Deaths with COVID-19 and from all-causes following first-ever SARS-CoV-2 infection in individuals with preexisting mental disorders: A national cohort study from Czechia

• Published in: PLoS medicine 2024-07, Vol.21 (7), p.e1004422
• Main Authors: Formánek, Tomáš, Potočár, Libor, Wolfova, Katrin, Melicharová, Hana, Mladá, Karolína, Wiedemann, Anna, Chen, Danni, Mohr, Pavel, Winkler, Petr, Jones, Peter B, Jarkovský, Jiří
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Betacoronavirus; Biology and life sciences; Cause of Death; Cohort Studies; Comorbidity; Coronavirus Infections - complications; Coronavirus Infections - epidemiology; Coronavirus Infections - mortality; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - mortality; Czech Republic - epidemiology; Death of; Female; Humans; Male; Medicine and Health Sciences; Mental Disorders - epidemiology; Mentally ill; Middle Aged; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - epidemiology; Pneumonia, Viral - mortality; Registries; SARS-CoV-2; Statistics; Young Adult
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1004422

Evidence suggests reduced survival rates following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in people with preexisting mental disorders, especially psychotic disorders, before the broad introduction of vaccines. It remains unknown whether this elevated mortality risk persisted at later phases of the pandemic and when accounting for the confounding effect of vaccination uptake and clinically recorded physical comorbidities. We used data from Czech national health registers to identify first-ever serologically confirmed SARS-CoV-2 infections in 5 epochs related to different phases of the pandemic: 1st March 2020 to 30th September 2020, 1st October 2020 to 26th December 2020, 27th December 2020 to 31st March 2021, 1st April 2021 to 31st October 2021, and 1st November 2021 to 29th February 2022. In these people, we ascertained cases of mental disorders using 2 approaches: (1) per the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes for substance use, psychotic, affective, and anxiety disorders; and (2) per ICD-10 diagnostic codes for the above mental disorders coupled with a prescription for anxiolytics/hypnotics/sedatives, antidepressants, antipsychotics, or stimulants per the Anatomical Therapeutic Chemical (ATC) classification codes. We matched individuals with preexisting mental disorders with counterparts who had no recorded mental disorders on age, sex, month and year of infection, vaccination status, and the Charlson Comorbidity Index (CCI). We assessed deaths with Coronavirus Disease 2019 (COVID-19) and from all-causes in the time period of 28 and 60 days following the infection using stratified Cox proportional hazards models, adjusting for matching variables and additional confounders. The number of individuals in matched-cohorts ranged from 1,328 in epoch 1 to 854,079 in epoch 5. The proportion of females ranged from 34.98% in people diagnosed with substance use disorders in epoch 3 to 71.16% in individuals diagnosed and treated with anxiety disorders in epoch 5. The mean age ranged from 40.97 years (standard deviation [SD] = 15.69 years) in individuals diagnosed with substance use disorders in epoch 5 to 56.04 years (SD = 18.37 years) in people diagnosed with psychotic disorders in epoch 2. People diagnosed with or diagnosed and treated for psychotic disorders had a consistently elevated risk of dying with COVID-19 in epochs 2, 3, 4, and 5, with adjusted hazard ratios (aHRs) ranging from