Schizophrenia hospitalization in the US 2005–2014

Abstract

Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost. In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t -test, and adjusted linear regression trend. Hospitalizations were most prevalent for individuals ages 45–64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71–9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790–1142/100,000 admissions, while the US 2010 census standardized rates were 380–552/100,000 from 2005–2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender ( P > .001). The hospitalizations’ overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased ( P < .001). From 2005–2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.

Electroconvulsive therapy is associated with lower readmission rates in patients with schizophrenia

“…It is possible that shorter inpatient LOS might mean inadequate treatment which leads to poorer outcomes. However, the mean LOS in our sample (43.78±31.56 days) should have been adequate for optimal care and is much longer than the LOS reported in most western studies [25] . It is also worth mentioning that in China, discharge is decided based on clinical improvement, with less pressure from insurance companies.…”

Real-world predictors of relapse in patients with schizophrenia and schizoaffective disorder in a large health system

“…Further, patients who relapsed were younger, indicating more potential years, and opportunities, for progression. A previous analysis of the Nationwide Inpatient Sample data of hospitalization trends from 2005-2014 showed higher overall and increasing hospitalization rates over time for individuals 18-44 of age when compared to individuals 45-64 and 65 and over 42 . Other studies have also demonstrated a relationship between the age of onset of schizophrenia and relapse; however, we cannot assume that the younger age variable in this study reflects the younger age of onset.…”

Adult Psychiatric Hospitalizations in Ontario, Canada Before and During the COVID-19 Pandemic

“…3 The extent to which the breakdown of community supports has exacerbated severe mental illness (and thus the need for hospitalization) is unknown, though this is one plausible explanation for the increase in the volume of hospitalizations that we observed. Given the complex and costly needs of those living with psychotic disorders (e.g., high and often poorly managed multimorbidity, higher costs, and long lengths of stay when hospitalized), [25][26][27][28] the sustained 9% rise in hospitalizations for these conditions represents a challenge for a hospital system facing increasingly acute staffing and budgetary shortfalls. Thus, further research is warranted to investigate the causes of these increases in hospitalizations for psychotic disorders, including whether there has been a clinical deterioration for those with severe mental health conditions during the pandemic period.…”