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Socioeconomic Position and Somatic Comorbidity in Mental Disorders
28 Pages Posted: 14 May 2025
More...Abstract
Background: Individuals with mental disorders face an elevated risk for somatic noncommunicable diseases (NCD), such as cardiovascular disease (CVDs), chronic obstructive pulmonary disease (COPD), diabetes, and cancer. Low socioeconomic position (SEP) is linked to both mental disorders and somatic NCDs, but its role in this association remains unclear. Here, we provide a comprehensive overview of how associations between mental disorders and somatic NCDs vary by SEP indicators.
Methods: Data on all adult individuals resident in Norway from 01.01.2008 to 01.01.2010 (N= 3,589,719) were linked to several Norwegian nationwide registries, including registries on primary and secondary health care, dispensed drugs, causes of death, and socioeconomic variables. We assessed four broad types of mental disorders (psychotic, bipolar, depressive and anxiety disorders) and four categories of somatic NCDs (CVD, COPD, diabetes, cancer) diagnosed during follow-up from 01.01.2010 to 31.12.2020. Educational attainment and household income were used as SEP indicators, in addition to parental educational attainment. Cox regression models estimated hazard ratios for somatic NCDs among individuals with mental disorders compared to the general population, adjusting for and stratifying by SEP, sex, and age.
Outcomes: All mental disorders were associated with an increased risk of somatic NCDs, strongest for COPD and weakest for cancer. Risk increased with disorder severity, with psychotic and bipolar disorders showing the strongest associations. Young adults with psychosis had a 4–5-fold increased risk of diabetes and COPD. Low SEP was associated with both mental disorders and somatic NCDs and contributed moderately to their co-occurrence, but with little variation across SEP strata.
Interpretation: We found an increased risk of somatic NCDs in individuals with mental disorders and identified young adults with psychosis as a particularly vulnerable subgroup. Low SEP compounds this burden, underscoring the need for integrated mental and somatic healthcare strategies.
Keywords: Mental disorders, noncommunicable diseases, socioeconomic position, comorbidity
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