COVID-19 Prevalence and Mortality Among Schizophrenia Patients

A Large-Scale Retrospective Cohort Study

Dana Tzur Bitan; Israel Krieger; Khalaf Kridin; Doron Komantscher; Yochai Scheinman; Orly Weinstein; Arnon Dov Cohen; Assi Albert Cicurel; Daniel Feingold

Disclosures

Schizophr Bull. 2021;47(5):1211-1217. 

In This Article

Results

Table 1 presents the sociodemographic and clinical characteristics of the study participants. Participants were 25 539 individuals with schizophrenia and their age-and-sex matched controls. Mean age was 51.51 among individuals with schizophrenia (SE = 15.42) and 51.37 among controls (SE = 15.70). A total of 15 572 men (61.0%) were sampled in both groups. Compared to age-and-sex matched controls, individuals with schizophrenia were significantly less likely to be married [OR 0.19 95% CI 0.18–0.2] and to belong to the Ultraorthodox sector [OR 0.61, 95% CI 0.58–0.64], and were more likely to present with a low [OR 1.88, 95% CI 1.79–1.98] or medium [OR 1.80, 95% CI 1.71–1.89] socioeconomic status. Examination of clinical characteristics indicated that individuals with schizophrenia were significantly more likely to receive a lifetime diagnosis of obesity [OR 1.68 95% CI 1.61–1.75], smoking [OR 1.64 95% CI 1.59–1.70], diabetes [OR 1.65 95% CI 1.58–1.73], hyperlipidemia [OR 1.44 95% CI 1.39–1.49] or COPD [OR 2.32 95% CI 2.09–2.76], and significantly less likely to receive a diagnosis of IHD [OR 0.67 95% CI 0.64–0.74]. As can be expected, psychiatric admissions were more prevalent in schizophrenia patients compared to the controls, with prevalence of 1.4% compared to 0.0% in the controls [OR 91.78 95% CI 34.25–245.91].

Table 2 presents the COVID-19 disease characteristics among schizophrenia and control participants. Of the entire sample (total n = 51 078), 13 350 (26.2%) individuals were tested for COVID-19, and 1358 (2.6%) screened positive for COVID-19. In addition, 238 (0.5%) were hospitalized, out of whom 29 died (12.2%). Within the schizophrenia patient group, 642 patients tested positive, 162 (25.23% of those who tested positive) were hospitalized for COVID-19, and 22 (3.42% of those who tested positive) died due to COVID-19. Of the control group, 709 patients tested positive, 76 (10.71% of those who tested positive) were hospitalized for COVID-19, and 7 (0.9% of those who tested positive) died due to COVID-19. Univariate comparative analyses indicated that individuals with schizophrenia were significantly more likely to be tested for COVID-19 [OR 1.52 95%CI 1.46–1.58] and underwent more tests compared to controls [OR 1.19 95%CI 1.17–1.21]. They were also significantly less likely to receive a positive diagnosis of COVID-19 compared to controls [OR 0.64 95%CI 0.57–0.71]. Nonetheless, individuals with schizophrenia were more than twice as likely to be hospitalized due to COVID-19 [OR 2.13 95%CI 1.62–2.81 P < .0001] and more than 3 times more susceptible to COVID-19 mortality [OR 3.14 95%CI 1.34–7.36 P < .0001], compared to controls.

Table 3 presents the odds of COVID-19 morbidity and mortality among individuals with schizophrenia and their matched controls while adjusting for sociodemographic and clinical factors. As can be viewed, the odds for COVID-19 hospitalization among schizophrenia patients remained significant after controlling for sociodemographic factors [adjusted odds ratio (AOR) 1.85 95%CI 1.37–2.50] and for clinical factors [AOR 1.88 95%CI 1.39–2.55]. For mortality, the base-adjusted model (controlling for age and sex) indicated that schizophrenia patients were more than 3 times more likely to experience COVID-19 mortality [AOR 3.27 95%CI 1.39–7.68]. Exploratory analyses controlling for additional covariates indicated that this association also remained after controlling for sociodemographic [AOR 2.79 95%CI 1.16–6.72] and clinical factors [AOR 2.77 95%CI 1.13–6.79]; nonetheless, due to the low number of overall deaths, these models should be interpreted with caution.

An exploratory analysis examining the characteristics of hospitalized and deceased individuals indicated that hospitalized schizophrenia patients were predominantly males at a higher mean age and with a higher prevalence of smoking, obesity, diabetes, and COPD. When examining mortality from COVID-19, deceased individuals with schizophrenia were at a lower mean age, as well as there being a higher proportion of men, smoking, and COPD. These rates were not comparable due to low sample size (Table 4).

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