How different pre-existing mental disorders and their co-occurrence affects clinical outcomes of COVID-19? A study based on real-world data in the Southern United States

ImportanceA growing body of research focuses on the impact of pre-existing mental disorders on clinical outcomes of COVID-19 illness. Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. ObjectiveTo explore how different pre-existing mental disorders and their co-occurrence affects COVID-19-related clinical outcomes based on real-world data. Design, Setting, and ParticipantsUsing a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Main Outcomes and MeasuresKey COVID-19 clinical outcomes included severity, hospitalization, and death. COVID-19 severity was defined as asymptomatic, mild, and moderate/severe. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients healthcare utilization data via ICD-10 codes. Mental disorders were categorized into internalizing disorders, externalizing disorders, and thought disorders. ResultsOf the 476,775 COVID-19 patients, 55,300 had pre-existing mental disorders. There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic covariates (i.e., age, gender, race, ethnicity, residence, smoking). Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 2.50 (95%CI 2.284, 2.728) for patients with internalizing and externalizing disorders, 3.34 (95%CI 2.637, 4.228) for internalizing and thought disorders, 3.29 (95%CI 2.288, 4.733) for externalizing and thought disorders, and 3.35 (95%CI 2.604, 4.310) for three clusters of mental disorders. Conclusions and RelevancePre-existing internalizing disorders, externalizing disorders, and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.

Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

BackgroundCurrent literature examining the clinical characteristics of COVID-19 patients under-represent COVID-19 cases who were either asymptomatic or had a mild illness. ObjectiveTo generate a state-level description and examine the demographic disparities of clinical outcomes of COVID-19. DesignStatewide population-based cohort study SettingCOVID-19 surveillance facilities in South Carolina PatientsAdults COVID-19 cases reported to the SC DHEC by Case Report Form during March 04-December 31, 2020 MeasurementsThe primary predictors were socio-demographic characteristics. The outcomes were COVID-19 disease severity, hospitalization, and mortality, which collected from the standardized CRF. ResultsAmong a total of 280,177 COVID-19 cases, 5.2% (14,451) were hospitalized and 1.9% (5,308) died. Individuals who were older, male gender, Blacks, Hispanic or Latino, and residing in small towns had higher odds for hospitalization and death from COVID-19 (Ps<0.0001). Regarding disease severity, 144,157 (51.5%) were asymptomatic, while 34.4% and 14.2% had mild and moderate/severe symptoms, respectively. Older individuals (OR: 1.14, 95%CI: 1.11, 1.18), Hispanic or Latino (OR: 2.07; 95%CI: 1.96, 2.18), and people residing in small towns (OR: 1.15; 95%CI: 1.08, 1.23) had higher odds of experiencing moderate/severe symptoms, while male and Asian (vs Whites) patients had lower odds of experiencing moderate/severe symptoms. LimitationsPotential misclassification of outcomes due to missing data; other variables were not evaluated, such as comorbidities. ConclusionAs the first statewide population-based study using data from multiple healthcare systems with a long follow-up period in the US, we provide a more generalizable picture of COVID-19 symptoms and clinical outcomes. The findings from this study reinforce the fact that rural residence, racial and ethnic social determinants of health, unfortunately, remain predictors of poor health outcomes for COVID-19 patients.