Lewis G, David A, Andréasson S, Allebeck P
Section of Epidemiology and General Practice, Institute of Psychiatry, Denmark Hill, London, UK.
Lancet. 1992 Jul 18;340(8812):137-40. doi: 10.1016/0140-6736(92)93213-7.
Prevalence of schizophrenia and rates of first admission to hospital for this disorder are higher in most modern industrialised cities, and in urban compared with rural areas. The "geographical drift" hypothesis (ie, most schizophrenics tend to drift into city areas because of their illness or its prodrome) has remained largely unchallenged. We have investigated the association between place of upbringing and the incidence of schizophrenia with data from a cohort of 49,191 male Swedish conscripts linked to the Swedish National Register of Psychiatric Care. The incidence of schizophrenia was 1.65 times higher (95% confidence interval 1.19-2.28) among men brought up in cities than in those who had had a rural upbringing. The association persisted despite adjustment for other factors associated with city life such as cannabis use, parental divorce, and family history of psychiatric disorder. This finding cannot be explained by the widely held notion that people with schizophrenia drift into cities at the beginning of their illness. We conclude that undetermined environmental factors found in cities increase the risk of schizophrenia.
在大多数现代工业化城市中，精神分裂症的患病率以及因该疾病首次住院的比率均高于农村地区，且城市地区高于农村地区。“地理漂移”假说（即大多数精神分裂症患者因患病或处于前驱期而倾向于流入城市地区）在很大程度上一直未受到质疑。我们利用来自49191名瑞典男性应征入伍者队列的数据（这些数据与瑞典国家精神科护理登记处相关联），研究了成长地与精神分裂症发病率之间的关联。在城市长大的男性中，精神分裂症的发病率比在农村长大的男性高1.65倍（95%置信区间为1.19 - 2.28）。尽管对与城市生活相关的其他因素进行了调整，如大麻使用、父母离异和精神疾病家族史，但这种关联依然存在。这一发现无法用人们普遍认为的精神分裂症患者在疾病初期流入城市这一观点来解释。我们得出结论，城市中存在的未确定环境因素会增加患精神分裂症的风险。
