Heightened COVID-19 Mortality in People With Severe Mental Illness Persists After Vaccination: A Cohort Study of Greater Manchester Residents (vol 49, pg 275, 2023)

Background and hypothesis Previous studies show that people with severe mental illness (SMI) are at higher risk of COVID-19 mortality, however limited evidence exists regarding risk post-vaccination. We investigated COVID-19 mortality among people with schizophrenia and other SMIs before, during and after the UK vaccine roll-out. Study Design Using the Greater Manchester (GM) Care Record to access routinely collected health data linked with death records, we plotted COVID-19 mortality rates over time in GM residents with schizophrenia/psychosis, bipolar disorder (BD) and/or recurrent major depressive disorder (MDD) from February 2020 to September 2021. Multivariable logistic regression was used to compare mortality risk (risk ratios; RRs) between people with SMI (N=190,188) and age-sex matched controls (N=760,752), adjusted for sociodemographic factors, pre-existing comorbidities and vaccination status.Study Results Mortality risks were significantly higher among people with SMI compared with matched controls, particularly among people with schizophrenia/psychosis (RR 3.14, CI 2.66-3.71) and/or BD (RR 3.17, CI 2.15-4.67). In adjusted models, the relative risk of COVID-19 mortality decreased, though remained significantly higher than matched controls for people with schizophrenia (RR 1.53, CI 1.24-1.88) and BD (RR 2.28, CI 1.49-3.49), but not recurrent MDD (RR 0.92, CI 0.78-1.09). People with SMI continued to show higher mortality rate ratios relative to controls throughout 2021, during vaccination roll-out. Conclusions People with SMI, notably schizophrenia and bipolar disorder, were at greater risk of COVID-19 mortality compared to matched controls. Despite population vaccination efforts that have prioritised people with SMI, disparities still remain in COVID-19 mortality for people with SMI.