Schizophrenia worsens COVID-19 hospitalization and mortality, reduces vaccination rate

A recent cohort study showed an increased risk of coronavirus disease 2019 (COVID-19) hospitalization and mortality as well as a lower rate of vaccination in individuals with schizophrenia compared with the general population.

“People with schizophrenia are frequently diagnosed with medical comorbidities and have a reduce life expectancy. This, coupled with the emergence of COVID-19 and other barriers to medical attention, might have resulted in stable and long-lasting inequalities compared with the general population, as shown in our study,” suggested the authors. [Lancet Psychiatry 2021;S2215-0366(21)00256-X]

“Further, the association between presence of medical comorbidities and increased vaccination rate demonstrated in the study suggests the possible role of medical caretakers in facilitating such outreach when medically imperative. Future studies are required to assess the benefits of family members or mental health workers in providing such facilitation,” the authors added.

In the study, data of a total of 51,078 adults (male, 61.0 percent; mean age, 51.94 years; Jewish, 75.9 percent) with schizophrenia and matched controls were extracted from the Clalit Health Services (CHS) registry before and after vaccination up to 30 April 2021. The CHS is the largest healthcare organization in Israel and provides health services to >50 percent of the country’s population.

Of all participants in the study, 0.7 percent (n=356) were hospitalized in a COVID-19 hospital unit during the first year of the pandemic, of whom 83.7 percent (n=298) were adults with schizophrenia. The mortality rate due to COVID-19 was 0.3 percent, with 75 percent (n=100) of deaths occurring in adults with schizophrenia.

Adults with schizophrenia vs controls had a 4.81-fold and a 2.52-fold increase in risk of COVID-19 hospitalization (95 percent confidence interval [Cl], 3.57 to 6.48; p<0.001) and mortality (95 percent CI, 1.64 to 3.85; p<0.0001), respectively, after adjustments for confounders. The decline in COVID-19 survival rate was significantly shaper in adults with schizophrenia than in controls (both p<0.0001).

Since the launch of the national COVID-19 vaccination plan in Israel and up until the beginning of March 2021, 53.6 percent of all participants in the study had received COVID-19 vaccination, with a 2.2 percent difference in vaccination rate between adults with schizophrenia (50.6 percent) and controls (52.8 percent).

Adults with schizophrenia were significantly less inclined for vaccination compared with controls during the first 3 months of the vaccination plan (log-rank test 309.88; p<0.001).

Medical comorbidities of diabetes, hypertension, obesity and ischaemic heart disease played a significant role in predicting vaccination rates in the schizophrenia group (all p<0.0001), but not in the control group.

The difference in incidence of COVID-19 hospitalization and mortality between adults with schizophrenia and controls among non-vaccinated individuals was 6.2 and 3.2, respectively, with the differences in rates substantially declining following vaccination (1.1 and -0.9, respectively).