Finnerty Molly T, Khan Atif, You Kai, Wang Rui, Gu Gyojeong, Layman Deborah, Chen Qingxian, Elhadad Noémie, Joshi Shalmali, Appelbaum Paul S, Lencz Todd, Markx Sander, Kushner Steven A, Rzhetsky Andrey
Office of Population Health and Evaluation, NYC Field Office, New York State Office of Mental Health, New York, NY, USA.
Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
Schizophrenia (Heidelb). 2024 Aug 22;10(1):68. doi: 10.1038/s41537-024-00490-0.
Given the chronic nature of schizophrenia, it is important to examine age-specific prevalence and incidence to understand the scope of the burden of schizophrenia across the lifespan. Estimates of lifetime prevalence of schizophrenia have varied widely and have often relied upon community-based data estimates from over two decades ago, while more recent studies have shown considerable promise by leveraging pooled datasets. However, the validity of measures of schizophrenia, particularly new onset schizophrenia, has not been well studied in these large health databases. The current study examines prevalence and validity of incidence measures of new diagnoses of schizophrenia in 2019 using two U.S. administrative health databases: MarketScan, a national database of individuals receiving employer-sponsored commercial insurance (N = 16,365,997), and NYS Medicaid, a large state public insurance program (N = 4,414,153). Our results indicate that the prevalence of schizophrenia is over 10-fold higher, and the incidence two-fold higher, in the NYS Medicaid population compared to the MarketScan database. In addition, prevalence increased over the lifespan in the Medicaid population, but decreased in the employment based MarketScan database beginning in early adulthood. Incident measures of new diagnoses of schizophrenia had excellent validity, with positive predictive values and specificity exceeding 95%, but required a longer lookback period for Medicaid compared to MarketScan. Further work is needed to leverage these findings to develop robust clinical outcome predictors for new onset of schizophrenia within large administrative health data systems.
鉴于精神分裂症的慢性特征，研究特定年龄的患病率和发病率对于了解精神分裂症在整个生命周期中的负担范围至关重要。精神分裂症终生患病率的估计差异很大，且常常依赖于二十多年前基于社区的数据估计，而最近的研究通过利用汇总数据集显示出了很大的前景。然而，在这些大型健康数据库中，精神分裂症测量方法的有效性，尤其是新发精神分裂症的测量方法，尚未得到充分研究。本研究使用两个美国行政健康数据库，即接受雇主赞助商业保险的个人的全国数据库MarketScan（N = 16,365,997）和大型州公共保险计划纽约州医疗补助计划（NYS Medicaid，N = 4,414,153），研究2019年精神分裂症新诊断发病率测量的患病率和有效性。我们的结果表明，与MarketScan数据库相比，纽约州医疗补助计划人群中精神分裂症的患病率高出10倍以上，发病率高出两倍。此外，医疗补助计划人群中的患病率在整个生命周期中有所上升，但在基于就业的MarketScan数据库中，从成年早期开始患病率下降。精神分裂症新诊断的发病测量具有出色的有效性，阳性预测值和特异性超过95%，但与MarketScan相比，医疗补助计划需要更长的回顾期。需要进一步开展工作，利用这些发现为大型行政健康数据系统中新发精神分裂症开发强大的临床结局预测指标。
