Schizophrenia Patients Face Longer Hospitalization Stays for Non-Psychiatric Conditions

Patients with schizophrenia are more likely to be admitted for hospital stays—and experience lengthier durations of stay and therefore, costlier care—for conditions including sepsis, COPD exacerbation, and pneumonia.

According to a data analysis presented at the American Psychiatric Association (APA) 2024 Annual Meeting in New York, NY, this week, investigators reported findings highlighting a significantly disparate hospitalization experience for patients with schizophrenia when presenting with non-psychiatric conditions for emergent care. The data may allude to potential pursuits in qualitative research that can better identify the drivers of elongated and exacerbated hospital stays experienced by patients with schizophrenia.

The research team conducted a retrospective analysis to identify the most common reasons for hospital admissions among patients with schizophrenia. As they noted, such patients have a well-evidenced shorter life span than the general population—up to 20 years on average, according to research. But their shorter life spans are often due to illnesses beyond their psychiatric condition.

“Understanding the most common causes of hospitalization in patients with mental illness could provide clues on how to improve preventive health monitor adverse effects of medications and provide better in-hospital care,” the team wrote.

Investigators compiled state-level inpatient hospitalization data for adults aged ≥18 years old between 2016 - 2019 from the National Inpatient Sample (NIS) database. They identified the 10 most common primary diagnoses for hospital admission of patients with and without schizophrenia based on the data, before conducting a multivariate logistic regression to assess the impact of schizophrenia on the odds of being admitted with each of the top 10 primary diagnoses.

They then analyzed proportions for each diagnosis, as well as odds ratios (ORs) for admission while excluding for schizophrenia-based admissions to fully interpret the drivers of non-psychiatric hospital admissions among patients with schizophrenia. Lastly, they compared the characteristics, lengths of stay, and in-hospital mortality of patients with each diagnosis across the schizophrenia and control cohorts.

Their final analysis showed schizophrenia-related diagnoses accounted for only one-third (35%) of hospital admissions among such patients, compared to 65% of admissions being due to other causes. Among the primary diagnoses to be 1 of the 10 most prevalent in both hospitalized patients with and without schizophrenia included:

• Sepsis
• COPD exacerbation
• Acute renal failure
• Pneumonia
• Urinary tract infection (UTI)
• Hypertensive heart failure

The other most prevalent primary diagnoses in patients with schizophrenia included hyponatremia, aspiration pneumonia, and acute hypoxic respiratory failure. Patients without schizophrenia were more likely to be admitted to the hospital due to non-ST-elevation myocardial infarction or knee osteoarthritis than patients with schizophrenia.

Investigators found that patients with schizophrenia were significantly more likely to be admitted for most of the observed medical illnesses, except for heart failure and acute renal failure. Though patients with schizophrenia were likely to die from sepsis, acute hypoxic respiratory failure and aspiration pneumonia than the control cohort, they were also shown to have significantly longer lengths of hospital stay for all diagnoses, as well as greater costs of care for most diagnoses.

The data elucidated a tendency for patients with schizophrenia to experience a more difficult hospitalization—despite their non-psychiatric diagnoses trending similarly to hospitalized patients without schizophrenia.

“Our results can guide future directions for targeting disparities in healthcare for patients with schizophrenia and illustrate possible areas of research,” investigators concluded.

References

1. ^{Venkataramanan A, et al. Most common causes of nonpsychiatric hospitalizations in patients with schizophrenia in the United States. Paper presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4-8, 2024.}
2. ^{Peritogiannis V, Ninou A, Samakouri M. Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management. Healthcare (Basel). 2022;10(12):2366. Published 2022 Nov 25. doi:10.3390/healthcare10122366}