Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19

A National Cohort Study

Guillaume Fond; Vanessa Pauly; Marc Leone; Pierre-Michel Llorca; Veronica Orleans; Anderson Loundou; Christophe Lancon; Pascal Auquier; Karine Baumstarck; Laurent Boyer

Disclosures

Schizophr Bull. 2021;47(3):624-634. 

In This Article

Results

Characteristics of the Patients

During the study period, 50 750 patients were included in the analysis (median age, 71 years [interquartile range, 57–83]; 43.2% female), with 823 SCZ patients (1.6%) and 49 927 non-SCZ patients (Figure 1, Table 1). SCZ patients were more likely to be female (51.2% vs 43.1%, P = .0005), to be younger (predominance of age between 65 and 80 years vs >80 years in controls), to be tobacco smokers (10.1% vs 4.2%, P < .0001), to be institutionalized (19.1% vs 9.7%, P < .0001), to have dementia (25.2% vs 9.6%, P < .0001), to be hospitalized in University hospitals (40.8% vs 33.1%, P < .0001), and to have a longer length of hospital stay (median [interquartile range], 11 [6–20] vs 9 [5–16], P < .0001) than controls. SCZ patients were less likely to have invasive care (ie, invasive mechanical ventilation: 10.7% vs 13.4%, P = .0443 and renal replacement therapy: 2.1% vs 3.6%, P = .0387) than controls.

Figure 1.

Flow chart.

In-hospital Mortality

The overall in-hospital mortality was 21.8%. The univariable analysis is presented in Supplementary Table S1. SCZ patients had an increased mortality compared to controls (25.6% vs 21.7%; P = .0188) (Table 1), confirmed by the multivariable analysis (adjusted OR, 1.30 [95% CI, 1.08–1.56]; P = .0093) (Table 2). There was a significant interaction between SCZ and age (P = .0006), with significantly increased mortality only for SCZ patients between 65 and 80 years (adjusted OR, 1.62 [95% CI, 1.27–2.06]; P = .0002). The characteristics of SCZ patients and controls according to age classes are presented in Table 3. The difference in in-hospital mortality between SCZ and controls varied with age as follows: <55 years: +3.65%; 55–65 years: +4.64%; 65–80 years: +7.89%; and >80 years: −3.17% (Figure 2). There was no heterogeneity in the interaction between SCZ and geographical areas of hospitalization (P = .0797).

Figure 2.

In-hospital mortality by age classes. <55 years: P = .0643; ≥55 and <65 years: P = .1083; ≥65 and <80 years: P = .0063; >80 years: P = .3762.

ICU Admission

A total of 14 351 patients (28.3%) were admitted to the ICU. The univariable analysis is presented in Supplementary Table S2. SCZ patients were less frequently admitted to the ICU than controls (23.7% vs 28.4%; P = .0113) (Table 1), confirmed by the multivariable analysis (adjusted OR, 0.75 [95% CI, 0.62–0.91]; P = .0062) (Table 2). There was a significant interaction between SCZ and age (P < .0001), with more ICU admissions for SCZ patients younger than 55 years (adjusted OR, 1.58 [95% CI, 1.09–2.30]; P = .0177) and less ICU admissions for SCZ patients between 65 and 80 years (adjusted OR, 0.53 [95% CI, 0.41–0.70]; P < .001) and older than 80 years (adjusted OR, 0.51 [95% CI, 0.29–0.88]; P = .0168). The difference in ICU admission between SCZ patients and controls varied with age as follows: <55 years: +13.93%; 55–65 years: −2.84%; 65–80 years: −15.44%; and >80 years: −5.93% (Figure 3). There was no heterogeneity in the interaction between SCZ and geographical areas of hospitalization (P = .0591).

Figure 3.

ICU admission by age classes. <55 years: P = .0055; ≥55 and <65 years: P = .5175; ≥65 and <80 years: P < .0001; >80 years: P = .0246.

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