Fond Guillaume, Llorca Pierre-Michel, Lançon Christophe, Auquier Pascal, Boyer Laurent
FondaMental Academic Centers of Expertise for Schizophrenia, Créteil, France.
Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean-Moulin, 13005 Marseille, France.
Ann Med Psychol (Paris). 2021 Apr;179(4):353-362. doi: 10.1016/j.amp.2021.02.016. Epub 2021 Feb 17.
Patients with schizophrenia 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 schizophrenia 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 schizophrenia. 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 schizophrenia patients (1.6%). The schizophrenia patients had an increased in-hospital mortality (25.6% vs. 21.7%; adjusted odds ratio (aOR) 1.30 [95% CI 1.08-1.56], p = 0.0093) and a decreased ICU admission rate (23.7% vs. 28.4%; aOR 0.75 [95% CI 0.62-0.91], p = 0.0062) compared to controls. Significant interactions between schizophrenia and age for mortality and ICU admission were observed (p = 0.0006 and p < 0.0001). Schizophrenia patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). schizophrenia patients younger than 55 years had more ICU admissions (+13.93%) and schizophrenia 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 schizophrenia patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of schizophrenia 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.
精神分裂症患者是一个脆弱群体，在新冠病毒疾病（COVID-19）研究中未得到充分研究。我们旨在确定精神分裂症患者与未诊断出患有严重精神疾病的患者在健康结局和护理方面是否存在差异。我们对2020年2月至6月期间在法国住院的所有确诊患有COVID-19且有呼吸道症状的患者进行了一项基于人群的队列研究。病例组为被诊断患有精神分裂症的患者。对照组为未诊断出患有严重精神疾病的患者。结局指标为住院死亡率和重症监护病房（ICU）收治率。总共纳入了50750名患者，其中823名是精神分裂症患者（1.6%）。与对照组相比，精神分裂症患者的住院死亡率更高（25.6%对21.7%；调整后的优势比（aOR）为1.30[95%置信区间1.08 - 1.56]，p = 0.0093），而ICU收治率更低（23.7%对28.4%；aOR为0.75[95%置信区间0.62 - 0.91]，p = 0.0062）。观察到精神分裂症与年龄在死亡率和ICU收治率方面存在显著交互作用（p = 0.0006和p < 0.0001）。65至80岁的精神分裂症患者的死亡风险显著高于同年龄对照组（高出7.89%）。55岁以下的精神分裂症患者有更多的ICU收治（高出13.93%），65至80岁及80岁以上的精神分裂症患者的ICU收治率低于同年龄对照组（分别低15.44%和5.93%）。我们的研究结果表明，精神分裂症患者与未诊断出患有严重精神疾病的患者在健康和医疗保健方面存在差异。这些差异因精神分裂症患者的年龄和临床特征而异，这表明在住院前、住院期间和住院后进行个性化的COVID-19临床管理和医疗保健策略对于减少这一脆弱人群的健康差异具有重要意义。
