Infectious Disease

COVID-19 vaccination rates for schizophrenia lower despite increased risks

August 11, 2021

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Disclosure:
Bitan reports that he has received a research grant from Pfizer and the American Psychological Foundation. Please refer to the study for all relevant financial information from the other authors. De Picker does not report any relevant financial information.

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People with schizophrenia had lower COVID-19 vaccination rates than the general population, although they had a higher risk of hospitalization and mortality, according to a longitudinal study.

“In two cross-sectional studies published in 2021, we reported an association between schizophrenia and COVID-19 hospitalization and mortality, and an association between schizophrenia and reduced chances of vaccination.” Dana Tzur Bitan, PhD, of the Behavioral Science Department at Ariel University in Israel, and colleagues wrote in The Lancet Psychiatry. “However, to the best of our knowledge, no study has examined the longitudinal trends of these effects over time in this patient population. Therefore, this study aimed to enable a longitudinal assessment of hospital stays, mortality and vaccination as well as the assessment of the results before and after vaccination. ”

Infographic data derived from: Bitan DT, et al. Lancet psychiatry. 2021; doi: 10.1016 / S2215-0366 (21) 00256-X.

The researchers evaluated the pre-vaccination and post-vaccination results in 25,539 people with schizophrenia compared to 25,539 control subjects (total participants, 61% men; mean age 51.94 years) in Israel as of April 30. They performed Cox proportional hazard regression models and Kaplan. by -Meier analyzes to evaluate longitudinal trends. They obtained data through databases from Israel’s largest health organization. A total of 75.9% of the sample came from the general Jewish population, 19.1% from the Arab population, and 5.1% from the Jewish ultra-Orthodox population.

Of the total study population, 356 (0.7%) people had been hospitalized, 133 (0.3%) had died and 27,400 (53.6%) had been vaccinated. Those with schizophrenia were at increased risk for COVID-19 hospitalization (HR = 4.81; 95% CI 3.57-6.48) and mortality (HR = 2.52; 95% CI, 1.64 -3.85) as well as a more significant decrease in survival as time progressed. Those in the control group showed a greater increase in the likelihood of vaccination. Significant predictors of vaccination rates in the schizophrenia group included medical comorbidity of diabetes, hypertension, obesity, or ischemic heart disease (all, P <0.0001); however, these did not serve as significant predictors in the control group. Although the differences in hospitalization and mortality remained higher in non-vaccinated persons with schizophrenia compared to the control persons (incidence rate difference = 6.2 and 3.2, respectively), they decreased significantly in fully vaccinated groups (incidence rate difference = 1.1 and –0, respectively , 9).

“This study did not control psychiatric clinical factors such as drug exposure, duration of illness, or inpatient status,” wrote Bitan and colleagues. “Future studies should evaluate the predictive effects of these factors on vaccination rates. Taken together, the results emphasize the importance of empowering people with severe mental illness to have better prevention strategies in order to provide better care for those with severe mental illness. “

In a related editorial Livia J. De Picker, MD, a psychiatrist and postdoctoral fellow at Duffel University Psychiatric Hospital in Belgium noted that the pandemic presents a “unique opportunity” for certain psychiatric research opportunities.

“The pandemic offers a unique opportunity to understand the individual (e.g. clinical predictors of risk groups), mental health care (e.g. treatment setting) and macro-organizational (e.g. the country’s health system) determinants of COVID-19 – To study outcomes and vaccine intake in patients with mental disorders, ”wrote De Picker. “I consider this a priority on the research agenda of mental health researchers around the world. Evidence is a prerequisite for effective action during and after the COVID-19 pandemic. “

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