Background
Methods
Setting & data sources
Data linkage
Measures
Primary care data from Lambeth DataNet (LDN)
Secondary mental health care measures from CRIS
Variable | Definition | Data source |
---|---|---|
SMI status | Recorded on the QOF Mental Health register with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses | LDN |
Gender | Male/female | LDN |
Age | Date of extraction - date of birth (years) | LDN |
Deprivation | Index of Multiple deprivation 2010 score (quintiles) | LDN ONS |
Primary care consultation | Mean annual number of GP face-to-face, telephone and home visits and nurse consultations between October 2010–2013 | LDN |
Breast cancer screening | Read code indicating breast cancer screen (mammography) & date of last screen | LDN |
Cervical cancer screening | Read code indicating cervical cancer screen (smear) & date of last screen | LDN |
SMI diagnosis | ICD-10 diagnostic code (primary and secondary diagnosis) | CRIS |
Depot injectable | Ever recorded as prescribed depot injectable antipsychotic | CRIS |
SMI severity | Any record of a mental health inpatient stay, treatment under the Mental Health Act, difficulty managing their physical health as recorded in a clinical risk assessment; or contact with Assertive Outreach, Crisis team or A&E liaison team | CRIS |
SMI risk | Ever recorded with a history of violence, non-compliance, or a forensic history (on the risk assessment violence and aggression subscale) | CRIS |
Statistical analyses
Results
Linkage sample
Study sample
Patients eligible for cancer screening
Mammography eligible population | Cervical smear eligible population | ||||||
---|---|---|---|---|---|---|---|
Non-SMI (n = 25,385) | SMI (n = 625) | p | Non-SMI (n = 106,554) | SMI (n = 1393) | p | ||
n (%) |
n (%) | ||||||
Age group (years)a
| |||||||
Mammography | Cervical smear | 0.709 | <0.001 | ||||
- | 25–34 | - | - | 47449 (44.5) | 261 (18.7) | ||
- | 35–44 | - | - | 27579 (25.9) | 382 (27.4) | ||
50–54 | 45–54 | 9035 (35.6) | 218 (34.9) | 19910 (18.7) | 454 (32.6) | ||
55–64 | 55–64 | 11616 (45.8) | 296 (47.4) | 11616 (10.9) | 296 (21.3) | ||
65–70 | - | 4734 (18.7) | 111 (17.8) | - | - | ||
Ethnicity | <0.001 | <0.001 | |||||
British/mixed British | 7742 (35.8) | 189 (33.4) | 30953 (33.7) | 362 (28.8) | |||
Irish | 528 (2.4) | 24 (4.2) | 1972 (2.2) | 31 (2.5) | |||
Indian/Bangladeshi/Pakistani | 1423 (6.6) | 44 (7.8) | 5870 (6.4) | 75 (6.0) | |||
Caribbean/mixed Caribbean | 3309 (15.3) | 142 (25.1) | 8880 (9.7) | 300 (23.9) | |||
African/mixed African | 2957 (13.7) | 71 (12.5) | 11382 (12.4) | 227 (18.1) | |||
Chinese/other | 991 (4.6) | 8 (1.4) | 4608 (5.0) | 30 (2.4) | |||
Other white | 3741 (17.3) | 59 (10.4) | 23848 (25.9) | 135 (10.7) | |||
Other black | 620 (2.9) | 21 (3.7) | 2586 (2.8) | 73 (5.8) | |||
Other mixed | 307 (1.4) | 8 (1.4) | 1826 (2.0) | 24 (1.9) | |||
Deprivation quintile | <0.001 | <0.001 | |||||
Most deprived | 4706 (19.1) | 165 (26.5) | 18464 (18.0) | 365 (26.4) | |||
2 | 5188 (21.1) | 123 (19.7) | 21223 (20.7) | 303 (21.9) | |||
3 | 4891 (19.8) | 120 (19.3) | 21544 (21.0) | 272 (19.7) | |||
4 | 5024 (20.4) | 118 (18.9) | 22554 (22.0) | 247 (17.9) | |||
Least deprived | 4838 (19.6) | 97 (15.6) | 18904 (18.4) | 197 (14.2) | |||
Consultations | <0.001 | <0.001 | |||||
Median/below median | 7222 (30.8) | 64 (10.5) | 42642 (44.1) | 184 (13.7) | |||
Above median | 16238 (69.2) | 545 (89.5) | 53982 (55.9) | 1158 (86.3) |
Cancer screening uptake by SMI status
Mammography eligible population (N = 26,010) | Cervical smear eligible population (N = 107,947) | |||||||
---|---|---|---|---|---|---|---|---|
Recorded mammography in last 3 years n (%) | Unadjusted OR (95 % CI) | Adjusted for socio-demographics ORa (95 % CI) | Additionally adjusted for consultation rate ORb (95 % CI) | Recorded cervical smear in last 3/5 years n (%) | Unadjusted OR (95 % CI) | Adjusted for socio-demographics ORa (95 % CI) | Additionally adjusted for consultation rate ORb (95 % CI) | |
Non-SMI | 14205 (65.7) | 1.00 | 1.00 | 1.00 | 67823 (77.8) | 1.00 | 1.00 | 1.00 |
SMI overall | 305 (58.1) | 0.72 (0.61 – 0.86)***
| 0.69 (0.57 – 0.84)***
| 0.60 (0.49 – 0.73)***
| 848 (80.2) | 1.16 (0.99 – 1.35) | 0.72 (0.60 – 0.85)***
| 0.35 (0.29 – 0.42)***
|
SMI by diagnosis | ||||||||
Schizophrenia | 136 (55.1) | 0.64 (0.50 – 0.82)***
| 0.59 (0.45 – 0.78)***
| 0.52 (0.40 – 0.69)***
| 270 (76.9) | 0.95 (0.74 – 1.22) | 0.48 (0.36 – 0.63)***
| 0.24 (0.18 – 0.32)***
|
Bipolar affective disorder | 67 (62.0) | 0.85 (0.58 – 1.26) | 0.89 (0.59 – 1.35) | 0.72 (0.47 – 1.10) | 231 (87.2) | 1.94 (1.35 – 2.78)***
| 1.23 (0.84 – 1.80) | 0.50 (0.33 – 0.74)**
|
Other non-organic psychoses | 34 (50.8) | 0.54 (0.33 – 0.87)*
| 0.53 (0.31 – 0.90)*
| 0.47 (0.27 – 0.80)**
| 153 (74.3) | 0.82 (0.60 – 1.13) | 0.57 (0.40 –0.80)**
| 0.33 (0.22 –0.47)***
|
Depot injectable | ||||||||
No | 191 (64.3) | 0.94 (0.74 – 1.20) | 0.97 (0.75 – 1.26) | 0.83 (0.64 – 1.09) | 524 (82.3) | 0.32 (1.08 – 1.62)**
| 0.82 (0.65 – 1.02) | 0.36 (0.29 – 0.46)***
|
Yes | 80 (49.1) | 0.50 (0.37 – 0.68)***
| 0.46 (0.33 – 0.64)***
| 0.39 (0.27 –0.54)***
| 199 (76.3) | 0.92 (0.69 – 1.22) | 0.48 (0.35 –0.66)***
| 0.26 (0.18 – 0.36)***
|
Any indicator of severity1
| ||||||||
No | 168 (65.6) | 1.00 (0.77 – 1.29) | 0.91 (0.69 – 1.21) | 0.79 (0.59 –1.06) | 411 (82.2) | 1.32 (1.05 – 1.66)*
| 0.82 (0.63 – 1.06) | 0.40 (0.31 – 0.53)***
|
Yes | 137 (50.9) | 0.54 (0.43 – 0.69)***
| 0.54 (0.42 –0.70)***
| 0.46 (0.36 – 0.61)***
| 437 (78.5) | 1.04 (0.85 – 1.27) | 0.65 (0.52 – 0.81)***
| 0.31 (0.25 –0.40)***
|
Any indicator of risk2
| ||||||||
No | 205 (61.8) | 0.84 (0.67 – 1.05) | 0.81 (0.63–1.03) | 0.70 (0.55 – 0.90)**
| 535 (82.1) | 1.31 (1.07 – 1.60)**
| 0.79 (0.63 – 1.00)*
| 0.38 (0.30 –0.49)***
|
Yes | 100 (51.8) | 0.56 (0.42 – 0.74)***
| 0.53 (0.39 –0.73)***
| 0.46 (0.34 –0.63)***
| 313 (77.3) | 0.97 (0.77 – 1.23) | 0.62 (0.48 – 0.80)***
| 0.31 (0.24 – 0.41)***
|