Table 3. Associations Between Psychiatric Disorders and SARS-CoV-2 Breakthrough Infections Among Fully Vaccinated VA Patients, Including Covariates.
| Characteristic | Model 1a | Model 2b | ||
|---|---|---|---|---|
| RR (95% CI) | P value | RR (95% CI) | P value | |
| Full sample (N = 263 697) | ||||
| Any psychiatric disorder | 1.07 (1.05-1.09) | <.001 | 1.03 (1.01-1.05) | .001 |
| Age (per 5-y change) | 0.93 (0.92-0.95) | <.001 | 0.88 (0.86-0.90) | <.001 |
| Age squared | 1.00 (1.00-1.00) | <.001 | 1.00 (1.00-1.00) | <.001 |
| Male (vs female) | 1.05 (1.01-1.08) | .004 | 1.00 (0.97-1.03) | .90 |
| Black or African American (vs White) | 0.81 (0.79-0.83) | <.001 | 0.81 (0.79-0.83) | <.001 |
| Other or unknown race (vs White)c | 0.94 (0.91-0.97) | <.001 | 0.95 (0.92-0.98) | .002 |
| Hispanic or Latinx (vs not Hispanic or Latinx) | 0.90 (0.87-0.93) | <.001 | 0.90 (0.87-0.93) | <.001 |
| Time since vaccination | 0.82 (0.81-0.83) | <.001 | 0.82 (0.81-0.83) | <.001 |
| Moderna vaccine | 0.16 (0.15-0.17) | <.001 | 0.16 (0.14-0.17) | <.001 |
| Pfizer-BioNTech vaccine | 0.24 (0.22-0.26) | <.001 | 0.24 (0.22-0.26) | <.001 |
| Johnson & Johnson–Janssen vaccine | 1 [Reference] | NA | 1 [Reference] | NA |
| Moderna vaccine × time since vaccination | 1.24 (1.22-1.26) | <.001 | 1.24 (1.22-1.26) | <.001 |
| Pfizer-BioNTech vaccine × time since vaccination | 1.20 (1.18-1.22) | <.001 | 1.20 (1.18-1.22) | <.001 |
| Johnson & Johnson–Janssen vaccine × time since vaccination | 1 [Reference] | NA | 1 [Reference] | NA |
| Diabetes | NA | NA | 1.10 (1.08-1.12) | <.001 |
| Cardiovascular disease | NA | NA | 1.19 (1.17-1.22) | <.001 |
| Obstructive sleep apnea | NA | NA | 1.13 (1.10-1.15) | <.001 |
| Cancer | NA | NA | 1.07 (1.04-1.09) | <.001 |
| COPD | NA | NA | 1.18 (1.15-1.20) | <.001 |
| Chronic kidney disease | NA | NA | 1.23 (1.20-1.26) | <.001 |
| Liver disease | NA | NA | 1.11 (1.07-1.14) | <.001 |
| HIV | NA | NA | 1.20 (1.10-1.31) | <.001 |
| Obesity | NA | NA | 1.10 (1.08-1.13) | <.001 |
| Current or former smoker (vs never smoker) | NA | NA | 0.95 (0.93-0.97) | <.001 |
| Age <65 y (n = 82 180) | ||||
| Any psychiatric disorder | 1.03 (1.00-1.07) | .03 | 1.00 (0.97-1.03) | .82 |
| Age (per 5-y change) | 0.98 (0.97-0.99) | <.001 | 0.95 (0.94-0.96) | <.001 |
| Male (vs female) | 1.04 (1.00-1.08) | .04 | 1.00 (0.96-1.04) | .92 |
| Black or African American (vs White) | 0.86 (0.83-0.89) | <.001 | 0.84 (0.81-0.87) | <.001 |
| Other or unknown race (vs White)c | 0.92 (0.88-0.97) | .001 | 0.93 (0.89-0.97) | .002 |
| Hispanic or Latinx (vs not Hispanic or Latinx) | 0.01 (0.96-1.06) | .69 | 1.00 (0.95-1.04) | .88 |
| Time since vaccination | 0.81 (0.79-0.82) | <.001 | 0.81 (0.79-0.82) | <.001 |
| Moderna vaccine | 0.18 (0.16-0.20) | <.001 | 0.18 (0.16-0.20) | <.001 |
| Pfizer-BioNTech vaccine | 0.26 (0.24-0.29) | <.001 | 0.26 (0.24-0.29) | <.001 |
| Johnson & Johnson–Janssen vaccine | 1 [Reference] | NA | 1 [Reference] | NA |
| Moderna vaccine × time since vaccination | 1.22 (1.19-1.25) | <.001 | 1.22 (1.19-1.24) | <.001 |
| Pfizer-BioNTech vaccine × time since vaccination | 1.19 (1.16-1.21) | <.001 | 1.19 (1.16-1.21) | <.001 |
| Johnson & Johnson–Janssen vaccine × time since vaccination | 1 [Reference] | NA | 1 [Reference] | NA |
| Diabetes | NA | NA | 1.10 (1.06-1.13) | <.001 |
| Cardiovascular disease | NA | NA | 1.22 (1.18-1.27) | <.001 |
| Obstructive sleep apnea | NA | NA | 1.11 (1.08-1.14) | <.001 |
| Cancer | NA | NA | 1.11 (1.07-1.16) | <.001 |
| COPD | NA | NA | 1.20 (1.14-1.26) | <.001 |
| Chronic kidney disease | NA | NA | 1.23 (1.17-1.30) | <.001 |
| Liver disease | NA | NA | 1.13 (1.08-1.19) | <.001 |
| HIV | NA | NA | 1.19 (1.06-1.33) | .003 |
| Obesity | NA | NA | 1.09 (1.06-1.13) | <.001 |
| Current or former smoker (vs never smoker) | NA | NA | 0.94 (0.91-0.97) | <.001 |
| Age ≥65 y (n = 142 208) | ||||
| Any psychiatric disorder | 1.10 (1.07-1.13) | <.001 | 1.05 (1.03-1.08) | <.001 |
| Age (per 5-y change) | 1.02 (1.01-1.03) | <.001 | 1.01 (1.00-1.02) | .009 |
| Male (vs female) | 1.11 (1.04-1.18) | .003 | 1.04 (0.98-1.11) | .21 |
| Black or African American (vs White) | 0.77 (0.74-0.79) | <.001 | 0.77 (0.74-0.79) | <.001 |
| Other or unknown race (vs White)c | 0.95 (0.91-0.99) | .03 | 0.97 (0.93-1.02) | .23 |
| Hispanic or Latinx (vs not Hispanic or Latinx) | 0.78 (0.74-0.82) | <.001 | 0.80 (0.76-0.84) | <.001 |
| Time since vaccination | 0.84 (0.82-0.86) | <.001 | 0.84 (0.82-0.86) | <.001 |
| Moderna vaccine | 0.15 (0.14-0.18) | <.001 | 0.15 (0.13-0.17) | <.001 |
| Pfizer-BioNTech vaccine | 0.23 (0.20-0.26) | <.001 | 0.23 (0.20-0.26) | <.001 |
| Johnson & Johnson–Janssen vaccine | 1 [Reference] | NA | 1 [Reference] | NA |
| Moderna vaccine × time since vaccination | 1.23 (1.20-1.27) | <.001 | 1.23 (1.20-1.27) | <.001 |
| Pfizer-BioNTech vaccine × time since vaccination | 1.19 (1.16-1.22) | <.001 | 1.19 (1.16-1.22) | <.001 |
| Johnson & Johnson–Janssen vaccine × time since vaccination | 1 [Reference] | NA | 1 [Reference] | NA |
| Diabetes | NA | NA | 1.12 (1.09-1.15) | <.001 |
| Cardiovascular disease | NA | NA | 1.18 (1.15-1.21) | <.001 |
| Obstructive sleep apnea | NA | NA | 1.13 (1.10-1.16) | <.001 |
| Cancer | NA | NA | 1.06 (1.04-1.09) | <.001 |
| COPD | NA | NA | 1.17 (1.14-1.20) | <.001 |
| Chronic kidney disease | NA | NA | 1.23 (1.20-1.26) | <.001 |
| Liver disease | NA | NA | 1.09 (1.05-1.14) | <.001 |
| HIV | NA | NA | 1.20 (1.03-1.39) | .02 |
| Obesity | NA | NA | 1.11 (1.08-1.15) | <.001 |
| Current or former smoker (vs never smoker) | NA | NA | 0.96 (0.94-0.99) | .002 |
Abbreviations: COPD, chronic obstructive pulmonary disease; NA, not applicable; RR, relative risk; VA, US Department of Veterans Affairs.
a
Model 1: age, age squared, sex, race, ethnicity, vaccine type, time since vaccination, and vaccine type × time since vaccination. Reference group is no psychiatric disorders.
b
Model 2: model 1 plus obesity status, diabetes, cardiovascular disease including hypertension, obstructive sleep apnea, COPD, cancer, chronic kidney disease, liver disease, HIV, and smoking. Reference group is no psychiatric disorders.
c
Other race includes American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander.