Key Points Question Do people with major psychiatric disorders have greater odds of testing positive for COVID-19 and dying from it? Findings This cross-sectional study based on nationwide electronic health record data from 2 535 098 participants showed that the schizophrenia and mood disorder cohorts had significantly lower rates of positivity (9.86%) than the anxiety disorder cohort (11.17%) and the general population (11.91%). Conversely, patients with schizophrenia had a higher rate of death from COVID-19 than the reference group or those with mood disorders or anxiety disorders. Meaning This study suggests that patients with major psychiatric disorders may be more likely to have medical comorbidities associated with worse COVID-19 outcome and yet have a higher mortality rate independent of comorbidities.

Objective To create and validate a methodology to assign a severity level to an episode of COVID-19 for retrospective analysis in claims data. Data Source Secondary data obtained by license agreement from Optum provided claims records nationally for 19,761,754 persons, of which, 692,094 persons had COVID-19 in 2020. Study Design The World Health Organization (WHO) COVID-19 Progression Scale was used as a model to identify endpoints as measures of episode severity within claims data. Endpoints used included symptoms, respiratory status, progression to levels of treatment and mortality. Data Collection/Extraction methods The strategy for identification of cases relied upon the February 2020 guidance from the Centers for Disease Control and Prevention (CDC). Principal Findings A total of 709,846 persons (3.6%) met the criteria for one of the nine severity levels based on diagnosis codes with 692,094 having confirmatory diagnoses. The rates for each level varied considerably by age groups, with the older age groups reaching higher severity levels at a higher rate. Mean and median costs increased as severity level increased. Statistical validation of the severity scales revealed that the rates for each level varied considerably by age group, with the older ages reaching higher severity levels (p < 0.001). Other demographic factors such as race and ethnicity, geographic region, and comorbidity count had statistically significant associations with severity level of COVID-19. Conclusion A standardized severity scale for use with claims data will allow researchers to evaluate episodes so that analyses can be conducted on the processes of intervention, effectiveness, efficiencies, costs and outcomes related to COVID-19.