Background

Individuals with schizophrenia have an increased risk of severe COVID-19 outcomes, nonetheless, no previous study has provided a year-long account of this risk, or assessed postvaccination trends in this population. This study assessed temporal trends in COVID-19 hospitalisation and mortality among people with schizophrenia during the first year of the pandemic, the predictors for COVID-19 vaccination, postvaccination infection, admission to hospital, and mortality.

Methods

In this longitudinal cohort study, people with schizophrenia (n=25 539) and controls (n=25 539) were assessed for COVID-19 outcomes before and after vaccination, up to April 30, 2021. Cox proportional hazard regression models and Kaplan-Meier analyses were done to assess longitudinal trends. The study used the databases of Clalit Health Services, the largest health-care organisation in Israel.

Findings

The sample included 51 078 participants, of which 31 141 (61·0%) male and 19 937 (39·0%) female participants, with a mean age of 51·94 years (SD 15·62). Most of the sample was from the general Jewish population (75·9%), followed by the Arab (19·1%) and Jewish Ultraorthodox population (5·1%). Overall of 51 078 individuals, 356 (0·7%) people had been hospitalised, 133 (0·3%) had died, and a total of 27 400 (53·6%) had been vaccinated. People with schizophrenia showed a higher risk for COVID-19 hospitalisation (HR 4·81, 95% CI 3·57–6·48, p<0·0001) and mortality (HR 2·52, 95% CI 1·64–3·85, p<0·0001), and showed a sharper decline in survival as time progressed. The control group showed a sharper incline in probability to vaccinate (log-rank=309·88, p<0·0001). Medical comorbidity of diabetes, hypertension, obesity, or 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. Hospitalisation and mortality disparities remained higher among people with schizophrenia who had not been vaccinated in comparison to controls (incidence rate difference of 6·2 and 3·2, respectively) but substantially declined in fully vaccinated groups (incidence rate difference of 1·1 and −0·9, respectively).

Interpretation

People with schizophrenia have higher hospitalisation and mortality risk, yet have lower rates of vaccination than in the general population. Disparities in COVID-19 severe outcomes can be substantially reduced by national vaccination plans aimed at actively reaching out to people with schizophrenia.

Funding

No funding.

中文翻译：

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以色列精神分裂症患者的 COVID-19 住院、死亡率、疫苗接种和疫苗接种后趋势：一项纵向队列研究

背景

精神分裂症患者发生 COVID-19 严重后果的风险增加，但是，之前的研究没有提供这种风险的长达一年的说明，或评估该人群的疫苗接种后趋势。本研究评估了大流行第一年精神分裂症患者 COVID-19 住院和死亡率的时间趋势、COVID-19 疫苗接种、疫苗接种后感染、住院和死亡率的预测因素。

方法

在这项纵向队列研究中，截至 2021 年 4 月 30 日，对精神分裂症患者（n=25539）和对照组（n=25539）的 COVID-19 结果进行了评估，直至 2021 年 4 月 30 日。进行迈耶分析以评估纵向趋势。该研究使用了以色列最大的医疗保健组织 Clalit Health Services 的数据库。

发现

样本包括 51 078 名参与者，其中男性 31 141 (61·0%) 名和女性 19 937 (39·0%) 名参与者，平均年龄为 51·94 岁 (SD 15·62)。大部分样本来自一般犹太人口 (75·9%)，其次是阿拉伯人 (19·1%) 和犹太极端正统派 (5·1%)。总共有 51 078 人，其中 356 人 (0·7%) 住院，133 人 (0·3%) 死亡，总共 27 400 人 (53·6%) 接种了疫苗。精神分裂症患者的 COVID-19 住院风险较高（HR 4·81，95% CI 3·57–6·48，p<0·0001）和死亡率（HR 2·52，95% CI 1·64-） 3·85，p<0·0001)，随着时间的推移，存活率下降得更厉害。对照组在接种疫苗的可能性方面表现出更急剧的倾斜（log-rank=309·88，p<0·0001）。糖尿病、高血压、肥胖症的合并症，或缺血性心脏病在预测精神分裂症组的疫苗接种率方面发挥了重要作用（所有 p<0·0001），但在对照组中没有。与对照组相比，未接种疫苗的精神分裂症患者的住院率和死亡率差异仍然更高（发病率差异分别为 6·2 和 3·2），但在完全接种疫苗组中大幅下降（发病率差异为 1·1 和−0·9，分别）。

解释

精神分裂症患者的住院和死亡风险较高，但疫苗接种率低于一般人群。通过旨在积极接触精神分裂症患者的国家疫苗接种计划，可以大大减少 COVID-19 严重后果的差异。

资金

没有资金。