Rates of Covid 19 testing and positivity in US military veterans with SMI

Abstract: Objective: to compare differences in COVID-19 testing rates and rates of positive test results between Veterans with and without SMI and identify the sociodemographic and clinical characteristics affecting COVID-19 testing/results. Methods: Cohort study on data from the VA Corporate Data Warehouse (CDW), a data repository from clinical and administrative VA systems. The sample included Veterans who had ≥1 outpatient encounters nationally between 01/01/2019 and 12/31/2020. SMI diagnoses were derived as relevant ICD codes within the calendar years 2019–2020. Non-SMI Veterans were matched to SMI Veterans by age, gender, race and ethnicity for comparisons. Results: The study included 1,018,047 Veterans, 339,349 had a diagnosis of SMI, and 83% were male. In unadjusted analyses, Veterans with SMI were more likely to receive testing for Covid 19 than non-SMI, however after adjusting for age, sex, race/ethnicity, region, and service utilization, Veterans with SMI were 6% less likely to receive testing for Covid 19 than non-SMI, with differences by type of SMI diagnosis: patients with psychosis (9.8%, P = .008) and schizophrenia (12.2%, P < .0001) were significantly less likely to receive an order for testing, compared to controls. Veterans with SMI were also less likely to receive a positive test result compared to controls. Conclusions: Differences in access to testing exist across a nationally representative sample of US military Veterans with and without SMI. The finding that individuals with SMI are less likely to receive a positive test result can help reduce stigma.