Area deprivation, urbanicity, severe mental illness and social drift ? A population -based linkage study using routinely collected primary and secondary care data
Area deprivation, urbanicity, severe mental illness and social drift ? A population -based linkage study using routinely collected primary and secondary care data
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DOI：
10.1016/j.schres.2020.03.044
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发表时间：
2020-06-01
影响因子：
4.5
通讯作者：
John, Ann
中科院分区：
文献类型：
--
作者：
Lee, Sze Chim;DelPozo-Banos, Marcos;John, Ann
我们调查了区域剥夺，城市化和严重精神疾病（SMI，包括精神分裂症和双相情感障碍）风险升高之间的关联是否是由社会漂移或社会因果关系引起的。我们从390万人口中提取了2004年至2015年的初级和二级医疗电子健康记录。我们确定了普遍和事件的个人与SMI和他们的剥夺和城市化水平，使用威尔士指数的多重残疾人（WIMD）和城市/农村指标。通过logistic回归的比值比（OR）是否大于Poisson回归的发生率比（IRR）来确定是否存在社会漂移。此外，我们进行了纵向分析，以测量在SMI事件诊断后10年的贫困水平和农村/城市居住的变化比例，并使用标准化比率（SRR）将其与普通人群进行比较。SMI的患病率和发病率与贫困和城市化显著相关（所有OR和IRR均显著>1）。所有条件和队列的OR和IRR相似（范围为1.1 - 1.4）。纵向分析的结果显示，与一般人群相比，患有SMI的人更容易移动。然而，他们并不倾向于搬到更贫困的地区或城市地区，在10年的时间里，几乎没有证据表明社会地位下降。这些研究结果对贫困社区的资源分配、服务配置和获得服务的机会，以及更广泛的公共卫生干预措施，解决贫困问题以及社会和环境问题都有影响。
We investigated whether associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs, including schizophrenia and bipolar disorder) is accounted for by social drift or social causation.We extracted primary and secondary care electronic health records from 2004 to 2015 from a population of 3.9 million. We identified prevalent and incident individuals with SMIs and their level of deprivation and urbanicity using the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator. The presence of social drift was determined by whether odds ratios (ORs) from logistic regression is greater than the incidence rate ratios (IRRs) from Poisson regression. Additionally, we performed longitudinal analysis to measure the proportion of change in deprivation level and rural/urban residence 10 years after an incident diagnosis of SMI and compared it to the general population using standardised rate ratios (SRRs).Prevalence and incidence of SMIs were significantly associated with deprivation and urbanicity (all ORs and IRRs significantly >1). ORs and IRRs were similar across all conditions and cohorts (ranging from 1.1 to 1.4). Results from the longitudinal analysis showed individuals with SMIs are more likely to move compared to the general population. However, they did not preferentially move to more deprived or urban areas.There was little evidence of downward social drift over a 10-year period. These findings have implications for the allocation of resources, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.