ◽

Mental Disorders ◽

Mental Health Treatment ◽

Mental Healthcare ◽

Poor Mental Health ◽

Secondary Outcome ◽

Black African ◽

Black Caribbean ◽

Clinical Records

ObjectivesSickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner (GP) and determined access to mental health treatment stratified by health complaint and demographic variables.DesignLongitudinal study of health records.SettingPrimary care and secondary mental health care in the borough of Lambeth, South London. Forty-five GP practices in Lambeth and the local secondary mental healthcare trust.ParticipantsThe analytical sample included 293 933 working age adults (16–60 years) registered at a Lambeth GP practice between 1 January 2014 and 30 April 2016.Primary and secondary outcome measuresThree indicators of mental healthcare in the year after first fit note were antidepressant prescription, contact with Improving Access to Psychological Therapy (IAPT) services and contact with secondary mental health services.Results75% of people with an identified mental health condition at first fit note had an indicator of mental healthcare in the following year. Black Caribbean and Black African groups presenting with mental disorders were less likely to have a mental healthcare indicator compared with White British groups.ConclusionsThe majority of those with an identified mental health need receive some treatment in the year following a fit note; however, our results suggest Black African and Black Caribbean groups with an identified mental healthcare need have less complete access compared to the White British group.

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486 Clinical composite endpoint classification of REVIVE II corresponds to all-cause mortality risk

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60295-1 ◽

2007 ◽

Vol 6 (1) ◽

pp. 106-107

Author(s):

J TEERLINK ◽

L DELGADOHERRERA ◽

R THAKKAR ◽

B HUANG ◽

R PADLEY

Keyword(s):

Mortality Risk ◽

Composite Endpoint ◽

All Cause Mortality

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Prejudicial beliefs and COVID-19 disruptions among sexual minority men living with and not living with HIV in a high SARS-CoV-2 prevalence area

Translational Behavioral Medicine ◽

10.1093/tbm/ibab050 ◽

2021 ◽

Author(s):

Seth C Kalichman ◽

Renee El-Krab ◽

Bruno Shkembi ◽

Moira O Kalichman ◽

Lisa A Eaton

Keyword(s):

African American ◽

African American Men ◽

People Living With Hiv ◽

Sex Partners ◽

Black African ◽

Sexual Minority Men ◽

Mediation Analyses ◽

Personal Action ◽

Male Sex ◽

Living With Hiv

Abstract The COVID-19 pandemic has had profound health and social impacts. COVID-19 also affords opportunities to study the emergence of prejudice as a factor in taking protective actions. This study investigated the association of COVID-19 concerns, prejudicial beliefs, and personal actions that involve life disruptions among people not living with and people living with HIV. 338 Black/African American men not living with HIV who reported male sex partners and 148 Black/African American men living with HIV who reported male sex partners completed a confidential survey that measured COVID-19 concern, COVID-19 prejudice, and personal action and institutionally imposed COVID-19 disruptions. Participants reported having experienced multiple social and healthcare disruptions stemming from COVID-19, including reductions in social contacts, canceling medical appointments, and inability to access medications. Mediation analyses demonstrated that COVID-19 concerns and COVID-19 prejudice were associated with personal action disruptions, indicating that these social processes are important for understanding how individuals modified their lives in response to COVID-19. It is imperative that public health efforts combat COVID-19 prejudice as these beliefs undermine investments in developing healthcare infrastructure to address COVID-19 prevention.

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High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

Innovation in Aging ◽

10.1093/geroni/igaa057.1632 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 505-506

Author(s):

Dominika Seblova ◽

Kelly Peters ◽

Susan Lapham ◽

Laura Zahodne ◽

Tara Gruenewald ◽

...

Keyword(s):

High School ◽

Mortality Risk ◽

Race And Ethnicity ◽

Proportional Hazards ◽

School Quality ◽

Cox Proportional Hazards ◽

School Level ◽

Lower Mortality ◽

All Cause Mortality ◽

Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

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Effect of Perceived Social Support on Mortality Rate Among Older Chinese Americans

Innovation in Aging ◽

10.1093/geroni/igaa057.642 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 198-199

Author(s):

Charu Verma ◽

Mengting Li ◽

XinQi Dong

Keyword(s):

Social Support ◽

Mortality Risk ◽

Perceived Social Support ◽

Chinese Americans ◽

Well Being ◽

Time Of Death ◽

All Cause Mortality ◽

Older Chinese ◽

Older Chinese Americans ◽

Over Time

Abstract Most existing studies have examined the relationship between social support and health in cross-sectional data. However, the changing dynamics of social support over time and its relationship with all-cause mortality have not been well explored. Using data from the Pine Study (N = 3,157), this study examined whether social support was associated with time of death at an 8 years follow-up among older Chinese Americans. Social support from a spouse, family members and friend were collected at the baseline using an HRS social support scale. Perceived social support and time of death were ascertained from the baseline through wave 4. Cox proportional hazard models were used to assess associations of perceived support with the risk of all-cause mortality using time-varying covariate analyses. Covariates included age, sex, education, income, and medical comorbidities. All study participants were followed up for 8 years, during which 492 deaths occurred. In multivariable analyses, the results showed that positive family support [HR 0.91; 95% CI (0.86, 0.98)] and overall social support [HR 0.95; 95% CI (0.92,0.98)] were significantly associated with a lower risk of 8-year mortality. Results demonstrate robust association in which perceived positive family and overall social support over time had a protective effect on all-cause mortality risk in older Chinese Americans. Interventions could focus on older adults with low social support and protect their health and well-being. Future studies could further explore why social support from family is different from social support from other sources regarding mortality risk in older Chinese Americans.

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Prognostic Value of Serum Magnesium in Mortality Risk among Patients on Hemodialysis: A Meta-Analysis of Observational Studies

Kidney Diseases ◽

10.1159/000510513 ◽

2020 ◽

pp. 1-10

Author(s):

Hongwei Wu ◽

Qiang Li ◽

Lijing Fan ◽

Dewang Zeng ◽

Xianggeng Chi ◽

...

Keyword(s):

Mortality Risk ◽

Cardiovascular Mortality ◽

Observational Studies ◽

Prognostic Value ◽

Meta Analysis ◽

Serum Magnesium ◽

Cochrane Library ◽

Lower Serum ◽

All Cause Mortality ◽

End Stage

Background: Previous studies have reported that serum magnesium (Mg) deficiency is involved in the development of heart failure, particularly in patients with end-stage kidney disease. The association between serum Mg levels and mortality risk in patients receiving hemodialysis is controversial. We aimed to estimate the prognostic value of serum Mg concentration on all-cause mortality and cardiovascular mortality in patients receiving hemodialysis. Methods: We did a systematic literature search in PubMed, EMBASE, Cochrane Library, and Web of Science to identify eligible studies that reported the prognostic value of serum Mg levels in mortality risk among patients on hemodialysis. We performed a meta-analysis by pooling and analyzing hazard ratios (HRs) and 95% confidence intervals (CIs). Results: We identified 13 observational studies with an overall sample of 42,967 hemodialysis patients. Higher all-cause mortality (adjusted HR 1.58 [95% CI: 1.31–1.91]) and higher cardiovascular mortality (adjusted HR 3.08 [95% CI: 1.27–7.50]) were found in patients with lower serum Mg levels after multivariable adjustment. There was marked heterogeneity (I2 = 79.6%, p < 0.001) that was partly explained by differences in age stratification and study area. In addition, subgroup analysis showed that a serum Mg concentration of ≤1.1 mmol/L might be the vigilant cutoff value. Conclusion: A lower serum Mg level was associated with higher all-cause mortality and cardiovascular mortality in patients receiving hemodialysis.

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Ethnicity and impact on the receipt of cognitive–behavioural therapy in people with psychosis or bipolar disorder: an English cohort study

BMJ Open ◽

10.1136/bmjopen-2019-034913 ◽

2020 ◽

Vol 10 (12) ◽

pp. e034913

Author(s):

Rohan Michael Morris ◽

William Sellwood ◽

Dawn Edge ◽

Craig Colling ◽

Robert Stewart ◽

...

Keyword(s):

Bipolar Disorder ◽

Cohort Study ◽

Cognitive Behavioural Therapy ◽

Secondary Care ◽

Behavioural Therapy ◽

Single Session ◽

Black African ◽

Cognitive Behavioural ◽

Black Caribbean ◽

To Receive

Objectives(1) To explore the role of ethnicity in receiving cognitive–behavioural therapy (CBT) for people with psychosis or bipolar disorder while adjusting for differences in risk profiles and symptom severity. (2) To assess whether context of treatment (inpatient vs community) impacts on the relationship between ethnicity and access to CBT.DesignCohort study of case register data from one catchment area (January 2007–July 2017).SettingA large secondary care provider serving an ethnically diverse population in London.ParticipantsData extracted for 30 497 records of people who had diagnoses of bipolar disorder (International Classification of Diseases (ICD) code F30-1) or psychosis (F20–F29 excluding F21). Exclusion criteria were: <15 years old, missing data and not self-defining as belonging to one of the larger ethnic groups. The sample (n=20 010) comprised the following ethnic groups: white British: n=10 393; Black Caribbean: n=5481; Black African: n=2817; Irish: n=570; and ‘South Asian’ people (consisting of Indian, Pakistani and Bangladeshi people): n=749.Outcome assessmentsORs for receipt of CBT (single session or full course) as determined via multivariable logistic regression analyses.ResultsIn models adjusted for risk and severity variables, in comparison with White British people; Black African people were less likely to receive a single session of CBT (OR 0.73, 95% CI 0.66 to 0.82, p<0.001); Black Caribbean people were less likely to receive a minimum of 16-sessions of CBT (OR 0.83, 95% CI 0.71 to 0.98, p=0.03); Black African and Black Caribbean people were significantly less likely to receive CBT while inpatients (respectively, OR 0.76, 95% CI 0.65 to 0.89, p=0.001; OR 0.83, 95% CI 0.73 to 0.94, p=0.003).ConclusionsThis study highlights disparity in receipt of CBT from a large provider of secondary care in London for Black African and Caribbean people and that the context of therapy (inpatient vs community settings) has a relationship with disparity in access to treatment.

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POS0141 ACTIVE SCREENING FOR GOUT IDENTIFIES A LARGER CARDIOVASCULAR POPULATION AT HIGH MORTALITY RISK

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1872 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 282.2-282

Author(s):

S. Ruiz-Simón ◽

I. Calabuig ◽

M. Gomez-Garberi ◽

M. Andrés

Keyword(s):

High Mortality ◽

Mortality Risk ◽

Cardiovascular Events ◽

Cox Regression ◽

Field Studies ◽

High Mortality Risk ◽

Active Screening ◽

Tertiary Centre ◽

All Cause Mortality

Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal

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