Point-in-time survey of healthcare resource utilization, employment, quality of life and caregiver status by disease severity in patients with schizophrenia in the US

Figures & data

Figure 1. Flow diagram.

Table 1. Patient demographics and clinical characteristics.

	Total (n = 1083)	Mild (n = 435)	Moderate (n = 401)	Severe (n = 247)	p Value^a
Age^b, years, mean (SD)	40.4 (16.0)	38.9 (15.7)	40.8 (15.7)	42.2 (16.7)	.027
Male^b, n (%)	632 (58.4)	229 (52.6)	247 (61.6)	156 (63.2)	.007
BMI^b, kg/m², mean (SD)	27.3 (5.0)	26.9 (4.8)	27.2 (4.9)	28.2 (5.5)	.006
Years since schizophrenia diagnosis^c, mean (SD)	8.7 (11.2)	7.1 (10.8)	9.1 (10.1)	12.7 (13.3)	<.001
Ethnicity^b, n (%)					<.001
White/Caucasian	657 (60.7)	289 (66.4)	231 (57.6)	137 (55.5)
African American	263 (24.3)	64 (14.7)	117 (29.2)	82 (33.2)
Hispanic/Latino	72 (6.6)	33 (7.6)	23 (5.7)	16 (6.5)
Other	91 (8.4)	49 (11.3)	30 (7.5)	12 (4.9)
Education^b, n (%)					<.001
Did not complete high school	199 (18.4)	41 (9.4)	80 (20.0)	78 (31.6)
High school diploma/GED	537 (49.6)	219 (50.3)	203 (50.6)	115 (46.6)
College degree (2 year or 4 year)	281 (25.9)	149 (34.3)	94 (23.4)	38 (15.4)
Graduate degree/trade school/certificate program	53 (4.9)	21 (4.8)	18 (4.5)	14 (5.7)
Other	13 (1.2)	5 (1.1)	6 (1.5)	2 (0.8)
Treatment setting^b,d, n (%)					<.001
Inpatient	193 (17.8)	35 (8.0)	79 (19.7)	79 (32.0)
Outpatient	890 (82.2)	400 (92.0)	322 (80.3)	168 (68.0)
Any health insurance^e, n (%)					.002
Yes	968 (94.9)	397 (96.6)	363 (95.8)	208 (90.4)
No	52 (5.1)	14 (3.4)	16 (4.2)	22 (9.6)
Among patients with health insurance, type of health insurance^f, n (%)					<.001
Medicaid	375 (40.1)	110 (28.8)	165 (46.9)	100 (49.5)
Commercial	250 (26.7)	156 (40.8)	73 (20.7)	21 (10.4)
Medicare	208 (22.2)	54 (14.1)	86 (24.4)	68 (33.7)
Private (Health insurance exchange plan, Cobra)	81 (8.7)	56 (14.7)	20 (5.7)	5 (2.5)
Other (Tricare/Veteran’s healthcare, other)	22 (2.4)	6 (1.6)	8 (2.3)	8 (4.0)
Smoking^g, n (%)					<.001
Current smoker	350 (34.4)	100 (24.7)	145 (37.9)	105 (46.1)
Ex-smoker	198 (19.5)	77 (19.0)	74 (19.3)	47 (20.6)
Never smoked	468 (46.1)	228 (56.3)	164 (42.8)	76 (33.3)
Cardiometabolic comorbidities^b, n (%)
Hypertension	256 (23.6)	68 (15.6)	118 (29.4)	70 (28.3)	<.001
Dyslipidemia	198 (18.3)	58 (13.3)	91 (22.7)	49 (19.8)	.002
Obesity	189 (17.5)	63 (14.5)	62 (15.5)	64 (25.9)	<.001
GERD	76 (7.0)	21 (4.8)	38 (9.5)	17 (6.9)	.031
Diabetes without chronic complications	75 (6.9)	25 (5.7)	21 (5.2)	29 (11.7)	.003
Psychiatric comorbidities^b, n (%)
Anxiety	307 (28.3)	99 (22.8)	120 (29.9)	88 (35.6)	.001
Depression	155 (14.3)	48 (11.0)	58 (14.5)	49 (19.8)	.007
Stress	145 (13.4)	48 (11.0)	51 (12.7)	46 (18.6)	.018
Insomnia	131 (12.1)	35 (8.0)	62 (15.5)	34 (13.8)	.003
Substance use disorder	67 (6.2)	10 (2.3)	32 (8.0)	25 (10.1)	<.001
Alcohol use disorder	60 (5.5)	10 (2.3)	30 (7.5)	20 (8.1)	<.001

Abbreviations. BMI, Body mass index; GED, General Education Development (high school equivalency diploma); GERD, Gastroesophageal reflux disease; kg, Kilogram; m, Meter; n, Number of patients; SD, Standard deviation.

^ap Values are reported for differences between the three groups.

^bReported for full sample of 435, 401 and 247 patients with mild, moderate and severe schizophrenia, respectively.

^cTime since schizophrenia diagnosis reported for 256, 168 and 83 patients with mild, moderate and severe schizophrenia, respectively.

^dA quota of 8 outpatients and 2 inpatients was set for each physician to ensure an adequate number of inpatients for analysis.

^eAny health insurance reported for 411, 379 and 230 patients with mild, moderate and severe schizophrenia, respectively.

^fType of health insurance reported for 382, 352 and 202 patients with mild, moderate and severe schizophrenia, respectively. A conflicting value of no health insurance reported for one patient with moderate schizophrenia was not included.

^gSmoking status reported for 405, 383 and 228 patients with mild, moderate and severe schizophrenia, respectively.

Figure 2. Adjusted HCRU related to schizophrenia relapse (physician reported). Abbreviations. CI, Confidence interval; ER, Emergency room; HCP, Healthcare practitioner; HCRU, Healthcare resource utilization; IRR, Incidence rate ratio; OR, Odds ratio; ref, Reference. Bold text indicates statistical significance vs. mild severity based on 95% CI. Outcomes were adjusted for patient age, sex and race/ethnicity.

Figure 3. Adjusted employment status and housing circumstances (physician reported). Abbreviations. CI, Confidence interval; OR, Odds ratio; ref, Reference. ^aUpper limit of adjusted OR not shown on x-axis but reported in list of adjusted OR. Bold text indicates statistical significance vs. mild severity based on 95% CI. Outcomes were adjusted for patient age, sex and race/ethnicity.

Table 2. Adjusted physician-reported patient outcomes.

	Mild (n = 435)	Moderate (n = 401)	Severe (n = 247)
Healthcare utilization in the previous 12 months related to schizophrenia relapse
Number of HCP visits
n (% not missing)	386 (88.7)	360 (89.8)	204 (82.6)
Mean [95% CI]	7.4 [6.3–8.5]	8.2 [7.1–9.3]	9.2 [7.5–10.9]
Any hospitalizations
n (% not missing)	400 (92.0)	374 (93.3)	220 (89.1)
% [95% CI]	18.0% [12.4–23.6%]	36.9% [29.1–44.7%]	62.6% [54.6–70.6%]
Number of hospitalizations
n (% not missing)	400 (92.0)	374 (93.3)	220 (89.1)
Mean [95% CI]	0.2 [0.2–0.3]	0.5 [0.4–0.6]	1.3 [0.9–1.7]
Number of hospital admissions through the ER
n (% not missing)	393 (90.3)	365 (91.0)	206 (83.4)
Mean [95% CI]	0.2 [0.1–0.2]	0.4 [0.3–0.5]	0.9 [0.7–1.1]
Number of days hospitalized
n (% not missing)	389 (89.4)	354 (88.3)	184 (74.5)
Mean [95% CI]	1.9 [0.5–3.2]	3.9 [2.6–5.1]	9.9 [5.5–14.2]
Number of hospitalizations since diagnosis related to schizophrenia relapse
n (% not missing)	231 (53.1)	144 (35.9)	68 (27.5)
Mean [95% CI]	1.1 [0.7–1.5]	2.4 [1.5–3.3]	5.4 [3.2–7.7]
Employment status
n (% not missing)	428 (98.4)	395 (98.5)	239 (96.8)
Full-time employment, % [95% CI]	19.1% [14.0–24.3%]	3.4% [1.6–5.1%]	0.4% [−0.4–1.2%]
Part-time employment, % [95% CI]	28.3% [23.6–33.1%]	19.7% [15.3–24.1%]	5.8% [2.6%–8.9%]
Student/homemaker/retired, % [95% CI]	20.1% [16.0–24.1%]	13.6% [9.5–17.6%]	10.4% [6.0–14.8%]
Unemployed due to disability, % [95% CI]	20.1% [15.4–24.9%]	51.7% [44.7–58.6%]	73.2% [65.8–80.6%]
Unemployed for other reason, % [95% CI]	4.6% [1.7–7.6%]	5.1% [2.9–7.4%]	5.4% [2.9–7.8%]
Sick leave, % [95% CI]	1.3% [0.2–2.4%]	2.8% [0.7–4.8%]	2.3% [0.2–4.3%]
Housing circumstances
n (% not missing)	435 (100.0)	401 (100.0)	247 (100.0)
Lives alone, % [95% CI]	17.6% [12.8–22.3%]	12.7% [9.0–16.4%]	12.0% [7.6–16.5%]
Lives with partner/spouse, % [95% CI]	28.0% [22.5–33.4%]	17.3% [13.2–21.4%]	8.8% [4.5–13.0%]
Lives with relatives/friends/other, % [95% CI]	41.2% [35.3–47.2%]	49.4% [43.7–55.1%]	47.0% [40.0–54.1%]
Supported housing, % [95% CI]	4.4% [2.1–6.7%]	11.7% [7.5–15.8%]	16.4% [11.2–21.6%]
Homeless shelter, % [95% CI]	1.2% [0.2–2.2%]	3.0% [1.3–4.8%]	7.9% [4.2–11.7%]

Abbreviations. ER, Emergency room; HCP, Healthcare practitioner; n, Sample size included in the analysis of the outcome.

Outcomes were adjusted for patient age, sex and race/ethnicity. Average margin estimates are reported for means and proportions.

Figure 4. Adjusted patient work and activity impairment and QoL outcomes (patient reported). Abbreviations. CI, Confidence interval; diff, Difference; EQ-5D, EuroQoL 5-dimension; HI, Health index; Q-LES-Q-SF, Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form; QoL, Quality of life; VAS, Visual analogue scale; WPAI, Work Productivity and Activity Impairment questionnaire. *Significant vs. mild severity at p < .05. Outcomes were adjusted for patient age, sex and race/ethnicity.

Table 3. Adjusted patient-reported outcomes.

	Mild (n = 217)	Moderate (n = 200)	Severe (n = 89)
Productivity in the past week
WPAI overall work impairment
n (% not missing)	84 (38.7)	38 (19.0)	7 (7.9)
Mean [95% CI]	27.7 [23.9–31.5]	39.2 [30.9–47.5]	52.1 [30.6–73.6]
WPAI overall activity impairment
n (% not missing)	199 (91.7)	186 (93.0)	84 (94.4)
Mean [95% CI]	32.7 [29.1–36.4]	49.9 [45.2–54.6]	63.5 [55.1–71.8]
QoL
EQ-5D Health Index
n (% not missing)	212 (97.7)	189 (94.5)	87 (97.8)
Mean [95% CI]	0.81 [0.77–0.85]	0.79 [0.74–0.83]	0.65 [0.58–0.73]
EQ-5D VAS
n (% not missing)	213 (98.2)	196 (98.0)	88 (98.9)
Mean [95% CI]	76.2 [73.3–79.2]	71.0 [66.7–75.3]	61.2 [53.5–68.9]
Q-LES-Q-SF
n (% not missing)	169 (77.9)	156 (78.0)	67 (75.3)
Mean [95% CI]	56.5 [52.6–60.4]	51.3 [47.4–55.2]	40.3 [34.7–45.9]

Abbreviations. EQ-5D, EuroQoL 5-dimension; n, sample size included in the analysis of the outcome; Q-LES-Q-SF, Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form; QoL, Quality of life; VAS, Visual analogue scale; WPAI, Work Productivity and Activity Impairment questionnaire.

Outcomes were adjusted for patient age, sex and race/ethnicity. Average margin estimates are reported for means and proportions.

Table 4. Adjusted patients’ caregiver status.

	Mild (n = 435)	Moderate (n = 401)	Severe (n = 247)
Patient requires a caregiver (physician reported)
n (% not missing)	424 (97.5)	380 (94.8)	232 (93.9)
% of patients [95% CI]	12.7% [8.6–16.8%]	35.7% [28.8–42.5%]	50.0% [40.6–59.4%]
aOR [95% CI]	ref	3.82 [2.51–5.80]	6.89 [4.29–11.07]
Among patients requiring care, total hours of care per week (physician reported)
n (% not missing)	52 (98.1)	132 (96.4)	117 (99.2)
Mean [95% CI]	25.0 [17.7–32.2]	32.1 [23.7–40.5]	47.1 [32.0–62.2]
aIRR [95% CI]	ref	1.29 [0.98–1.69]	1.89 [1.25–2.84]

Abbreviations. aIRR, Adjusted incidence rate ratio; aOR, Adjusted odds ratio; CI, Confidence interval; n, Sample size included in the analysis of the outcome; ref, Reference.

Outcomes were adjusted for patient age, sex and race/ethnicity. Average margin estimates are reported for means and proportions.

Data availability statement

Data collection was undertaken by Adelphi Real World as part of an independent survey, entitled the Adelphi Schizophrenia Disease Specific Programme, subscribed to by multiple pharmaceutical companies of which one was Sunovion. Sunovion did not influence the original survey through either contribution to the design of questionnaires or data collection. All data that support the findings of this survey are the intellectual property of Adelphi Real World.