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Medical Comorbidity in Women and Men With Bipolar Disorders: A Population-Based Controlled Study

From the Departments of Psychiatry and Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana (C.P.C.); Regenstrief Institute, Indianapolis, Indiana (C.P.C.); Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa (L.E.J.).

Address correspondence and reprint requests to Caroline P. Carney, MD, MSc, Department of Internal Medicine, 449 RT, Indiana University School of Medicine, Indianapolis, IN 46250. E-mail: ccarneyd{at}iupui.edu

Objective: Rarely has validated information on chronic medical comorbidity been presented for persons with bipolar disorder. To deliver appropriate health services, it is important to understand the prevalence of chronic medical conditions in this population. This study examines chronic medical comorbidity using validated methodology in persons with bipolar disorder.

Methods: This is a retrospective study of a 100% sample of administrative claims (1996–2001) from Wellmark Blue Cross Blue Shield. Three thousand five hundred fifty-seven subjects had bipolar I disorder and did not have claims for schizophrenia or schizoaffective disorder. Controls had no documented claims for psychiatric conditions. Using validated methodology, inpatient and outpatient claims were used to determine prevalence of 44 chronic medical conditions. Odds ratios (ORs) were adjusted for age, gender, residence, and nonmental healthcare utilization.

Results: Persons with bipolar disorder were young (mean age, 38.8 years) and significantly more likely to have medical comorbidity, including three or more chronic conditions (41% versus 12%, p < .001) compared with controls. Elevated ORs were found for conditions spanning all organ systems. Hyperlipidemia, lymphoma, and metastatic cancer were the only conditions less likely to occur in persons with bipolar disorder.

Conclusion: Bipolar disorders are associated with substantial chronic medical burden. Familiarity with conditions affecting this population may assist in programs aimed at providing medical care for the chronically mentally ill.

Key Words: bipolar disorder • medical comorbidity • chronic disease • administrative data

Abbreviations: AIDS = acquired immunodeficiency syndrome; HIV = human immunodeficiency virus; ICD-9 = International Classification of Diseases, Ninth Revision; AOR = adjusted odds ratio; OR = odds ratio; CI = confidence interval; BC/BS = BlueCross BlueShield.

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