Neighborhood deprivation and coronary heart disease in patients with bipolar disorder

Abstract

The aim was to study the potential effect of neighborhood deprivation on incident and fatal coronary heart disease (CHD) in patients with bipolar disorder. This was a nationwide cohort study which included all adults aged 30 years or older with bipolar disorder (n = 61,114) in Sweden (1997-2017). The association between neighborhood deprivation and the outcomes was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (CIs). Patients with bipolar disorder living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores. There was an association between level of neighborhood deprivation and incident and fatal CHD among patients with bipolar disorder. The HRs were 1.24 (95% CI 1.07-1.44) for men and 1.31 (1.13-1.51) for women for incident CHD among patients with bipolar disorder living in high deprivation neighborhoods compared to those from low deprivation neighborhoods, after adjustments for potential confounders. The corresponding HR for fatal CHD were 1.35 (1.22-1.49) in men and 1.30 (1.19-1.41) in women living in high deprivation neighborhoods. Increased incident and fatal CHD among patients with bipolar disorder living in deprived neighborhoods raises important clinical and public health concerns.

Figure 1

Hazard ratios (HR) and 95% confidence intervals (CI) for incident CHD in patients with bipolar disorder. The full model is adjusted for all the individual level sociodemographic variables and comorbidities. CHD Coronary heart disease HR Hazard ratio, CI Confidence interval.

Figure 2

Hazard ratios (HR) and 95% confidence intervals (CI) for fatal CHD in patients with bipolar disorder. The full model is adjusted for all the individual level sociodemographic variables and comorbidities. CHD Coronary heart disease, HR Hazard ratio, CI Confidence interval.