Dang Wen, Long Iman, Zhao Yiwei, Xiang Yu-Tao, Smith Robert David
Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
Vaccines (Basel). 2024 Sep 18;12(9):1064. doi: 10.3390/vaccines12091064.
Prior to the introduction of COVID-19 vaccines, patients with severe mental illness (SMI) were at greater risk of COVID-19-related outcomes than the general population. It is not yet clear whether COVID-19 vaccines have reduced the risk gap. We systematically searched nine international databases and three Chinese databases to identify relevant studies from December 2020 to December 2023 to compare the risk of COVID-19-related outcomes for SMI patients to those without SMI after vaccination. Random effects meta-analysis was performed to estimate the pooled odds ratio (OR) with 95% confidence intervals (CI). Subgroup analysis, sensitivity analysis, and publication bias analysis were conducted with R software 4.3.0. A total of 11 observational studies were included. Compared with controls, SMI patients were associated with a slightly increased risk of infection (pooled OR = 1.10, 95% CI, 1.03-1.17, = 43.4%), while showing a 2-fold higher risk of hospitalization (pooled OR = 2.66, 95% CI, 1.13-6.22, = 99.6%), even after both groups have received COVID-19 vaccines. Limited evidence suggests a higher mortality risk among SMI patients compared to controls post vaccination, but the findings did not reach statistical significance. SMI patients remain at increased risk compared to their peers in COVID-19-related outcomes even after vaccination. Vaccination appears an effective approach to prevent severe COVID-19 illness in SMI patients, and actions should be taken by healthcare providers to improve vaccination coverage in these vulnerable groups.
在新冠疫苗引入之前，严重精神疾病（SMI）患者相比普通人群，出现与新冠相关后果的风险更高。目前尚不清楚新冠疫苗是否缩小了这一风险差距。我们系统检索了9个国际数据库和3个中文数据库，以识别2020年12月至2023年12月期间的相关研究，比较接种疫苗后SMI患者与非SMI患者出现与新冠相关后果的风险。采用随机效应荟萃分析来估计合并比值比（OR）及95%置信区间（CI）。使用R软件4.3.0进行亚组分析、敏感性分析和发表偏倚分析。共纳入11项观察性研究。与对照组相比，SMI患者感染风险略有增加（合并OR = 1.10，95% CI，1.03 - 1.17，I² = 43.4%），而住院风险则高出2倍（合并OR = 2.66，95% CI，1.13 - 6.22，I² = 99.6%），即使两组均接种了新冠疫苗。有限的证据表明，接种疫苗后SMI患者的死亡风险高于对照组，但结果未达到统计学显著性。即使接种疫苗后，SMI患者出现与新冠相关后果的风险仍高于同龄人。接种疫苗似乎是预防SMI患者出现严重新冠疾病的有效方法，医疗服务提供者应采取行动提高这些弱势群体的疫苗接种覆盖率。
