Cardiometabolic screening, elevated results and clinical follow-up actions in Māori and non-Māori with psychosis in Canterbury, Aotearoa New Zealand.

Abstract

Objective: Estimate and compare rates of cardiometabolic blood screening, elevated results and clinical follow-up actions for Māori and non-Māori mental health service users with psychosis in Canterbury, Aotearoa New Zealand.

Methods: A retrospective cohort study (N = 3840) with dynamic entry was conducted with people aged 18-64 years with a psychosis diagnosis in Canterbury Specialist Mental Health Service (1 August 2012 to 31 December 2019). Linked administrative data captured lipid and HbA1c screening within 1 year of study entry, elevated results (triglycerides > 2.2 mmol/L; total cholesterol:high-density lipoprotein cholesterol > 5; HbA1c > 40 mmol/mol) from individual study entry to 31 December 2023, and clinical actions (repeat test; statin/metformin dispensing) within 1 year following an elevated result.

Results: 887/3840 (23%) of Canterbury Specialist Mental Health Service users with psychosis were Māori. First-year screening rates were modest (31-44%), similar by ethnicity and broadly higher among clozapine/olanzapine users. Māori had higher odds of both elevated lipids and HbA1c. About one-third of elevated results were followed up with re-testing within 1 year. Rates of follow-up testing and medication dispensing were broadly similar for Māori and non-Māori, except Māori were more likely to receive repeat HbA1c testing after an elevated result (odds ratio = 1.71 [1.16, 2.50]).

Conclusions: Findings highlight large gaps in cardiometabolic screening and follow-up actions among Māori and non-Māori Specialist Mental Health Service users with psychosis. Māori presented with psychosis 4 years younger, had significantly higher rates of elevated cardiometabolic risk markers and were more likely to receive HbA1c re-testing following an elevated result.