title: Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK.
abstract: OBJECTIVE
  Little is known about the prevalence of comorbidity rates in people with severe mental illness (SMI) in UK primary care. We calculated the prevalence of SMI by UK country, English region and deprivation quintile, antipsychotic and antidepressant medication prescription rates for people with SMI, and prevalence rates of common comorbidities in people with SMI compared with people without SMI.
  
  
  METHODS
  Retrospective cohort study from 2000 to 2012.
  
  
  METHODS
  627 general practices contributing to the Clinical Practice Research Datalink, a UK primary care database.
  
  
  METHODS
  Each identified case (346,551) was matched for age, sex and general practice with 5 randomly selected control cases (1,732,755) with no diagnosis of SMI in each yearly time point.
  
  
  METHODS
  Prevalence rates were calculated for 16 conditions.
  
  
  RESULTS
  SMI rates were highest in Scotland and in more deprived areas. Rates increased in England, Wales and Northern Ireland over time, with the largest increase in Northern Ireland (0.48% in 2000/2001 to 0.69% in 2011/2012). Annual prevalence rates of all conditions were higher in people with SMI compared with those without SMI. The discrepancy between the prevalence of those with and without SMI increased over time for most conditions. A greater increase in the mean number of additional conditions was observed in the SMI population over the study period (0.6 in 2000/2001 to 1.0 in 2011/2012) compared with those without SMI (0.5 in 2000/2001 to 0.6 in 2011/2012). For both groups, most conditions were more prevalent in more deprived areas, whereas for the SMI group conditions such as hypothyroidism, chronic kidney disease and cancer were more prevalent in more affluent areas.
  
  
  CONCLUSIONS
  Our findings highlight the health inequalities faced by people with SMI. The provision of appropriate timely health prevention, promotion and monitoring activities to reduce these health inequalities are needed, especially in deprived areas.
authors.affiliation: Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Reilly
authors.affiliation: Manchester Institute of Biotechnology, University of Manchester, Manchester, UK.
authors.forename: Ivan
authors.initials: I
authors.lastname: Olier
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Planner
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Doran
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011320:Primary Health Care; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology
keywords: EPIDEMIOLOGY; MENTAL HEALTH; comorbidity; physical health; severe mental illness