Anderson Kelly K, Cheng Joyce, Susser Ezra, McKenzie Kwame J, Kurdyak Paul
Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont.
CMAJ. 2015 Jun 16;187(9):E279-E286. doi: 10.1503/cmaj.141420. Epub 2015 May 11.
Evidence suggests that migrant groups have an increased risk of psychotic disorders and that the level of risk varies by country of origin and host country. Canadian evidence is lacking on the incidence of psychotic disorders among migrants. We sought to examine the incidence of schizophrenia and schizoaffective disorders in first-generation immigrants and refugees in the province of Ontario, relative to the general population.
We constructed a retrospective cohort that included people aged 14-40 years residing in Ontario as of Apr. 1, 1999. Population-based administrative data from physician billings and hospital admissions were linked to data from Citizenship and Immigration Canada. We used Poisson regression models to calculate age- and sex-adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for immigrant and refugee groups over a 10-year period.
In our cohort (n = 4,284,694), we found higher rates of psychotic disorders among immigrants from the Caribbean and Bermuda (IRR 1.60, 95% CI 1.29-1.98). Lower rates were found among immigrants from northern Europe (IRR 0.50, 95% CI 0.28-0.91), southern Europe (IRR 0.60, 95% CI 0.41-0.90) and East Asia (IRR 0.56, 95% CI 0.41-0.78). Refugee status was an independent predictor of risk among all migrants (IRR 1.27, 95% CI 1.04-1.56), and higher rates were found specifically for refugees from East Africa (IRR 1.95, 95% CI 1.44-2.65) and South Asia (IRR 1.51, 95% CI 1.08-2.12).
The differential pattern of risk across ethnic subgroups in Ontario suggests that psychosocial and cultural factors associated with migration may contribute to the risk of psychotic disorders. Some groups may be more at risk, whereas others are protected.
有证据表明，移民群体患精神障碍的风险增加，且风险水平因原籍国和东道国而异。加拿大缺乏关于移民中精神障碍发病率的证据。我们试图研究安大略省第一代移民和难民中精神分裂症及分裂情感性障碍的发病率，并与普通人群进行比较。
我们构建了一个回顾性队列，纳入了截至1999年4月1日居住在安大略省、年龄在14至40岁之间的人群。将基于人群的医生账单和医院入院行政数据与加拿大公民及移民部的数据相链接。我们使用泊松回归模型计算10年间移民和难民群体的年龄和性别调整发病率比（IRR）及95%置信区间（CI）。
在我们的队列（n = 4,284,694）中，我们发现来自加勒比地区和百慕大的移民中精神障碍发病率较高（IRR 1.60，95% CI 1.29 - 1.98）。来自北欧（IRR 0.50，95% CI 0.28 - 0.91）、南欧（IRR 0.60，95% CI 0.41 - 0.90）和东亚（IRR 0.56，95% CI 0.41 - 0.78）的移民发病率较低。难民身份是所有移民中风险的独立预测因素（IRR 1.27，95% CI 1.04 - 1.56），特别是来自东非（IRR 1.95，95% CI 1.44 - 2.65）和南亚（IRR 1.51，95% CI 1.08 - 2.12）的难民发病率更高。
安大略省不同种族亚组之间的风险差异模式表明，与移民相关的社会心理和文化因素可能导致精神障碍风险增加。一些群体可能风险更高，而另一些群体则受到保护。
