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330752
Premature Mortality Among Public Mental Health Clients Enrolled in Medicaid


Wednesday, November 4, 2015

Mia Papas, PhD, Department of Behavioral Health and Nutrtition, University of Delaware, Newark, DE
Mary Joan McDuffie, MA, Center for Community Research and Services, University of Delaware, Newark, DE
Katie Gifford, PhD, School of Public Policy and Administration, University of Delaware, Newark, DE
Noel Mazade, PhD, Mazade and Associates, Greenville, DE
Amanda L. Botticello, PhD, MPH, Outcomes and Assessment Research, The Kessler Foundation Research Center, West Orange, NJ
David Tulsky, PhD, Physical Therapy, University of Delaware, Newark, DE
Ryan Pohlig, PhD, MHS, University of Delaware, Newark, DE
Gerard Gallucci, PhD, MHS, Delaware Department of Health and Social Services, New Castle, DE
Background:Higher premature mortality rates are evident among persons with a mental illness diagnosis relative to the general population.  Contributing factors for this disparity are not well understood.  This investigation seeks to elucidate risk factors for premature mortality among Delaware Medicaid enrollees with mental illness. 

Method: A retrospective cohort study of mental health clients enrolled in Delaware Medicaid as of January 1, 2011 was conducted.  Date of death was ascertained between January 1, 2011 through December 31, 2013.  Gender-stratified, age-adjusted standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were estimated.  In addition, we evaluated predictors of premature mortality by fitting logistic regression models to estimate odds ratios (OR) and 95% CIs. 

Findings: 6,257 mental health clients were identified and 99 deaths occurred among these persons from 2011 to 2013.  The average age of death was 48.6 years compared to the Delaware average age of death of 78.4 years.  Significantly increased SMRs were observed for females (SMR=2.5, 95% CI: 1.8, 3.5) and for males (SMR=3.0, 95% CI: 2.1, 4.1).   Mental health clients who died were more likely to have a comorbid disability (38.5% vs. 23.8%, p < 0.001).  Medicaid recipients with a mental illness diagnosis in the state of Delaware had much higher mortality rates compared to the US general population reference rate.  Comorbid disability status was an important predictor of premature mortality. 

Implications: Subsequent research will identify causes of premature mortality in order to develop specific lifestyle and behavioral interventions to improve health outcomes among mental health Medicaid clients.

Learning Areas:

Epidemiology
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the disparity in premature mortality rates that exists among those with serious mental illness compared to the general population. Identify factors that may contribute to disparities in premature mortality rates among those with serious mental illness.

Keyword(s): Mental Health, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral trained epidemiologist with extensive experience analyzing data from large secondary datasets and health claims databases, such as the Medicaid data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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