Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
JAMA Psychiatry. 2020 Jan 1;77(1):17-24. doi: 10.1001/jamapsychiatry.2019.2299.
Evidence linking parental socioeconomic position and offspring's schizophrenia risk has been inconsistent, and how risk is associated with parental socioeconomic mobility has not been investigated.
To elucidate the association between parental income level and income mobility during childhood and subsequent schizophrenia risk.
DESIGN, SETTING, AND PARTICIPANTS: National cohort study of all persons born in Denmark from January 1, 1980, to December 31, 2000, who were followed up from their 15th birthday until schizophrenia diagnosis, emigration, death, or December 31, 2016, whichever came first. Data analyses were from March 2018 to June 2019.
Parental income, measured at birth year and at child ages 5, 10, and 15 years.
Hazard ratios (HRs) for schizophrenia were estimated using Cox proportional hazard regression. Cumulative incidence values (absolute risks) were also calculated.
The cohort included 1 051 033 participants, of whom 51.3% were male. Of the cohort members, 7544 (4124 [54.7%] male) were diagnosed with schizophrenia during 11.6 million person-years of follow-up. There was an inverse association between parental income level and subsequent schizophrenia risk, with children from lower income families having especially elevated risk. Estimates were attenuated, but risk gradients remained after adjustment for urbanization, parental mental disorders, parental educational levels, and number of changes in child-parent separation status. A dose-response association was observed with increasing amount of time spent in low-income conditions being linked with higher schizophrenia risk. Regardless of parental income level at birth, upward income mobility was associated with lower schizophrenia risk compared with downward mobility. For example, children who were born and remained in the lowest income quintile at age 15 years had a 4.12 (95% CI, 3.71-4.58) elevated risk compared with the reference group, those who were born in and remained in the most affluent quintile, but even a rise from the lowest income quintile at birth to second lowest at age 15 years appeared to lessen the risk elevation (HR, 2.80; 95% CI, 2.46-3.17). On the contrary, for those born in the most affluent quintile, downward income mobility between birth and age 15 years was associated with increased risks of developing schizophrenia.
This study's findings suggest that parental income level and income mobility during childhood may be linked with schizophrenia risk. Although both causation and selection mechanisms could be involved, enabling upward income mobility could influence schizophrenia incidence at the population level.
将父母的社会经济地位与子女患精神分裂症的风险联系起来的证据一直不一致，而且风险与父母社会经济流动性的关联尚未得到调查。
阐明儿童时期父母收入水平和收入流动性与随后精神分裂症风险之间的关联。
设计、地点和参与者：这是一项全国性队列研究，研究对象为 1980 年 1 月 1 日至 2000 年 12 月 31 日期间在丹麦出生的所有人，他们从 15 岁生日开始接受随访，直至精神分裂症诊断、移民、死亡或 2016 年 12 月 31 日，以先到者为准。数据分析于 2018 年 3 月至 2019 年 6 月进行。
父母的收入，按出生年份和孩子 5 岁、10 岁和 15 岁时的收入进行测量。
使用 Cox 比例风险回归估计精神分裂症的风险比 (HR)。还计算了累积发病率值（绝对风险）。
该队列包括 1051033 名参与者，其中 51.3%为男性。在 1160 万人年的随访中，队列中有 7544 人（5474 名男性[54.7%]）被诊断为精神分裂症。父母的收入水平与随后的精神分裂症风险呈负相关，来自低收入家庭的孩子患病风险尤其高。在调整城市化、父母精神障碍、父母教育水平和子女父母分离状态变化次数后，这些估计值有所减弱，但风险梯度仍然存在。观察到与在低收入条件下花费的时间量呈剂量反应关系，与较高的精神分裂症风险相关。无论出生时父母的收入水平如何，与向下的收入流动相比，向上的收入流动与较低的精神分裂症风险相关。例如，与参考组相比，在 15 岁时出生并一直处于最低收入五分位数的孩子的患病风险升高了 4.12（95%CI，3.71-4.58），而那些在出生时和一直处于最富裕五分位数的孩子，但即使从出生时的最低五分位数上升到 15 岁时的第二低五分位数，似乎也降低了风险升高（HR，2.80；95%CI，2.46-3.17）。相反，对于那些出生在最富裕五分位数的人来说，出生到 15 岁期间的收入下降与患精神分裂症的风险增加有关。
本研究结果表明，父母的收入水平和儿童时期的收入流动性可能与精神分裂症风险有关。尽管因果关系和选择机制都可能涉及，但使收入向上流动可能会影响精神分裂症在人群中的发病率。
