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

Ranger, Tom Alan; Clift, Ash Kieran; Patone, Martina; Coupland, Carol A. C.; Hatch, Robert; Thomas, Karen; Watkinson, Peter; Hippisley-Cox, Julia

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.

Citation

Ranger, T. A., Clift, A. K., Patone, M., Coupland, C. A. C., Hatch, R., Thomas, K., Watkinson, P., & Hippisley-Cox, J. (2022). Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections. JAMA Psychiatry, 80(1), 57-65. https://doi.org/10.1001/jamapsychiatry.2022.3614

• Journal Article Type: Article
• Acceptance Date: Sep 14, 2022
• Online Publication Date: Nov 9, 2022
• Publication Date: Nov 9, 2022
• Deposit Date: Nov 16, 2022
• Publicly Available Date: Nov 16, 2022
• Journal: JAMA Psychiatry
• Print ISSN: 2168-622X
• Electronic ISSN: 2168-6238
• Publisher: American Medical Association
• Peer Reviewed: Peer Reviewed
• Volume: 80
• Issue: 1
• Pages: 57-65
• DOI: https://doi.org/10.1001/jamapsychiatry.2022.3614
• Keywords: Psychiatry and Mental health
• Public URL: https://nottingham-repository.worktribe.com/output/13747119
• Publisher URL: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2798511