TY - JOUR
AU - Fleetwood, Kelly
AU - Nolan, John
AU - Padmanabhan, Sandosh
AU - Smith, Daniel
AU - Stewart, Robert
AU - Mercer, Stewart W.
AU - Jackson, Caroline A.
PY - 2025
DA - October
TI - Impact of the COVID-19 pandemic on incidence of myocardial infarction, heart failure and stroke, by mental disorder diagnosis, in England, 2019–2023: a cohort study
JO - Open Heart
VL - 12
IS - 2
DO - https://doi.org/10.1136/openhrt-2025-003398
AB - Background We aimed to estimate mental disorder disparities in CVD incidence and determine whether these disparities were worsened by the COVID-19 pandemic. Methods For each outcome (myocardial infarction (MI), heart failure and stroke), we created a population based cohort of people without a prior diagnosis of the outcome using linked electronic health records, with follow-up from November 2019 until December 2023. We ascertained pre-existing schizophrenia, bipolar disorder and depression and each CVD outcome from primary care and hospital admission records and (for CVD outcomes), mortality records. We calculated sex-stratified age-standardised incidence rates by mental disorder diagnosis and used quasi-Poisson modelling to obtain rate ratios (RRs) of CVD among people with each of schizophrenia, bipolar disorder or depression versus those without any of these disorders, adjusting for sociodemographic factors and time period. We investigated whether mental disorder disparities changed as a consequence of the COVID-19 pandemic by including an interaction term between mental disorder and time. Results During follow-up 383,365 people had incident MI, 868,590 had incident heart failure and 455,300 had incident stroke. Age-standardised incidence of each CVD outcome decreased markedly between February and April 2020, with incidence levels returning to, but not exceeding, pre-pandemic levels in subsequent years. Mental disorder was associated with a higher incidence of each CVD outcome, with RRs ranging from 1.31 (95% CI 1.25, 1.38) to 2.15 (95% CI 2.05, 2.24). There was generally no evidence of interaction between mental disorder and time, with mental disorder disparities in CVD incidence stable over time.  Conclusion We found no clear evidence that the mental disorder disparities in CVD incidence widened during the acute period of the pandemic or during the subsequent years. Continued monitoring of the CVD burden in the general population and among marginalised groups is critical to identifying longer term impacts on CVD and worsening disparities.
PB - BMJ Publishing Group
UR - https://www.research.ed.ac.uk/en/publications/f7259da3-3784-4e7e-a2fd-d48386f52eb6
KW - Coronavirus (COVID-19)
KW - Mental health and wellbeing
ER