Prediagnosis Healthcare Utilization May Aid Earlier Schizophrenia Detection

doctor asking patient a question
doctor asking patient a question
Researchers posit that based upon their data there are opportunities for intervention in schizophrenia based on healthcare use prior to diagnosis.

Patients with schizophrenia show extensive use of healthcare resources up to 5 years before they are diagnosed, with increasing rates of use prior to diagnosis, according to a study published in Schizophrenia Research. Researchers indicated these findings may be used to help establish predictive models for identifying patients at high risk of developing schizophrenia.

Many individuals eventually diagnosed with schizophrenia exhibit subsyndromal clinical symptoms before they are diagnosed. This retrospective, longitudinal, cohort study was designed to analyze prediagnosis healthcare resource utilization and comorbidities in these patients because treatment prior to the first episode of psychosis can mitigate disease development. Claims data between January 2007 and April 2016 from the HealthCore Integrated Research Database were used, comparing patients with newly diagnosed schizophrenia (15-54 years old) with matched comparators without schizophrenia (1:4). Demographics, comorbidities, medications, physician specialties, related services, and other healthcare resource utilization were compared between patients with schizophrenia and comparators for up to 5 years prediagnosis.

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Among patients in the schizophrenia cohort (n=6732, mean age 30.3 years for men and 36.2  years for women), all outcomes were more prevalent than in the comparator cohort. Even 4 to 5 years before diagnosis, substantial healthcare resource utilization, comorbidity, and medication use were observed in the schizophrenia cohort, with findings increasing approaching diagnosis. Resource use increased from 20.5% at 4 to 5 years before diagnosis to 53.3% at 0 to 12 months before diagnosis for atypical antipsychotics, from 15.1% to 35.5% for psychiatric diagnostic examinations, and from 29.3% to 48.2% for antidepressants. During the 6 months before diagnosis, the prevalence of each behavioral health-related comorbidity in the schizophrenia cohort increased compared with 6 to 12 months before, with the greatest increase seen in depression, which rose from 23.7% to 35.8%.

In the 12 months before diagnosis, 32.7% of schizophrenia patients had an inpatient admission, and 32.5% had an emergency department visit, compared with 3.9% and 11.9%, in the comparator cohort. Throughout the study, inpatient hospitalizations and emergency department visits remained stable in the comparator cohort (hospitalization 3.2%-3.9%; emergency department 10.7%-12.4%) but steadily increased in the schizophrenia cohort in the 12 months prior to diagnosis (hospitalization 8.7%-32.7%; emergency department 18.2%-32.5%).

Study investigators concluded, “These analyses demonstrate that patients receiving a schizophrenia diagnosis extensively use healthcare resources of all types, even up to 5 years before the diagnosis appears formally in a healthcare claims sample, and present with a different profile vs comparators without the disease. Such early presentation for medical care provides healthcare professionals with an opportunity for early identification and intervention. Claims data may also be used in predictive models to aid identification of high-risk patients; however, further research in this area is required.”

Disclosure: This study was supported by Boehringer Ingelheim International GmbH. Please see the original reference for a full list of authors’ disclosures.


Wallace A, Isenberg K, York W, et al. Detecting schizophrenia early: prediagnosis healthcare utilization characteristics of patients with schizophrenia may aid early detection [published online September 1, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.08.011