Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections.
Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections.
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DOI：
10.1001/jamapsychiatry.2022.3614
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发表时间：
2023-01-01
期刊：
影响因子：
25.8
通讯作者：
Hippisley-Cox, Julia
中科院分区：
文献类型：
--
作者：
Ranger, Tom Alan;Clift, Ash Kieran;Patone, Martina;Coupland, Carol A. C.;Hatch, Robert;Thomas, Karen;Watkinson, Peter;Hippisley-Cox, Julia
这项队列研究调查了既往诊断为神经精神疾病与COVID-19感染和其他严重急性呼吸道感染的严重结局之间的潜在相关性。神经精神疾病的诊断与COVID-19感染的严重后果之间是否存在关联，如果存在，是否也在其他严重急性呼吸道感染（SARI）中观察到？在这项对超过1100万人的电子病历进行的纵向队列研究中，既存神经精神疾病诊断和相关药物治疗处方均与COVID-19感染和其他SARI严重结局的风险显著增加相关，主要程度相似。这些发现表明，认识到几种神经精神疾病与发生广泛呼吸道感染风险的关联，而不仅仅是COVID-19感染的重要性。有证据表明，既存神经精神疾病会增加COVID-19感染导致严重后果的风险。目前尚不清楚这种增加的风险与其他严重急性呼吸道感染（SARI）相关的风险如何比较。确定既存神经精神疾病的诊断和/或治疗是否与COVID-19感染和其他SARI的严重结局相关，以及观察到的2种结局之间的任何相关性是否相似。大流行前（2015-2020年）和当代（2020-2021年）纵向队列来自英国初级保健记录的QResearch数据库。2022年4月，使用按初级保健诊所聚类的灵活参数生存模型估计了经调整的风险比（HR）和99% CI。这项研究包括一个基于人群的样本，包括数据库中所有在初级保健诊所注册至少1年的成年人。对常规收集的初级保健电子病历进行分析。焦虑、情绪或精神障碍的诊断和/或药物治疗，以及痴呆、抑郁、精神分裂症或双相情感障碍的诊断。COVID-19相关死亡率，或住院或重症监护室入院; SARI相关死亡率，或住院或重症监护室入院。大流行前队列包括11134789例成人（223569例SARI病例[2.0%]），中位（IQR）年龄为42（29-58）岁，其中5644525例（50.7%）为女性。当代队列包括8 388 956例成人（58 203例重度COVID-19病例[0.7%]），中位（IQR）年龄为48（34-63）岁，其中4 207 192例为男性（50.2%）。诊断和/或治疗痴呆以外的神经精神疾病与SARI严重结局的可能性增加相关（焦虑诊断：HR，1.16; 99%CI，1.13-1.18;精神病性障碍诊断和治疗：HR，2.56; 99%CI，2.40-2.72）和COVID-19（焦虑诊断：HR，1.16; 99%CI，1.12-1.20;精神病性障碍治疗：HR，2.37; 99%CI，2.20-2.55）。COVID-19患者痴呆严重结局的效应估计值高于SARI患者（HR，2.85; 99%CI，2.71-3.00 vs HR，2.13; 99%CI，2.07-2.19）。在这项纵向队列研究中，既存神经精神疾病和治疗的英国患者与COVID-19感染和SARI严重结局的风险增加相似，痴呆除外。
This cohort study investigates the potential association between a previous diagnosis of a neuropsychiatric condition and severe outcome from COVID-19 infection and other severe acute respiratory infections. Is there an association between having a diagnosis of a neuropsychiatric condition and severe outcome from COVID-19 infection, and if so, is it also observed in other severe acute respiratory infections (SARIs)? In this longitudinal cohort study of the electronic medical records from more than 11 million people, both a preexisting diagnosis of a neuropsychiatric condition and having a prescription for a related pharmacological treatment were associated with a significantly increased risk of severe outcomes from both COVID-19 infection and other SARIs, mainly to similar extents. These findings suggest the importance of recognizing the association of several neuropsychiatric illnesses with risk of developing a broad range of respiratory infections, not just COVID-19 infection. Evidence indicates that preexisting neuropsychiatric conditions confer increased risks of severe outcomes from COVID-19 infection. It is unclear how this increased risk compares with risks associated with other severe acute respiratory infections (SARIs). To determine whether preexisting diagnosis of and/or treatment for a neuropsychiatric condition is associated with severe outcomes from COVID-19 infection and other SARIs and whether any observed association is similar between the 2 outcomes. Prepandemic (2015-2020) and contemporary (2020-2021) longitudinal cohorts were derived from the QResearch database of English primary care records. Adjusted hazard ratios (HRs) with 99% CIs were estimated in April 2022 using flexible parametric survival models clustered by primary care clinic. This study included a population-based sample, including all adults in the database who had been registered with a primary care clinic for at least 1 year. Analysis of routinely collected primary care electronic medical records was performed. Diagnosis of and/or medication for anxiety, mood, or psychotic disorders and diagnosis of dementia, depression, schizophrenia, or bipolar disorder. COVID-19–related mortality, or hospital or intensive care unit admission; SARI-related mortality, or hospital or intensive care unit admission. The prepandemic cohort comprised 11 134 789 adults (223 569 SARI cases [2.0%]) with a median (IQR) age of 42 (29-58) years, of which 5 644 525 (50.7%) were female. The contemporary cohort comprised 8 388 956 adults (58 203 severe COVID-19 cases [0.7%]) with a median (IQR) age of 48 (34-63) years, of which 4 207 192 were male (50.2%). Diagnosis and/or treatment for neuropsychiatric conditions other than dementia was associated with an increased likelihood of a severe outcome from SARI (anxiety diagnosis: HR, 1.16; 99% CI, 1.13-1.18; psychotic disorder diagnosis and treatment: HR, 2.56; 99% CI, 2.40-2.72) and COVID-19 (anxiety diagnosis: HR, 1.16; 99% CI, 1.12-1.20; psychotic disorder treatment: HR, 2.37; 99% CI, 2.20-2.55). The effect estimate for severe outcome with dementia was higher for those with COVID-19 than SARI (HR, 2.85; 99% CI, 2.71-3.00 vs HR, 2.13; 99% CI, 2.07-2.19). In this longitudinal cohort study, UK patients with preexisting neuropsychiatric conditions and treatments were associated with similarly increased risks of severe outcome from COVID-19 infection and SARIs, except for dementia.
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影响因子：
7
作者：
Pardamean E;Roan W;Iskandar KTA;Prayangga R;Hariyanto TI
通讯作者：
Hariyanto TI
DOI：
10.1016/s2214-109x(21)00448-4
发表时间：
2022-01
期刊：
The Lancet. Global health
影响因子：
--
作者：
Reis G;Dos Santos Moreira-Silva EA;Silva DCM;Thabane L;Milagres AC;Ferreira TS;Dos Santos CVQ;de Souza Campos VH;Nogueira AMR;de Almeida APFG;Callegari ED;de Figueiredo Neto AD;Savassi LCM;Simplicio MIC;Ribeiro LB;Oliveira R;Harari O;Forrest JI;Ruton H;Sprague S;McKay P;Glushchenko AV;Rayner CR;Lenze EJ;Reiersen AM;Guyatt GH;Mills EJ;TOGETHER investigators
通讯作者：
TOGETHER investigators
影响因子：
5
作者：
Zhou, Z;Rahme, E;Pilote, L
通讯作者：
Pilote, L
影响因子：
25.8
作者：
Clift, Ashley Kieran;Ranger, Tom Alan;Patone, Martina;Coupland, Carol A. C.;Hatch, Robert;Thomas, Karen;Hippisley-Cox, Julia;Watkinson, Peter
通讯作者：
Watkinson, Peter
影响因子：
2.6
作者：
Nose, Michela;Recla, Elisabetta;Barbui, Corrado
通讯作者：
Barbui, Corrado