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Dental and Ophthalmic Health in Northern Ireland:  an examination of disparities in rates between those with severe mental Illness (SMI) and the general hospital population.

Safe People

Organisation name

Ulster University

Organisation sector

Academic Institute

Applicant name(s)

Michael Rosato

Safe Projects

Project ID

E047

Lay summary

People with severe mental illness die much younger than people in the general population. This is in the context of widespread health disparities there is some evidence to suggest that SMI is associated with suboptimal dental health outcomes (Kiseley et al., 2011, 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. Some key mechanisms that underpin the link include: avoidance and neglect; anxiety/dental phobia; side effects of medication; and more specific manifestations of particular SMI types. 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; William et al. 2008; Humphrey et al., 2009; Mitchell et al 1997, Hyman et al 2000) with implications for service use and provision and premature mortality. Using linked prescription, hospital admissions, dental, ophthalmic and mortality data, this proposed study will examine disparities in dental and ophthalmic health between adults with SMI compared to the general hospital population. Specifically, the following research questions will be addressed: 1. What are the rates of dental registrations, attendances and adverse outcomes/treatments (including decayed, missing, extracted and filled teeth and surfaces) among individuals with SMI compared to those without SMI? 2. What are the rates of ophthalmic service use and eye conditions/diseases among individuals with SMI compared to those without SMI? 3. Is all-cause mortality associated with adverse dental and ophthalmic health outcomes and does this vary between those with and without SMI?

Public benefit statement

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 oral 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 oral 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.

Latest approval date

27/08/2019

Safe Data

Dataset(s) name

Ophthalmic Practice Register

Safe Setting

Access type

TRE