title: Type 2 diabetes mellitus in people with severe mental illness: inequalities by ethnicity and age. Cross-sectional analysis of 588 408 records from the UK.
abstract: To investigate whether the association of severe mental illness with Type 2 diabetes varies by ethnicity and age.
  
  
  
  We conducted a cross-sectional analysis of data from an ethnically diverse sample of 588 408 individuals aged ≥18 years, registered to 98% of general practices (primary care) in London, UK. The outcome of interest was prevalent Type 2 diabetes.
  
  
  
  Relative to people without severe mental illness, the relative risk of Type 2 diabetes in people with severe mental illness was greatest in the youngest age groups. In the white British group the relative risks were 9.99 (95% CI 5.34, 18.69) in those aged 18-34 years, 2.89 (95% CI 2.43, 3.45) in those aged 35-54 years and 1.16 (95% CI 1.04, 1.30) in those aged ≥55 years, with similar trends across all ethnic minority groups. Additional adjustment for anti-psychotic prescriptions only marginally attenuated the associations. Assessment of estimated prevalence of Type 2 diabetes in severe mental illness by ethnicity (absolute measures of effect) indicated that the association between severe mental illness and Type 2 diabetes was more marked in ethnic minorities than in the white British group with severe mental illness, especially for Indian, Pakistani and Bangladeshi individuals with severe mental illness.
  
  
  
  The relative risk of Type 2 diabetes is elevated in younger populations. Most associations persisted despite adjustment for anti-psychotic prescriptions. Ethnic minority groups had a higher prevalence of Type 2 diabetes in the presence of severe mental illness. Future research and policy, particularly with respect to screening and clinical care for Type 2 diabetes in populations with severe mental illness, should take these findings into account.
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London.
authors.forename: J
authors.initials: J
authors.lastname: Das-Munshi
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: M
authors.initials: M
authors.lastname: Ashworth
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London.
authors.forename: M E
authors.initials: ME
authors.lastname: Dewey
authors.affiliation: South London and Maudsley NHS Foundation Trust, London.
authors.forename: F
authors.initials: F
authors.lastname: Gaughran
authors.affiliation: Blizard Institute, Barts and London School of Medicine and Dentistry, London.
authors.forename: S
authors.initials: S
authors.lastname: Hull
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London.
authors.forename: C
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Cathie Marsh Institute for Social Research, University of Manchester, Manchester.
authors.forename: J
authors.initials: J
authors.lastname: Nazroo
authors.affiliation: Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: P
authors.initials: P
authors.lastname: Schofield
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London.
authors.forename: R
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London.
authors.forename: G
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London.
authors.forename: M J
authors.initials: MJ
authors.lastname: Prince
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001459:Bangladesh / Q000208:ethnology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D057286:Electronic Health Records; D005260:Female; D058006:General Practice; D054624:Health Status Disparities; D006801:Humans; D007194:India / Q000208:ethnology; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology; D015995:Prevalence; D012306:Risk; D012720:Severity of Illness Index; D013222:State Medicine; D055815:Young Adult