Pulmonary disease among inpatient decedents: Impact of schizophrenia

Objectives: Determine the risk associated with schizophrenia for common pulmonary illness (pneumonia and chronic obstructive pulmonary disorder (COPD)) during the last year of life. Methods: Inpatient decedents in Veterans (VA) hospitals in 2002 (N = 27,798) were identified. Logistic regression modeled diagnosis of pulmonary illness in either the final year or final admission as a function of schizophrenia, smoking history and other covariates. Results: Among decedents, 943 (3%) had schizophrenia, 3% were women, most were white (76%) or African-American (18%), and average age at death was 72.4 years (SD 11.5). Three-fifths received VA outpatient care in the year prior to death. Among those with schizophrenia, only two-fifths had outpatient care. Pneumonia was more common among schizophrenia patients (38% vs 31%) as was COPD (46% vs 38%). In models controlling for history of smoking and other covariates, schizophrenia was a risk factor for pulmonary disease in the last year of life (OR = 1.9, 95% CI 1.6-2.2) but less so for final-stay pulmonary disease (OR = 1.5, 95% CI 1.3-1.7). Conclusions: VA inpatient decedents with schizophrenia were at increased risk for pneumonia and COPD, independent of smoking indicators. Clinicians treating schizophrenia patients need to be especially alert to potential comorbid medical conditions and ensure vulnerable patients receive appropriate care.