Research presented at AMCP Nexus 2021 shows patients with severe mental illness are at a higher risk for social risk factors, that negatively impact their overall health outcomes. This is particularly true among patients with schizophrenia who are insured by Medicaid, the research team suggested.

“There is growing evidence demonstrating the impact of Social Determinants of Health (SDOH) on health outcomes,” explained the authors of the study. “Social risk factors can be as important as clinical risk factors in health outcomes such as medication adherence in patients with severe mental illness.”

To better understand SDOH among patients with schizophrenia, Bipolar Type 1 Disorder, and major depressive disorder (MDD) in commercial and Managed Medicaid insured populations from 2016-2018, the authors conducted a retrospective cohort analysis.

The analysis included adults 18 years of age and older from Inovalon’s MORE2 Registry.

“SDOH were linked at the near neighborhood level resulting in a more precise assignment compared to commonly used Census data,” they explained. “Newly diagnosed members with ≥1 inpatient or ≥2 outpatient claims with diagnosis for [schizophrenia], [Bipolar Type 1 Disorder], or MDD were identified (populations mutually exclusive).”

For the analysis, the study authors identified 1,038,075 commercially insured patients and 1,234,371 Managed Medicaid patients. Of these patients, 55,848 were diagnosed with schizophrenia, 212,349 Bipolar Type 1 Disorder, and 1,762,937 MDD.

The research team found commercially insured patients with schizophrenia were younger compared to Managed Medicaid patients (mean age 40.6 and 45.4 respectively), but the mean age was similar in the Bipolar Type 1 Disorder and MDD cohorts (40-44).

“The [schizophrenia] population was 60% male in both groups, while BPD and MDD cohorts were predominantly female (60%-70%).”

Finally, the researchers reported that each cohort had low Charlson Comorbidity Index scores (0.4-1.0) with hypertension being the most common chronic condition, and Managed Medicaid insured patients with any severe mental illness were 3-4.5 times more likely to be low income.

“Results show patients with [severe mental illness] have significant social risk factors that may negatively impact overall health outcomes, especially in patients with [schizophrenia] insured by Medicaid,” the researchers concluded.

“Follow-up analyses will explore the specific SDOH and patient characteristics associated with disparities in clinical and economic outcomes for each SMI condition.”

Reference:
Mohammadi I, Teiglan C, Agatep B, Boskovi DH, Kim S. High prevalence of social determinants of health compounds burden of Illness in patients with severe mental illness. Poster presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO.