Comorbidities and Serious Mental Illness

Behavioral and medical conditions often overlap, but care can be siloed, leading to suboptimal outcomes1,2

​Patients with overlapping mental and medical conditions are often seen in the primary care setting. Several models of evidence-based collaborative care can help support the integration of care for these patients.2,3,4

​Clinical and economic burden of cardiometabolic comorbidities in patients with schizophrenia and bipolar disorder
Patients with bipolar disorder have a 1.5-to 2.5-fold greater risk for cardiovascular morality.5
In a recent meta-analysis, ~37% of patients with bipolar disorder had metabolic syndrome, a key contributor to increased risk for cardiovascular mortality.6

American Psychiatric Association | American Diabetes Association

Assessments at baseline and follow-up include personal and family history of obesity, diabetes, hyperlipidemia, hypertension, and cardiovascular disease; body mass index; waist circumference; blood pressure; and fasting plasma glucose; and fasting lipid profile7

​Methods: Data Source and Patient Inclusion Criteria


This retrospective observational study used administrative hospital data from the Premier Perspective Database® (Premier, Inc., Charlotte, NC, USA)
  • The Premier database is the largest hospital administrative database in the US and provides detailed service information from over 700 geographically dispersed hospitals and over 50 million discharges since 2000
  • The database contains detailed service level information, diagnostic information, hospital characteristics, and patient demographic information


PATIENT INCLUSION CRITERIA:
  • Primary, secondary or admitting diagnosis of schizophrenia* OR bipolar disorder† coded during their hospitalization stay (the first such hospitalization record was designated as the patient’s index hospitalization
  • Age ≥ 18 years
PATIENTS WERE EXCLUDED IF THEY:
  • Had both schizophrenia and bipolar disorder
  • Were transferred from another hospital or had an unknown admission source

Results: Effect of Number of Cardiometabolic Comorbidities on Length of Hospital Stay

The mean length of stay was 8.5 days for patients with schizophrenia and 5.2 days for bipolar disorder

Results from multivariate negative binomial regression showed that there was a negative association between cardiometabolic comorbidity burden and length of stay for schizophrenia (p<0.001), but a positive association for bipolar disorder (p<0.001)

The graph below shows that the length of stay increased with the number of cardiometabolic comorbidities for bipolar disorder but not for schizophrenia

*The following covariates were included in all regression analyses: age, gender, race, payer CCI, hospital region, hospital location (urban/rural), hospital type (teaching/non-teaching), and hospital bed count.

Results: Effect of Number of Cardiometabolic Comorbidities on All-cause Readmission
11.8% of the patients with schizophrenia and 9.3% of the patients with bipolar disorder were readmitted for any reason within 30 days of discharge from the index hospitalization
SCHIZOPHRENIA
Results from multivariate logistic regression showed that for each additional cardiometabolic comorbidity, the odds of all-cause readmission increased by 3.1% (p=0.042) for schizophrenia and by 6.4 % (p<0.001) for bipolar disorder
BIPOLAR DISORDER
The graph below shows all-cause readmission increased with the number of cardiometabolic comorbidities for schizophrenia and bipolar disorder
*The following covariates were included in all regression analyses: age, gender, race, payer CCI, hospital region, hospital location (urban/rural), hospital type (teaching/non-teaching), and hospital bed count

Results: Effect of Number of Cardiometabolic Comorbidities on Mortality