TY - JOUR
T1 - Severe mental illness, race/ethnicity, multimorbidity and mortality following COVID-19 infection
T2 - nationally representative cohort study
AU - Das-Munshi, Jayati
AU - Bakolis, Ioannis
AU - Bécares, Laia
AU - Dyer, Jacqueline
AU - Hotopf, Matthew
AU - Ocloo, Josephine
AU - Stewart, Robert
AU - Stuart, Ruth
AU - Dregan, Alex
N1 - Funding Information:
The funder for the study was the Health Foundation (award reference 2238180). J.O. and R. Stuart were funded by the Health Foundation (award reference 2238180). J.D.-M. is part supported by the Economic and Social Research Council (ESRC) Centre for Society and Mental Health at King's College London (ESRC reference: ES/S012567/1). J.O. and J.D.-M. are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King's College Hospital NHS Foundation Trust. M.H., R. Stewart, A.D. and J.D.-M. are supported by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. L.B. is supported by the Nuffield Foundation (grant number WEL/43881), the ESRC (grant numbers ES/V013475/1 and ES/W000849/1) and the Health Foundation (grant number AIMS 1874695). The views expressed are those of the authors and not necessarily those of the ESRC, NIHR or King's College London.
Funding Information:
The funder for the study was the Health Foundation (award reference 2238180). J.O. and R. Stuart were funded by the Health Foundation (award reference 2238180). J.D.-M. is part supported by the Economic and Social Research Council (ESRC) Centre for Society and Mental Health at King’s College London (ESRC reference: ES/S012567/1). J.O. and J.D.-M. are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College Hospital NHS Foundation Trust. M.H., R. Stewart, A.D. and J.D.-M. are supported by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. L.B. is supported by the Nuffield Foundation (grant number WEL/43881), the ESRC (grant numbers ES/V013475/1 and ES/W000849/1) and the Health Foundation (grant number AIMS 1874695). The views expressed are those of the authors and not necessarily those of the ESRC, NIHR or King’s College London.
Publisher Copyright:
© The Author(s), 2023.
PY - 2023/11/25
Y1 - 2023/11/25
N2 - BACKGROUND: The association of COVID-19 with death in people with severe mental illness (SMI), and associations with multimorbidity and ethnicity, are unclear. AIMS: To determine all-cause mortality in people with SMI following COVID-19 infection, and assess whether excess mortality is affected by multimorbidity or ethnicity. METHOD: This was a retrospective cohort study using primary care data from the Clinical Practice Research Database, from February 2020 to April 2021. Cox proportional hazards regression was used to estimate the effect of SMI on all-cause mortality during the first two waves of the COVID-19 pandemic. RESULTS: Among 7146 people with SMI (56% female), there was a higher prevalence of multimorbidity compared with the non-SMI control group (n = 653 024, 55% female). Following COVID-19 infection, the SMI group experienced a greater risk of death compared with controls (adjusted hazard ratio (aHR) 1.53, 95% CI 1.39-1.68). Black Caribbean/Black African people were more likely to die from COVID-19 compared with White people (aHR = 1.22, 95% CI 1.12-1.34), with similar associations in the SMI group and non-SMI group (P for interaction = 0.73). Following infection with COVID-19, for every additional multimorbidity condition, the aHR for death was 1.06 (95% CI 1.01-1.10) in the SMI stratum and 1.16 (95% CI 1.15-1.17) in the non-SMI stratum (P for interaction = 0.001). CONCLUSIONS: Following COVID-19 infection, patients with SMI were at an elevated risk of death, further magnified by multimorbidity. Black Caribbean/Black African people had a higher risk of death from COVID-19 than White people, and this inequity was similar for the SMI group and the control group.
AB - BACKGROUND: The association of COVID-19 with death in people with severe mental illness (SMI), and associations with multimorbidity and ethnicity, are unclear. AIMS: To determine all-cause mortality in people with SMI following COVID-19 infection, and assess whether excess mortality is affected by multimorbidity or ethnicity. METHOD: This was a retrospective cohort study using primary care data from the Clinical Practice Research Database, from February 2020 to April 2021. Cox proportional hazards regression was used to estimate the effect of SMI on all-cause mortality during the first two waves of the COVID-19 pandemic. RESULTS: Among 7146 people with SMI (56% female), there was a higher prevalence of multimorbidity compared with the non-SMI control group (n = 653 024, 55% female). Following COVID-19 infection, the SMI group experienced a greater risk of death compared with controls (adjusted hazard ratio (aHR) 1.53, 95% CI 1.39-1.68). Black Caribbean/Black African people were more likely to die from COVID-19 compared with White people (aHR = 1.22, 95% CI 1.12-1.34), with similar associations in the SMI group and non-SMI group (P for interaction = 0.73). Following infection with COVID-19, for every additional multimorbidity condition, the aHR for death was 1.06 (95% CI 1.01-1.10) in the SMI stratum and 1.16 (95% CI 1.15-1.17) in the non-SMI stratum (P for interaction = 0.001). CONCLUSIONS: Following COVID-19 infection, patients with SMI were at an elevated risk of death, further magnified by multimorbidity. Black Caribbean/Black African people had a higher risk of death from COVID-19 than White people, and this inequity was similar for the SMI group and the control group.
KW - COVID-19
KW - ethnicity
KW - Mortality
KW - multimorbidity
KW - severe mental illness
UR - http://www.scopus.com/inward/record.url?scp=85175661424&partnerID=8YFLogxK
U2 - 10.1192/bjp.2023.112
DO - 10.1192/bjp.2023.112
M3 - Article
C2 - 37876350
AN - SCOPUS:85175661424
SN - 0007-1250
VL - 223
SP - 518
EP - 525
JO - The British journal of psychiatry : the journal of mental science
JF - The British journal of psychiatry : the journal of mental science
IS - 5
ER -