Incidence and risk profiles for pneumonia in patients with schizophrenia receiving home-care case management intervention in Taiwan.

Abstract

Background: Home-care case management is a type of community outreach service. However, research on the incidence of infectious diseases in patients receiving home-care case management is limited. This study investigated the incidence of various infectious diseases and risk factors for pneumonia in patients with schizophrenia receiving home-care case management.

Methods: We used data from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2019, to construct a schizophrenia cohort receiving home-care case management (n = 19,687). Pneumonia was the most common infectious disease at follow-up (n = 3966). To identify risk factors for pneumonia, a nested case-control study was conducted. Risk-set sampling was conducted to randomly select controls for each pneumonia case. Conditional logistic regression was employed for statistical analysis.

Results: Among various infectious diseases, pneumonia had the highest standardized incidence ratio in our cohort. Of the 3966 patients with pneumonia identified, 56.9% were men. After pairing, 3961 case-control pairs were established. Psychiatric comorbidities, specifically dementia and depressive disorders, were associated with a higher risk of pneumonia (adjusted incidence rate ratios [aIRRs] = 2.73 and 1.34, respectively). In contrast to oral antipsychotics, long-acting injectables were not associated with an increased pneumonia risk, suggesting that long-acting injectables could be a safer treatment option for patients with schizophrenia.

Conclusion: Our results revealed a significantly elevated pneumonia risk in this patient population, especially in those with physical and psychiatric comorbidities. The findings advocate for comprehensive care strategies to reduce the risk of pneumonia in this population.