Socio-economic position as a moderator of cardiometabolic outcomes in patients receiving psychotropic treatment associated with weight gain: results from a prospective 12-month inception cohort study and a large population-based cohort

Abstract

Weight gain and metabolic complications are major adverse effects of many psychotropic drugs. We aimed to understand how socio-economic status (SES), defined as the Swiss socio-economic position (SSEP), is associated with cardiometabolic parameters after initiation of psychotropic medications known to induce weight gain. Cardiometabolic parameters were collected in two Swiss cohorts following the prescription of psychotropic medications. The SSEP integrated neighborhood-based income, education, occupation, and housing condition. The results were then validated in an independent replication sample (UKBiobank), using educational attainment (EA) as a proxy for SES. Adult patients with a low SSEP had a higher risk of developing metabolic syndrome over one year versus patients with a high SSEP (Hazard ratio (95% CI) = 3.1 (1.5-6.5), n = 366). During the first 6 months of follow-up, a significant negative association between SSEP and body mass index (BMI), weight change, and waist circumference change was observed (25 ≤ age < 65, n = 526), which was particularly important in adults receiving medications with the highest risk of weight gain, with a BMI difference of 0.86 kg/m² between patients with low versus high SSEP (95% CI: 0.03-1.70, n = 99). Eventually, a causal effect of EA on BMI was revealed using Mendelian randomization in the UKBiobank, which was notably strong in high-risk medication users (beta: -0.47 SD EA per 1 SD BMI; 95% CI: -0.46 to -0.27, n = 11,314). An additional aspect of personalized medicine was highlighted, suggesting the patients' SES represents a significant risk factor. Particular attention should be paid to patients with low SES when initiating high cardiometabolic risk psychotropic medications.

Fig. 1. Incidence of new onset metabolic syndrome according to SSEP over one year of psychotropic treatment in the adult population.

Analysis was performed in the adult population (25 ≤ age< 65) and was adjusted by age, sex, first available BMI, diagnosis, risk of psychotropic drug-induced weight gain, using a Cox proportional hazards model (n = 366). The number at risk at baseline: 168 High SSEP vs 198 Low SSEP, at 3 months: 98 High SSEP vs 109 Low SSEP, at 6 months: 47 High SSEP vs 54 Low SSEP, at 9 months: 29 High SSEP vs 29 Low SSEP, at 12 months: 16 High SSEP vs 16 Low SSEP. High and Low SSEP groups were defined as SSEP over (≥61.8) vs under (<61.8) median SSEP, respectively.