title: Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis.
abstract: BACKGROUND
  Serious mental illnesses are associated with increased risk of cardiometabolic comorbidities. The objective of this study was to evaluate the prevalence of cardiometabolic comorbidity and its association with hospitalization outcomes and costs among inpatients with schizophrenia or bipolar disorder.
  
  
  METHODS
  This retrospective database analysis reviewed patients with an inpatient diagnosis of schizophrenia or bipolar disorder from the Premier Perspective® Database (4/1/2010-6/30/2012). Patients were categorized into 4 cohorts based on the number of ICD-9-CM cardiometabolic comorbidities (i.e., 0, 1, 2, or 3+). Outcomes included length of stay, mortality during the index hospitalization, healthcare costs, and 30-day all-cause readmission rates.
  
  
  RESULTS
  Of 57,506 patients with schizophrenia, 66.1% had at least one cardiometabolic comorbidity; 39.3% had two or more comorbidities. Of 124,803 patients with bipolar disorder, 60.5% had at least one cardiometabolic comorbidity; 33.4% had two or more. Average length of stay was 8.5 (for patients with schizophrenia) and 5.2 (for patients with bipolar disorder) days. Each additional cardiometabolic comorbidity was associated with an increase in length of stay for patients with bipolar disorder (p< .001) but not for patients with schizophrenia. Mortality rates during the index hospitalization were 1.2% (schizophrenia) and .7% (bipolar disorder). Each additional cardiometabolic comorbidity was associated with a significant increase in mortality for patients with bipolar disorder (OR 1.218,p< .001), and a numerical increase in mortality for patients with schizophrenia (OR 1.014,p= .727). Patients with more cardiometabolic comorbidities were more likely to have a 30-day readmission (schizophrenia = 9-13%; bipolar disorder = 7-12%), and to incur higher costs (schizophrenia = $10,606-15,355; bipolar disorder = $7126-13,523) (allp< .01).
  
  
  CONCLUSIONS
  Over 60% of inpatients with schizophrenia or bipolar disorder had cardiometabolic comorbidities. Greater cardiometabolic comorbidity burden was associated with an increased likelihood of readmission and higher costs among patients with schizophrenia or bipolar disorder, and an increase in length of stay and mortality for patients with bipolar disorder.
authors.affiliation: Hofstra North Shore LIJ School of Medicine, Manhasset, NY USA.|The Zucker Hillside Hospital, Glen Oaks, NY USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Sunovion Pharmaceuticals Inc., 84 Waterford Dr., Marlborough, MA 01752 USA.
authors.forename: Daisy S
authors.initials: DS
authors.lastname: Ng-Mak
authors.affiliation: Xcenda, Palm Harbor, FL USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Stafkey-Mailey
authors.affiliation: Xcenda, Palm Harbor, FL USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Farrelly
authors.affiliation: Sunovion Pharmaceuticals Inc., 84 Waterford Dr., Marlborough, MA 01752 USA.
authors.forename: Krithika
authors.initials: K
authors.lastname: Rajagopalan
authors.affiliation: Sunovion Pharmaceuticals Inc., Fort Lee, NJ USA.
authors.forename: Antony
authors.initials: A
authors.lastname: Loebel
keywords: Bipolar disorder; Cardiometabolic comorbidity; Healthcare costs; Hospitalization; Schizophrenia