Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.
BMC Public Health. 2024 Sep 20;24(1):2576. doi: 10.1186/s12889-024-20064-0.
BACKGROUND: Findings from the Global Burden of Disease (GBD) study have shown that the burden of mental and substance use disorders is considerable, and unevenly distributed across demographic groups in the population. However, there is a lack of knowledge on how this burden differs by socioeconomic position. The aim of this study was to examine educational differences in years lived with disability (YLDs) from mental and substance use disorders among males and females in two high-income countries, taking comorbidity with other diseases into account. METHODS: The study included all registered residents in Denmark and Norway from 2011 to 2021. Diagnostic information was retrieved from records in the Norwegian National Patient Registry (NPR) and the Danish Psychiatric Central Research Register (PCRR) and used as proxy measures for disorder prevalence. Demographical and educational information was taken from administrative registries. The YLD is a measure of the non-fatal health loss in the population and was calculated by multiplying the duration of a disorder with a disability weight (DW), scaled between 0 and 1. Information on remission and DWs were retrieved from the GBD study and other sources, and disorder specific DWs were averaged by severity levels and adjusted for comorbidity. RESULTS: Educational gradients in YLD rates were found for mental and substance disorders overall, and for most of the specific disorders. The educational gradient was more pronounced for schizophrenia, intellectual disability and substance use disorders than for eating, anxiety, and affective disorders. Both higher YLD rates, and a larger attributed proportion of the total YLDs, were found for schizophrenia, intellectual disability, and substance use disorders in the groups with low versus high education. YLD rates for eating, anxiety, and affective disorders were more equal across educational levels, but constituted a smaller proportion of the total YLDs among the groups with low versus the groups with high educational level. CONCLUSION: Most of the disease burden related to mental and substance use disorders falls on those with the fewest years of education. This should be taken into consideration when public health targets aimed at improving mental health and reducing social inequalities in health are developed and implemented.
背景:全球疾病负担(GBD)研究的结果表明,精神和物质使用障碍的负担相当大,并且在人口中的不同人群中分布不均。然而,人们对这种负担如何因社会经济地位而异知之甚少。本研究旨在考察在两个高收入国家,考虑到与其他疾病的共病情况,男性和女性的精神和物质使用障碍导致的残疾年数(YLDs)方面的教育差异。
方法:该研究纳入了 2011 年至 2021 年期间丹麦和挪威的所有登记居民。从挪威国家患者登记处(NPR)和丹麦精神病学中央研究登记处(PCRR)的记录中检索诊断信息,并将其作为疾病流行率的替代指标。人口统计学和教育信息来自行政登记处。YLD 是衡量人群中非致命性健康损失的指标,通过将疾病持续时间乘以残疾权重(DW)来计算,DW 的取值范围为 0 到 1。缓解信息和 DW 从 GBD 研究和其他来源中获取,特定疾病的 DW 根据严重程度进行平均,并针对共病情况进行调整。
结果:发现精神和物质障碍的 YLD 率存在教育梯度,大多数特定障碍也是如此。与饮食、焦虑和情感障碍相比,精神分裂症、智力残疾和物质使用障碍的教育梯度更为明显。在低教育程度与高教育程度的人群中,精神分裂症、智力残疾和物质使用障碍的 YLD 率更高,而总 YLDs 的归因比例也更大。饮食、焦虑和情感障碍的 YLD 率在教育水平之间更为平等,但在低教育程度的人群中,总 YLDs 的比例较小。
结论:与精神和物质使用障碍相关的大部分疾病负担落在受教育程度最低的人群身上。在制定和实施旨在改善心理健康和减少健康方面社会不平等的公共卫生目标时,应考虑到这一点。
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