Ulster University

Academic Institute

Ulster University

Yes

249

People with severe mental illness die much younger than people in the general population. This is in the context of widespread health disparities, with some evidence suggesting that SMI is associated with suboptimal dental health outcomes (Kiseley et al., 2015; Hert et al., 2011; McCreadie et al., 2004). In a systematic review of dental disease, Kiseley et al (2015) found that people with SMI were 2.8 times more likely to have lost all their teeth than the general population. Similarly, but more sparsely evidenced, there is an association between SMI and adverse ophthalmic health: Wang et al (2012) for example found glaucoma to be predictive of depression in a nationally representative study. Critically, dental and ophthalmic health are associated with other life-limiting conditions (LLCs) (Chapple 2009; Humphrey et al., 2008; Mitchell et al 1997, Hyman et al 2000) with implications for service use and provision and premature mortality. Using linked census, prescription, dental, ophthalmic and mortality data, the proposed study will examine disparities in dental and ophthalmic health between adults with SMI compared to the general population, as well as the association with a wide range of socio-demographic characteristics. Specifically, the following research questions will be addressed: 1. What are the rates of dental service engagement, as indicated by registrations and attendances among individuals with SMI compared to those without SMI, controlling for other socio-demographic characteristics? 2. What are the rates of adverse dental health outcomes/treatments (including decayed, missing, extracted and filled teeth and surfaces) among individuals with SMI compared to those without SMI, controlling for other socio-demographic characteristics? 3. What are the rates of ophthalmic service use among individuals with SMI compared to those without SMI? 4. What are the rates of eye conditions/diseases (such as blindness, glaucoma, macular degeneration among others) among individuals with SMI compared to those without SMI? 5. How do rates of adverse dental and ophthalmic health outcomes compare among individuals with SMI and are the profile of risk factors similar? 6. Is all-cause and specific-cause mortality associated with adverse dental health outcomes and does this vary between those with and without SMI, controlling for other socio-demographic characteristics? 7. Is all-cause and specific-cause mortality associated with adverse ophthalmic health outcomes and does this vary between those with and without SMI, controlling for other socio-demographic characteristics?

Evidence suggests that individuals with SMI die up to twenty years younger than the general population (NICE, 2018), with this excess mortality largely accounted for by preventable causes due to physical illness. The elevated prevalence of life limiting conditions and associated mortality among people with SMI, such as respiratory disease, cardiovascular disease and cancer has received growing attention. Less attention has been afforded to the association of SMI with oral and ophthalmic health as key aspects of overall physical health (Kisely et al., 2016) and, in turn, their association with premature mortality. While there is an emergent evidence base on oral health among individuals with SMI, as far as can be detected, there are no studies available based on the NI population and none based on population wide administrative data on both SMI and a wide range of dental health outcomes. The available evidence on SMI and ophthalmic health associations is notably sparse. The proposed study will provide an in-depth analysis into disparities in dental and ophthalmic health (and associated premature mortality), which will allow recommendations to be made in relation to the management of physical health conditions in people with SMI and will potentially inform NI policy and strategy in this area.

01/10/2019

TRE