Understanding the Characteristics and Burden of Cognitive Impairments in Schizophrenia in the US: Medical Expenditure Panel Survey

Abstract

Objectives: To estimate prevalence and impact of cognitive impairments in schizophrenia in the US.

Methods: Retrospective analyses of the Medical Expenditure Panel Survey (1997-2021) were conducted to identify adults living with schizophrenia and cognitive impairments. Cognitive limitations (CL; 1997-2021) were defined as interference with daily activities, confusion/memory loss, problems making decisions, or requiring supervision for safety. Cognitive difficulties (CD; 2013-2021) were defined as difficulty in concentration/memory/decision-making. Descriptive analyses covered demographic, clinical, and socioeconomic characteristics, health care resource utilization (HCRU), humanistic, and indirect burdens. Multivariable regression analyses were conducted for hospitalizations, emergency department (ED) visits, and total costs. Sampling weights were applied.

Results: Among 661,243 weighted adults living with schizophrenia (mean age: 45.6 years; male: 56.7%), 57.7% reported CL, and 53.8% reported CD. Compared to no CL, CL was associated with lower education (no degree: +2.2%) and annual income (-$4,332) and higher Charlson Comorbidity Index (0.89 vs 0.55) and HCRU. Total health care costs were higher for CL ($18,478 vs $11,689), demonstrating greater economic burden. Individuals reporting CL reported more limitations in activities of daily living (+13.3%) and lower health utilities scores with higher percentage of poor perceived health (+10.1%), indicating higher humanistic burden. For indirect burden, CL was associated with higher unemployment (+15.3%) (all P <.05). Multivariable regression analysis showed that CL was associated with higher odds of hospitalizations (1.47; 95% CI, 1.05-2.06), ED visits (1.64; 95% CI, 1.22-2.20), and total health care costs (1.56; 95% CI, 1.30-1.86). CD showed similar results except that CD was not significantly associated with hospitalizations or ED visits.

Conclusions: Cognitive impairments in schizophrenia are associated with higher multilevel burdens compared to those without, highlighting the need for targeted interventions.