Severe mental illness, race/ethnicity, multimorbidity and mortality following COVID-19 infection: nationally representative cohort study.
Severe mental illness, race/ethnicity, multimorbidity and mortality following COVID-19 infection: nationally representative cohort study.
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DOI：
10.1192/bjp.2023.112
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发表时间：
2023-11
期刊：
影响因子：
--
通讯作者：
Dregan A
中科院分区：
文献类型：
--
作者：
Das-Munshi J;Bakolis I;Bécares L;Dyer J;Hotopf M;Ocloo J;Stewart R;Stuart R;Dregan A
COVID-19与严重精神疾病（SMI）患者死亡的相关性，以及与多发病率和种族的相关性尚不清楚。确定COVID-19感染后SMI患者的全因死亡率，并评估超额死亡率是否受多发病率或种族的影响。这是一项回顾性队列研究，使用了2020年2月至2021年4月临床实践研究数据库（CPRD）的初级保健数据。使用考克斯比例风险回归来估计在COVID-19大流行的前两波期间，SMI对全因死亡率的影响。在7，146名SMI患者（56%为女性）中，与非SMI对照组（N= 653，024，55%为女性）相比，多发病率较高。在COVID-19感染后，SMI组的死亡风险高于对照组（调整后风险比（aHR）=1.53，95%置信区间（CI），1.39-1.68）。与白色参照组相比，加勒比黑人/非洲黑人更有可能死于COVID-19（aHR：1.22（95% CI，1.12-1.34），SMI组和非SMI组的相关性相似（相互作用的p值=0.73）。感染COVID-19后，对于每一个额外的多发病条件，SMI分层中死亡的aHR为1.06（95% CI：1.01，1.10），非SMI分层中为1.16（95% CI：1.15，1.17）（相互作用的p值=0.001）。在COVID-19感染后，患有SMI的患者的死亡风险升高，并因多发病而进一步放大。加勒比黑人/非洲黑人相对于白色参照组有更高的COVID-19死亡风险，SMI和对照组的这种不公平性相似。
The association of COVID-19 with death in people with severe mental illnesses (SMI), and associations with multimorbidity and ethnicity are unclear. To determine all-cause mortality in people with SMI following COVID-19 infection and assess whether excess mortality is affected by multimorbidity or ethnicity. This was a retrospective cohort study using primary care data from the Clinical Practice Research Database (CPRD) from February 2020 to April 2021. Cox proportional hazards regression was used to estimate the impact of SMI on all-cause mortality during the first two-waves of the COVID-19 pandemic. Among 7,146 people with SMI (56% female), there was a higher prevalence of multimorbidity compared to the non-SMI control group (N=653,024, 55% female). Following COVID-19 infection, the SMI group experienced a greater risk of death compared to controls (adjusted hazard ratio (aHR)=1.53, 95% confidence interval (CI), 1.39-1.68). Black Caribbean/ Black African people were more likely to die from COVID-19 compared with the White reference group (aHR: 1.22 (95% CI, 1.12-1.34), with similar associations in the SMI group and non-SMI group (p-value for interaction=0.73). Following infection with COVID-19, for every additional multimorbidity condition, the aHR for death was 1.06 (95% CI 1.01, 1.10) in the SMI stratum and 1.16 (95% CI: 1.15, 1.17) in the non-SMI stratum (p-value for interaction=0.001). Following COVID-19 infection, patients living with SMI were at an elevated risk of death, further magnified by multimorbidity. Black Caribbean/ Black African people had a higher risk of death from COVID-19 relative to the White reference group, this inequity was similar for the SMI and the control group.
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DOI：
10.1016/s2215-0366(21)00232-7
发表时间：
2021-09
期刊：
The lancet. Psychiatry
影响因子：
--
作者：
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