COVID-19 Prevalence and Mortality Among Schizophrenia Patients: A Large-Scale Retrospective Cohort Study

Abstract

Objective Individuals with schizophrenia may be at an increased risk for COVID-19 morbidity due to the disease characteristics. In this study, we aimed to explore the odds of significant COVID-19 morbidity and mortality among schizophrenia patients while controlling for potential sociodemographic and medical confounders. Methods Schizophrenia patients and age-and-sex matched controls (total n = 51 078) were assessed for frequency of COVID-19 positivity, hospitalizations, and mortality. The odds for COVID-19-associated hospitalization and mortality were calculated using logistic regression models, while controlling for age, sex, marital status, sector, socioeconomic status, diabetes, ischemic heart disease, hypertension, hyperlipidemia, obesity, smoking, and chronic obstructive pulmonary disease. Results Individuals with schizophrenia were less likely to test positive for COVID-19; however, they were twice as likely to be hospitalized for COVID-19 (OR 2.15 95% CI 1.63–2.82, P < .0001), even after controlling for sociodemographic and clinical risk factors (OR 1.88 95% CI 1.39–2.55, P < .0001). Furthermore, they were 3 times more likely to experience COVID-19 mortality (OR 3.27 95% CI 1.39–7.68, P < .0001), compared to controls. Conclusions We found evidence of associations between schizophrenia and increased COVID-19 morbidity and mortality compared to controls regardless of sociodemographic and medical factors. As these patients present with a combination of potential risk factors for mortality, efforts should be made to minimize the effects of the pandemic on this vulnerable population.

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

“…Sensitivity analyses highlighted an effect of single studies on the overall estimates (appendix 4 pp 37-38). A high proportion of unexplained heterogeneity was identified (OR I²=93•01%, Q=128•76, p<0•0001; aOR I²=89•51%, Q=57•21, p<0•0001), and a subgroup analysis was done to explore whether the diagnostic category explained a Zimering et al (2020) 34 GeMRC (2021) 39 Turk et al (2020) 27 Genet et al (2020) 25 Fond et al (2020) 9 Huls et al (2021) 36 Poblador-Plou et al (2020) 8 Allen et al (2020) 21 Nemani et al (2021) 4 Baillargeon et al (2020) 24 Yang et al (2020) 32 Landes et al (2020) 26 Siso-Almirall et al (2020) 31 Li et al (2020) 30 Reilev et al (2020) 7 Landes et al (2021) 28 Bitan et al (2021) 37 Canal-Riveiro et al (2021) 38 Lee et al (2020) 29 Yanover et al (2020) 33 An et al (2020 proportion of the heterogeneity (appendix 4 pp 39-40). After correction for multiple comparisons, none of the diagnostic categories were found to be consistently associated with an increased risk for ICU admission.…”

“…53,54 Although we found no evidence for such a protective effect of antidepressants, this could have been confounded by the psychiatric indication. In contrast to antipsychotics and anxiolytics, Canal-Riveiro et al (2021) 38 Jeon et al (2021) 10 Yang et al (2020) 32 Bitan et al (2021) 37 Baillargeon et al (2020) 24 Reilev et al (2020) 7 Yanover et al (2020) 33 Allen et al (2020) 21 Siso-Almirall et al (2020) 31 the mortality risk associated with antidepressants was not increased after adjustment for age, sex, and other covariates.…”

Incidence and outcome of COVID-19 in patients with schizophrenia: A Study from India

“…In terms of the type of antipsychotics available data suggests that, compared to patients on other antipsychotics, those on clozapine have a higher risk of developing COVID-19 infection ( Govind et al, 2020 ). In terms of the risk of COVID-19 infection, data is conflicting with some of the authors suggesting a lower incidence of COVID-19 infection in patients with schizophrenia ( Tzur Bitan et al, 2021 ), whereas others suggest a higher rate of COVID-19 infection ( Wang et al, 2021 ). A recent systematic review which included data on risk of COVID-19-related mortality, hospitalization and intensive care unit admission rates, from different parts of the world suggests lack of data from India ( Vai et al, 2021 ).…”

“…Data emerging from various parts of the globe suggest that compared to controls, patients with mental illnesses develop a more severe infection, are more likely to be hospitalized and are at a higher risk of mortality ( Fond et al, 2021 ; Ji et al, 2020 ; Nemani et al, 2021 ; Tzur Bitan et al, 2021 ; Vai et al, 2021 ). Further, the data suggest that patients with schizophrenia are less likely to be admitted to the intensive care unit and this is attributed to the discrimination against the patients with schizophrenia ( Fond et al, 2021 ).…”

COVID-19 Morbidity Among Individuals with Autistic Spectrum Disorder: A Matched Controlled Population-Based Study

“…The ongoing spread of the coronavirus disease 19 caused by SARS-CoV-2, has led to wide implications in different areas of public health, with some populations reporting more serious adverse effects of the pandemic then others. Older age, male sex, obesity, type 1 and type 2 diabetes, hypertension and other background diseases have all been associated with greater morbidity (Zhou et al, 2021;Li et al, 2020), and vulnerable groups which tend to suffer from these conditions have previously demonstrated a more severe outcome (Tzur Bitan et al, 2021). As vaccination efforts are spreading worldwide, one of the challenges facing the medical community is to identify vulnerable groups which are more susceptible to significant morbidity, so as to focus prevention efforts on these populations.…”