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. 2023 Jan 1;80(1):57-65.
doi: 10.1001/jamapsychiatry.2022.3614.

Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections

Tom Alan Ranger  1 , Ash Kieran Clift  1   2 , Martina Patone  1 , Carol A C Coupland  1   3 , Robert Hatch  4 , Karen Thomas  5 , Peter Watkinson  4 , Julia Hippisley-Cox  1
Affiliations

Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections

Tom Alan Ranger et al. JAMA Psychiatry. .

Abstract

Importance: Evidence indicates that preexisting neuropsychiatric conditions confer increased risks of severe outcomes from COVID-19 infection. It is unclear how this increased risk compares with risks associated with other severe acute respiratory infections (SARIs).

Objective: To determine whether preexisting diagnosis of and/or treatment for a neuropsychiatric condition is associated with severe outcomes from COVID-19 infection and other SARIs and whether any observed association is similar between the 2 outcomes.

Design, setting, and participants: Prepandemic (2015-2020) and contemporary (2020-2021) longitudinal cohorts were derived from the QResearch database of English primary care records. Adjusted hazard ratios (HRs) with 99% CIs were estimated in April 2022 using flexible parametric survival models clustered by primary care clinic. This study included a population-based sample, including all adults in the database who had been registered with a primary care clinic for at least 1 year. Analysis of routinely collected primary care electronic medical records was performed.

Exposures: Diagnosis of and/or medication for anxiety, mood, or psychotic disorders and diagnosis of dementia, depression, schizophrenia, or bipolar disorder.

Main outcomes and measures: COVID-19-related mortality, or hospital or intensive care unit admission; SARI-related mortality, or hospital or intensive care unit admission.

Results: The prepandemic cohort comprised 11 134 789 adults (223 569 SARI cases [2.0%]) with a median (IQR) age of 42 (29-58) years, of which 5 644 525 (50.7%) were female. The contemporary cohort comprised 8 388 956 adults (58 203 severe COVID-19 cases [0.7%]) with a median (IQR) age of 48 (34-63) years, of which 4 207 192 were male (50.2%). Diagnosis and/or treatment for neuropsychiatric conditions other than dementia was associated with an increased likelihood of a severe outcome from SARI (anxiety diagnosis: HR, 1.16; 99% CI, 1.13-1.18; psychotic disorder diagnosis and treatment: HR, 2.56; 99% CI, 2.40-2.72) and COVID-19 (anxiety diagnosis: HR, 1.16; 99% CI, 1.12-1.20; psychotic disorder treatment: HR, 2.37; 99% CI, 2.20-2.55). The effect estimate for severe outcome with dementia was higher for those with COVID-19 than SARI (HR, 2.85; 99% CI, 2.71-3.00 vs HR, 2.13; 99% CI, 2.07-2.19).

Conclusions and relevance: In this longitudinal cohort study, UK patients with preexisting neuropsychiatric conditions and treatments were associated with similarly increased risks of severe outcome from COVID-19 infection and SARIs, except for dementia.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Clift reported receiving grants from Cancer Research UK during the conduct of the study. Dr Coupland reported receiving grants from Wellcome Trust, John Fell Oxford University Press Research Fund, Oxford Wellcome Institutional Strategic Support Fund, and Cancer Research UK during the conduct of the study. Dr Hatch reported receiving grants from Wellcome Trust and the National Institute for Health and Care Research (NIHR) doctoral research fellowship during the conduct of the study. Ms Thomas reported receiving grants from Wellcome Trust during the conduct of the study. Dr Watkinson reported receiving grants from Wellcome Trust, NIHR, and Sensyne Health; personal fees from Sensyne Health; being a chief medical officer for Sensyne Health; and holding shares in Sensyne Health outside the submitted work. Dr Hippisley-Cox reported receiving grants from Wellcome Trust, Medical Research Council, and the John Fell Fund; nonfinancial support from QResearch as director of QResearch; being a founder, shareholder, and previous director of ClinRisk Ltd, a software company; and being a current work member of Scientific Advisory Group for Emergencies committee for the UK government. No other disclosures were reported.

Figures

Figure.
Figure.. Forest Plot Showing Effect Estimates From Maximally Adjusted Survival Analyses of the Likelihood of Severe Acute Respiratory Infection (SARI) or COVID-19 Infection in People With a Diagnosed Neuropsychiatric Condition or Corresponding Pharmacological Treatment
HR indicates hazard ratio.
See this image and copyright information in PMC

References

    1. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533-534. doi:10.1016/S1473-3099(20)30120-1 - DOI - PMC - PubMed
    1. Clift AK, Ranger TA, Patone M, et al. . Neuropsychiatric ramifications of severe COVID-19 and other severe acute respiratory infections. JAMA Psychiatry. 2022;79(7):690-698. doi:10.1001/jamapsychiatry.2022.1067 - DOI - PMC - PubMed
    1. Fond G, Nemani K, Etchecopar-Etchart D, et al. . Association between mental health disorders and mortality among patients with COVID-19 in 7 countries: a systematic review and meta-analysis. JAMA Psychiatry. 2021;78(11):1208-1217. doi:10.1001/jamapsychiatry.2021.2274 - DOI - PMC - PubMed
    1. Ceban F, Nogo D, Carvalho IP, et al. . Association between mood disorders and risk of COVID-19 infection, hospitalization, and death: a systematic review and meta-analysis. JAMA Psychiatry. 2021;78(10):1079-1091. doi:10.1001/jamapsychiatry.2021.1818 - DOI - PMC - PubMed
    1. Pardamean E, Roan W, Iskandar KTA, Prayangga R, Hariyanto TI. Mortality from coronavirus disease 2019 (COVID-19) in patients with schizophrenia: a systematic review, meta-analysis and meta-regression. Gen Hosp Psychiatry. 2022;75:61-67. doi:10.1016/j.genhosppsych.2022.01.010 - DOI - PMC - PubMed

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