CEReSS - Health Service Research and Quality of Life Center, EA3279, Aix-Marseille University, Marseille, 13005, France.
Fondation FondaMental, F-94010, Créteil, France.
Mol Psychiatry. 2022 Dec;27(12):5186-5194. doi: 10.1038/s41380-022-01803-4. Epub 2022 Oct 7.
It remains unknown to what degree resource prioritization toward SARS-CoV-2 (2019-nCoV) coronavirus (COVID-19) cases had disrupted usual acute care for non-COVID-19 patients, especially in the most vulnerable populations such as patients with schizophrenia. The objective was to establish whether the impact of the COVID-19 pandemic on non-COVID-19 hospital mortality and access to hospital care differed between patients with schizophrenia versus without severe mental disorder. We conducted a nationwide population-based cohort study of all non-COVID-19 acute hospitalizations in the pre-COVID-19 (March 1, 2019 through December 31, 2019) and COVID-19 (March 1, 2020 through December 31, 2020) periods in France. We divided the population into patients with schizophrenia and age/sex-matched patients without severe mental disorder (1:10). Using a difference-in-differences approach, we performed multivariate patient-level logistic regression models (adjusted odds ratio, aOR) with adjustment for complementary health insurance, smoking, alcohol and substance addiction, Charlson comorbidity score, origin of the patient, category of care, intensive care unit (ICU) care, major diagnosis groups and hospital characteristics. A total of 198,186 patients with schizophrenia were matched with 1,981,860 controls. The 90-day hospital mortality in patients with schizophrenia increased significantly more versus controls (aOR = 1.18; p < 0.001). This increased mortality was found for poisoning and injury (aOR = 1.26; p = 0.033), respiratory diseases (aOR = 1.19; p = 0.008) and for both surgery (aOR = 1.26; p = 0.008) and medical care settings (aOR = 1.16; p = 0.001). Significant changes in the case mix were noted with reduced admission in the ICU and for several somatic diseases including cancer, circulatory and digestive diseases and stroke for patients with schizophrenia compared to controls. These results suggest a greater deterioration in access to, effectiveness and safety of non-COVID-19 acute care in patients with schizophrenia compared to patients without severe mental disorders. These findings question hospitals' resilience pertaining to patient safety and underline the importance of developing specific strategies for vulnerable patients in anticipation of future public health emergencies.
目前尚不清楚将资源优先用于严重急性呼吸综合征冠状病毒 2 型（2019-nCoV）冠状病毒（COVID-19）病例对非 COVID-19 患者的常规急性护理产生了何种程度的影响，尤其是在精神分裂症等弱势群体中。目的是确定 COVID-19 大流行对非 COVID-19 医院死亡率和获得医院护理的影响在患有精神分裂症的患者与无严重精神障碍的患者之间是否存在差异。我们对法国在 COVID-19 大流行之前（2019 年 3 月 1 日至 2019 年 12 月 31 日）和 COVID-19 期间（2020 年 3 月 1 日至 2020 年 12 月 31 日）所有非 COVID-19 急性住院患者进行了一项全国性基于人群的队列研究。我们将人群分为精神分裂症患者和年龄/性别匹配的无严重精神障碍患者（1:10）。我们使用差异中的差异方法，对患者水平的多变量逻辑回归模型（调整后的优势比，aOR）进行了调整，以补充健康保险、吸烟、酒精和药物滥用、Charlson 合并症评分、患者来源、护理类别、重症监护病房（ICU）护理、主要诊断组和医院特征。共有 198186 名精神分裂症患者与 1981860 名对照患者相匹配。与对照组相比，精神分裂症患者的 90 天医院死亡率显著增加（aOR=1.18；p<0.001）。这种增加的死亡率见于中毒和损伤（aOR=1.26；p=0.033）、呼吸系统疾病（aOR=1.19；p=0.008）和手术（aOR=1.26；p=0.008）和医疗保健环境（aOR=1.16；p=0.001）。与对照组相比，精神分裂症患者 ICU 入院率和包括癌症、循环和消化系统疾病以及中风在内的多种躯体疾病的入院率均有所下降，这表明非 COVID-19 急性护理的治疗效果和安全性都有所恶化。这些结果表明，与无严重精神障碍的患者相比，精神分裂症患者的非 COVID-19 急性护理的可及性、有效性和安全性都有所恶化。这些发现对医院的弹性提出了质疑，尤其是对患者安全方面的质疑，并强调了制定针对弱势患者的具体策略的重要性，以应对未来的公共卫生紧急情况。
