How Relational Continuity, Serious Mental Illness, and Substance Use Disorders Shape Management of Diabetes and Hypertension: Analysis of Population-Based Administrative Health Data in British Columbia

Abstract

People with serious mental illness (SMI) and substance use disorders (SUD) are at higher risk of chronic physical diseases like diabetes and hypertension and related acute complications, but face barriers to chronic disease management (including longitudinal monitoring in primary care, medication management, and laboratory testing). It remains poorly understood how relational continuity and treatment for comorbid SMI and/or SUD shape recommended management of diabetes or hypertension. I used linked BC administrative health data from April 1, 2020 to March 31, 2023 to compare patterns of chronic disease management among patients with diabetes or hypertension treated for comorbid SMI/SUD using descriptive statistics (frequency, means, and standardized differences). Modified-Poisson regression models were used to calculate adjusted risk ratios between relational continuity and recommended management and included interaction terms to evaluate whether associations were modified by SMI/SUD treatment. Findings reveal disparities in chronic disease management among people treated for SMI and/or SUDs.