School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; CIRRAU - Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark.
Schizophr Res. 2023 Jun;256:126-132. doi: 10.1016/j.schres.2022.05.015. Epub 2022 Jun 11.
Studies typically highlight area level variation in the incidence of non-affective but not affective psychoses. We compared neighbourhood-level variation for both types of disorder, and the specific effects of neighbourhood urbanicity and ethnic density, using Danish national registry data.
Population based cohort (2,224,464 people) followed from 1980 to 2013 with neighbourhood exposure measured at age 15 and incidence modelled using multilevel Poisson regression.
Neighbourhood variation was similar for both disorders with an adjusted median risk ratio of 1.37 (95% CI 1.34-1.39) for non-affective psychosis and 1.43 (1.38-1.49) for affective psychosis. Associations with neighbourhood urbanicity differed: living in the most compared to the least urban quintile at age 15 was associated with a minimal increase in subsequent affective psychosis, IRR 1.13 (1.01-1.27) but a substantial increase in rates of non-affective psychosis, IRR 1.66 (1.57-1.75). Mixed results were found for neighbourhood ethnic density: for Middle Eastern migrants there was an increased average incidence of both affective, IRR 1.54 (1.19-1.99), and non-affective psychoses, 1.13 (1.04-1.23) associated with each decrease in ethnic density quintile, with a similar pattern for African migrants, but for European migrants ethnic density appeared to be associated with non-affective psychosis only.
While overall variation and the effect of neighbourhood ethnic density were similar for both types of disorder, associations with urbanicity were largely confined to non-affective psychosis. This may reflect differences in aetiological pathways although the mechanism behind these differences remains unknown.
研究通常强调非情感性但非情感性精神病在地区层面的发病率差异。我们使用丹麦全国登记数据比较了这两种类型的疾病的邻里水平差异，以及邻里城市化和族裔密度的具体影响。
基于人群的队列（2224464 人）从 1980 年随访至 2013 年，15 岁时测量邻里暴露情况，采用多水平泊松回归模型对发病率进行建模。
两种疾病的邻里差异相似，非情感性精神病的调整后的中位数风险比为 1.37（95%置信区间 1.34-1.39），情感性精神病为 1.43（1.38-1.49）。与邻里城市化的关联不同：与 15 岁时居住在最城市化五分位数相比，居住在最不城市化五分位数与随后情感性精神病的发生率略有增加有关，IRR 为 1.13（1.01-1.27），而非情感性精神病的发生率则显著增加，IRR 为 1.66（1.57-1.75）。邻里族裔密度的结果喜忧参半：对于中东移民，情感性精神病和非情感性精神病的平均发病率都有所增加，IRR 分别为 1.54（1.19-1.99）和 1.13（1.04-1.23），与族裔密度五分位数的每一次降低相关，非洲移民也存在类似的模式，但对于欧洲移民，族裔密度似乎仅与非情感性精神病有关。
尽管两种类型的疾病总体差异和邻里族裔密度的影响相似，但与城市化的关联主要局限于非情感性精神病。这可能反映了病因途径的差异，尽管这些差异的机制尚不清楚。
