title: Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study.
abstract: BACKGROUND
  Health care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs) and non-MHCs.
  
  
  METHODS
  This was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA) from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharmaceutical benefits claims. Diabetes was identified from hospital diagnoses, prescriptions and diabetes-specific primary care claims (17,045 MHCs, 26,626 non-MHCs). Both univariate and multivariate analyses adjusted for socio-demographic factors and case mix were performed to compare the outcome measures among MHCs, category of mental disorders and non-MHCs.
  
  
  RESULTS
  The prevalence of diabetes was significantly higher in MHCs than in non-MHCs (crude age-sex-standardised point-prevalence of diabetes on 30 June 2006 in those aged ≥20 years, 9.3% vs 6.1%, respectively, P < 0.001; adjusted odds ratio (OR) 1.40, 95% CI 1.36 to 1.43). Receipt of recommended pathology tests (HbA1c, microalbuminuria, blood lipids) was suboptimal in both groups, but was lower in MHCs (for all tests combined; adjusted OR 0.81, 95% CI 0.78 to 0.85, at one year; and adjusted rate ratio (RR) 0.86, 95% CI 0.84 to 0.88, during the study period). MHCs also had increased risks of hospitalisation for diabetes complications (adjusted RR 1.20, 95% CI 1.17 to 1.24), diabetes-related mortality (1.43, 1.35 to 1.52) and all-cause mortality (1.47, 1.42 to 1.53). The disparities were most marked for alcohol/drug disorders, schizophrenia, affective disorders, other psychoses and personality disorders.
  
  
  CONCLUSIONS
  MHCs warrant special attention for primary and secondary prevention of diabetes, especially at the primary care level.
authors: School of Population Health, The University of Western Australia, Crawley, Australia. qmai@meddent.uwa.edu.au
authors: Qun
authors: Q
authors: Mai
authors: C D'Arcy J
authors: CD
authors: Holman
authors: Frank M
authors: FM
authors: Sanfilippo
authors: Jonathan D
authors: JD
authors: Emery
authors: David B
authors: DB
authors: Preen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D015995:Prevalence; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014904:Western Australia / Q000453:epidemiology