Severe mental illnesses, race/ ethnicity, multimorbidity and mortality following COVID-19 infection: Nationally representative cohort study

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Background: The association of COVID-19 with death in people with severe mental illnesses (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 (CPRD) from February 2020 to April 2021. Cox proportional hazards regression was used to estimate the impact of SMI on all-cause mortality during the first two-waves of the COVID-19 pandemic.
Results: Among 7,146 people with SMI (56% female), there was a higher prevalence of multimorbidity compared to the non-SMI control group (N=653,024, 55% female). Following COVID-19 infection, the SMI group experienced a greater risk of death compared to controls (adjusted hazard ratio (aHR)=1.53, 95% confidence interval (CI), 1.39-1.68). Black Caribbean/ Black African people were more likely to die from COVID-19 compared with the White reference group (aHR: 1.22 (95% CI, 1.12-1.34), with similar associations in the SMI group and non-SMI group (p-value 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-value for interaction=0.001).
Conclusions: Following COVID-19 infection, patients living 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 relative to the White reference group, this inequity was similar for the SMI and the control group.
Original languageEnglish
JournalBritish Journal of Psychiatry
Publication statusAccepted/In press - 5 Aug 2023

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