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From the Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa (L.E.J., C.P.C); and Regenstrief Institute, Indianapolis, Indiana, and the Departments of Psychiatry and Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana (C.P.C.).
Address correspondence and reprint requests to Caroline P. Carney, MD, Indiana University School of Medicine, 1050 Regenstrief Blvd., RG6, Indianapolis, IN 46202-2213. E-mail: ccarneyd{at}iupui.edu.
Objective: The objective of this study was to determine if receipt of revascularization was similar among commercially insured adults with mental disorders compared with people without mental disorders.
Methods: This was a retrospective analysis of a 100% sample of Blue Cross/Blue Shield of Iowa administrative claims data, 1996 to 2001. Logistic regression was used to calculate unadjusted and adjusted odds ratios (OR) for receipt of angioplasty (PTCA) and bypass graft surgery (CABG) within 30 days of discharge.
Results: A total of 3368 adults, aged 18 to 64 years, were hospitalized for myocardial infarction (MI) and 40% (n = 1342) had a mental disorder. Subjects with mental disorders were more likely to be younger, female, urban residents, and to have increased cardiovascular and medical comorbidity. They were similarly likely as subjects without mental disorders to have received PTCA (OR, 1.10; 95% confidence interval [CI], 0.95–1.29) and CABG (OR, 0.89; 95% CI, 0.71–1.11) in analyses adjusted for demographic and clinical characteristics. Revascularization rates did not differ by mental disorder type, with few exceptions.
Conclusions: Receipt of revascularization was similar for patients with and without mental disorders. Our results may differ from previous findings as a result of the younger population studied and increased comorbidity in people with mental disorders, which may have resulted in a contraindication for surgical intervention. Conversely, the increased burden of comorbidity could suggest that these patients should have received PTCA at higher rates because of the better prognosis associated with revascularization as compared with medical management. Prospective analyses with review of clinical data and behavioral risk factors are necessary to determine why some patients with mental illness may be less likely to receive cardiac interventions.
Key Words: myocardial infarction • revascularization • mental disorders • claims data • comorbidity
Abbreviations: MI = myocardial infarction; CVD = cardiovascular disease; MHD = mental health disorders; PTCA = percutaneous transluminal coronary angioplasty; CABG = coronary artery bypass graft surgery; CPT = Common Procedural Terminology; ICD = International Classification of Diseases; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; OR = odds ratio; COPD = chronic obstructive pulmonary disease; CI = confidence interval.
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