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Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales

Sarah Rees Orcid Logo, Alan Watkins Orcid Logo, Janet Keauffling, Ann John Orcid Logo

Clinical Epidemiology, Volume: 14, Pages: 21 - 38

Swansea University Authors: Sarah Rees Orcid Logo, Alan Watkins Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.2147/clep.s325235

Abstract

Introduction: Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and...

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Published in: Clinical Epidemiology
ISSN: 1179-1349
Published: Informa UK Limited 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa59166
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2022-08-16T16:14:19.6107999</datestamp><bib-version>v2</bib-version><id>59166</id><entry>2022-01-12</entry><title>Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales</title><swanseaauthors><author><sid>86073be88970f36d7ffa0a1f0768be2b</sid><ORCID>0000-0002-1939-0120</ORCID><firstname>Sarah</firstname><surname>Rees</surname><name>Sarah Rees</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>81fc05c9333d9df41b041157437bcc2f</sid><ORCID>0000-0003-3804-1943</ORCID><firstname>Alan</firstname><surname>Watkins</surname><name>Alan Watkins</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>ed8a9c37bd7b7235b762d941ef18ee55</sid><ORCID>0000-0002-5657-6995</ORCID><firstname>Ann</firstname><surname>John</surname><name>Ann John</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-01-12</date><deptcode>HDAT</deptcode><abstract>Introduction: Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK.Methods: A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11&#x2013; 25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan&#x2013;Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC).Results: Higher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12&#x2013; 1.24) in WLGP and 1.17 (1.10&#x2013; 1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20&#x2013; 29.40) in WLGP and 4.50 (4.08&#x2013; 4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00&#x2013; 3.58) in WLGP and 2.59 (2.36&#x2013; 2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78&#x2013; 0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54&#x2013; 0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84&#x2013; 1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5&#x2013; 10.0).Conclusion: Male sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage.</abstract><type>Journal Article</type><journal>Clinical Epidemiology</journal><volume>14</volume><journalNumber/><paginationStart>21</paginationStart><paginationEnd>38</paginationEnd><publisher>Informa UK Limited</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1179-1349</issnElectronic><keywords>routine data linkage, mental disorder, substance use, co-occurring conditions, dual diagnosis, mental health of young people</keywords><publishedDay>13</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-01-13</publishedDate><doi>10.2147/clep.s325235</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>Other</apcterm><funders>This work was funded by the Adolescent Mental Health Data Platform (ADP). The ADP is funded by MQ Mental Health Research Charity (Grant Reference MQBF/3 ADP). 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spelling 2022-08-16T16:14:19.6107999 v2 59166 2022-01-12 Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales 86073be88970f36d7ffa0a1f0768be2b 0000-0002-1939-0120 Sarah Rees Sarah Rees true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2022-01-12 HDAT Introduction: Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK.Methods: A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11– 25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan–Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC).Results: Higher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12– 1.24) in WLGP and 1.17 (1.10– 1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20– 29.40) in WLGP and 4.50 (4.08– 4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00– 3.58) in WLGP and 2.59 (2.36– 2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78– 0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54– 0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84– 1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5– 10.0).Conclusion: Male sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage. Journal Article Clinical Epidemiology 14 21 38 Informa UK Limited 1179-1349 routine data linkage, mental disorder, substance use, co-occurring conditions, dual diagnosis, mental health of young people 13 1 2022 2022-01-13 10.2147/clep.s325235 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Other This work was funded by the Adolescent Mental Health Data Platform (ADP). The ADP is funded by MQ Mental Health Research Charity (Grant Reference MQBF/3 ADP). This project was funded by MRC Pathfinder (MC_PC_17211). 2022-08-16T16:14:19.6107999 2022-01-12T15:34:37.0730783 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Sarah Rees 0000-0002-1939-0120 1 Alan Watkins 0000-0003-3804-1943 2 Janet Keauffling 3 Ann John 0000-0002-5657-6995 4 59166__22160__3ff3d55af62c4010a58204dbf56009dd.pdf 59166.pdf 2022-01-17T13:10:34.7488233 Output 7218734 application/pdf Version of Record true © 2022 Rees et al. This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License true eng https://creativecommons.org/licenses/by/4.0/
title Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales
spellingShingle Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales
Sarah Rees
Alan Watkins
Ann John
title_short Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales
title_full Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales
title_fullStr Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales
title_full_unstemmed Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales
title_sort Incidence, Mortality and Survival in Young People with Co-Occurring Mental Disorders and Substance Use: A Retrospective Linked Routine Data Study in Wales
author_id_str_mv 86073be88970f36d7ffa0a1f0768be2b
81fc05c9333d9df41b041157437bcc2f
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 86073be88970f36d7ffa0a1f0768be2b_***_Sarah Rees
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Sarah Rees
Alan Watkins
Ann John
author2 Sarah Rees
Alan Watkins
Janet Keauffling
Ann John
format Journal article
container_title Clinical Epidemiology
container_volume 14
container_start_page 21
publishDate 2022
institution Swansea University
issn 1179-1349
doi_str_mv 10.2147/clep.s325235
publisher Informa UK Limited
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Introduction: Mental disorder (MD) and substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine primary care (WLGP) and inpatient admission (PEDW) data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, in children and young people in Wales, UK.Methods: A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11– 25 between 2008 and 2017. We estimated first ever incidence of CC, plotted Kaplan–Meier survival curves and carried out Cox regression to estimate hazard ratios (HR) for risk of death by condition group (CC; MD or SUD only; NC).Results: Higher incidence of CC in WLGP and PEDW was associated with male sex, older age and greater deprivation. Male to female IRRs (95% CI) were 1.18 (1.12– 1.24) in WLGP and 1.17 (1.10– 1.24) in PEDW, oldest to youngest IRRs were 24.80 (21.20– 29.40) in WLGP and 4.50 (4.08– 4.98) in PEDW and most to least deprived IRRs were 3.28 (3.00– 3.58) in WLGP and 2.59 (2.36– 2.84) in PEDW. Incidence in WLGP significantly decreased between 2008 and 2017 (IRR = 0.88, 95% CI 0.78– 0.99); the greatest reduction occurred in the most deprived quintile (IRR 0.67, 95% CI 0.54– 0.82). Incidence of hospital admissions remained stable (IRR = 0.95, 95% CI 0.84– 1.08). Risk of death was significantly higher for CC compared with NC (HR = 8.7, 95% CI 7.5– 10.0).Conclusion: Male sex, older age and greater deprivation were associated with higher CC incidence, although the gap between WIMD quintiles has decreased. CC was associated with greater risk of death. Mental health and substance misuse services should be provided in ways that remove barriers, and are acceptable and accessible to all, particularly those at greatest risk, or who are less likely to engage.
published_date 2022-01-13T04:16:15Z
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