Table_1_Death Associated With Coronavirus (COVID-19) Infection in Individuals With Severe Mental Disorders in Sweden During the Early Months of the Outbreak—An Exploratory Cross-Sectional Analysis of a Population-Based Register Study.doc

Background: Individuals with severe mental disorder (SMD) have a higher risk of somatic comorbidity and mortality than the rest of the population. We set up a population-based study to assess whether individuals with SMD had a higher risk of death associated with a COVID-19 infection (COVID-19 associated death) than individuals without SMD.
Methods: Exploratory analysis with a cross-sectional design in the framework of a population-based register study covering the entire Swedish population. The Swedish Board for Health and Welfare (Socialstyrelsen) provided anonymized tabulated summary data for further analysis. We compared numbers of COVID-19 associated death in individuals with SMD (cases) and without SMD (controls). We calculated the odds ratio (OR) for the whole sample and by age group and four comorbidities, namely diabetes, cardiovascular disease, hypertension, chronic lung disease.
Results: The sample comprised of 7,923,859 individuals, 103,999 with SMD and 7,819,860 controls. There were 130 (0.1%) COVID-19 associated deaths in the SMD group and 4,945 (0.06%) in the control group, corresponding to an OR of 1.98 (CI 1.66-2.35; p < 0.001). The odds were 4-fold for the age groups between 60 and 79 years and 1.5-fold for cardiovascular diseases. Individuals with SMD without any of the risk factors under study had 3-fold odds of COVID-19 associated death.
Conclusion: Our preliminary results identify individuals with SMD as a further group at increased risk of COVID-19 associated death. In regard to comorbidities, future studies should explore the potential confounding or mediation role in the relationship between SMD and COVID-19 associated deaths.

研究背景：严重精神障碍（Severe Mental Disorder, SMD）患者相较于普通人群，躯体共病与死亡风险均更高。本研究开展基于人群的研究，旨在评估严重精神障碍患者是否较非严重精神障碍人群，具有更高的新冠病毒感染相关死亡（COVID-19 associated death）风险。
研究方法：本研究为覆盖全瑞典人群的基于人群登记研究框架下的横断面探索性分析。瑞典卫生与福利署（Socialstyrelsen）提供了匿名汇总制表数据以供后续分析。本研究对比了严重精神障碍患者（病例组）与非严重精神障碍人群（对照组）的新冠感染相关死亡例数。分别计算全样本以及按年龄组与4种共病（糖尿病、心血管疾病、高血压、慢性肺部疾病）分组的比值比（Odds Ratio, OR）。
研究结果：本研究样本共计7923859名个体，其中严重精神障碍患者103999名，对照组7819860名。严重精神障碍组中共计130例新冠感染相关死亡（占比0.1%），对照组为4945例（占比0.06%），对应比值比为1.98（置信区间1.66~2.35；p < 0.001）。60~79岁年龄组的死亡比值比为对照组的4倍，合并心血管疾病者的死亡比值比为对照组的1.5倍。未携带本研究提及的任一危险因素的严重精神障碍患者，其新冠感染相关死亡的比值比为3。
研究结论：本初步研究结果表明，严重精神障碍患者是新冠感染相关死亡风险升高的又一高危人群。针对共病因素，未来研究应进一步探讨其在严重精神障碍与新冠感染相关死亡关联中的混杂或中介作用。