Pedersen Carsten Bøcker, Antonsen Sussie, Timmermann Allan, Pedersen Marianne Giørtz, Ejlskov Linda, Horsdal Henriette Thisted, Agerbo Esben, Webb Roger T, Raaschou-Nielsen Ole, Sigsgaard Torben, Sabel Clive E, Fan Chun Chieh, Thompson Wesley K
National Centre for Register-Based Research, Aarhus BSS, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.
Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark.
Schizophr Bull Open. 2021 Dec 21;3(1):sgab056. doi: 10.1093/schizbullopen/sgab056. eCollection 2022 Jan.
Urban-rural differences in schizophrenia risk have been widely evidenced across Western countries. However, explanation of these differences is lacking. We aimed to identify contextual risk factors for schizophrenia that explain urban-rural differences in schizophrenia risk.
Utilizing Danish population-based registers, we partitioned Denmark into 1885 geographic "neighborhoods" homogeneously sized in terms of population. Information on the entire Danish population from 1981 to 2016 was used to quantify a spectrum of neighborhood-level domains. We subsequently conducted multilevel survival analyses following persons born in Denmark from 1971 to 1982 for the development of schizophrenia allowing for clustering of people within neighborhoods. We used this method to tease apart the effects of individual, specific, and general contextual risk factors for schizophrenia.
A significant general contextual effect in schizophrenia risk across neighborhoods was estimated (Medium Incidence Rate Ratio (MRR):1.41; 95% CI:1.35-1.48). Most of the specific contextual factors examined were associated with schizophrenia risk. For instance, neighborhood-level proportion of lone adult households (Incidence Rate Ratios (IRR):1.53; 95% CI:1.44-1.63) had largest risk estimate. Adjustment for all individual-level and specific contextual constructs reduced the IRR for urbanicity from 1.98 (95% CI:1.77-2.22) to 1.30 (95% CI:1.11-1.51).
In the largest prospective multilevel survival analyses of schizophrenia risk conducted to date, multiple neighborhood-level characteristics were associated with raised schizophrenia risk, with these contextual factors explaining most of the elevated risk linked with urbanicity. However, the unexplained heterogeneity that was evident in our multilevel models indicates that our understanding of the role of urbanicity in schizophrenia's etiology remains incomplete.
在西方国家，精神分裂症风险的城乡差异已得到广泛证实。然而，这些差异的原因尚不清楚。我们旨在确定导致精神分裂症风险城乡差异的背景风险因素。
利用丹麦基于人群的登记数据，我们将丹麦划分为1885个地理“社区”，这些社区在人口规模上保持一致。使用1981年至2016年丹麦全体人口的信息来量化一系列社区层面的领域。随后，我们对1971年至1982年在丹麦出生的人群进行了多水平生存分析，以研究精神分裂症的发病情况，并考虑了社区内人群的聚集性。我们使用这种方法来区分个体、特定和一般背景风险因素对精神分裂症的影响。
估计各社区精神分裂症风险存在显著的一般背景效应（中等发病率比（MRR）：1.41；95%置信区间：1.35 - 1.48）。所研究的大多数特定背景因素与精神分裂症风险相关。例如，社区层面独居成年家庭的比例（发病率比（IRR）：1.53；95%置信区间：1.44 - 1.63）的风险估计值最大。对所有个体层面和特定背景因素进行调整后，城市化的发病率比从1.98（95%置信区间：1.77 - 2.22）降至1.30（95%置信区间：1.11 - 1.51）。
在迄今为止进行的最大规模的精神分裂症风险前瞻性多水平生存分析中，多个社区层面的特征与精神分裂症风险升高相关，这些背景因素解释了大部分与城市化相关的风险升高。然而，我们的多水平模型中明显存在的无法解释的异质性表明，我们对城市化在精神分裂症病因学中的作用的理解仍然不完整。
