Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19: A National Cohort Study.
Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19: A National Cohort Study.
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DOI：
10.1093/schbul/sbaa158
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发表时间：
2021-04-29
影响因子：
6.6
通讯作者：
Boyer L
中科院分区：
文献类型：
--
作者：
Fond G;Pauly V;Leone M;Llorca PM;Orleans V;Loundou A;Lancon C;Auquier P;Baumstarck K;Boyer L
精神分裂症患者是新冠肺炎研究中研究不足的弱势群体。我们的目的是确定SCZ患者和未被诊断为严重精神疾病的患者之间的健康结果和护理是否存在差异。我们对2020年2月至6月期间在法国住院的所有确诊为新冠肺炎和呼吸道症状的患者进行了一项基于人群的队列研究。2例为确诊为SCZ的患者。对照组是没有被诊断出患有严重精神疾病的患者。结果是住院死亡率和重症监护病房(ICU)入院。共纳入50750例患者，其中823例为SCZ患者(1.6%)。与对照组相比，SCZ患者的住院死亡率增加(25.6%比21.7%；调整后OR 1.30[95%CI，1.08-1.56]，P=0.0093)，ICU住院率降低(23.7%比28.4%；调整OR 0.75[95%CI，0.62-0.91]，P=0.0062)。SCZ与死亡率和ICU入院年龄之间存在显著的交互作用(P=.0006和P<；.0001)。年龄在65岁至80岁之间的SCZ患者的死亡风险显著高于同龄对照组(+7.89%)。年龄<55岁的患者ICU入院率(+13.93%)，65~80岁和>80岁的患者ICU入院率(−分别为15.44%和−5.93%)。我们的发现报告了SCZ患者和没有被诊断为严重精神疾病的患者之间在健康和保健方面的差异。这些差异根据SCZ患者的年龄和临床特征而有所不同，这表明在住院前、住院期间和住院后个性化的新冠肺炎临床管理和医疗策略对于减少这一弱势群体的健康差异具有重要意义。
Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with SCZ and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50 750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs 21.7%; adjusted OR 1.30 [95% CI, 1.08–1.56], P = .0093) and a decreased ICU admission rate (23.7% vs 28.4%; adjusted OR, 0.75 [95% CI, 0.62–0.91], P = .0062) compared with controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (P = .0006 and P < .0001). SCZ patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). SCZ patients younger than 55 years had more ICU admissions (+13.93%) and SCZ patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (−15.44% and −5.93%, respectively). Our findings report the existence of disparities in health and health care between SCZ patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of SCZ patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during, and after hospitalization for reducing health disparities in this vulnerable population.
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