Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study
Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study
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DOI：
10.1001/jamapsychiatry.2017.3554
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发表时间：
2018-01-01
期刊：
影响因子：
25.8
通讯作者：
Kirkbride, James B.
中科院分区：
文献类型：
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作者：
Jongsma, Hannah E.;Gayer-Anderson, Charlotte;Kirkbride, James B.
重要性精神障碍对全球疾病负担有很大贡献，但最新的国际精神障碍发病率研究是在20世纪80年代进行的。目的：采用可比方法估计6个国家17个集水区的精神障碍发病率，并通过假定的环境危险因素检查集水区之间的差异。一项国际多中心发病率研究（欧洲国家精神分裂症网络研究基因-环境相互作用网络）于2010年5月1日至2015年4月1日在来自英格兰的2774名个体中进行（2个集水区），法国（3个集水区），意大利（3个集水区），荷兰（2个集水区），西班牙（6个集水区）和巴西（1个集水区）首次发生非器质性精神障碍（疾病和相关健康问题国际统计分类，第十次修订[ICD-10]代码F20-F33）。分母人口估计使用官方国家statistics.EXPOSURES年龄，性别和种族/少数民族的地位被视为先验混杂因素。纬度、人口密度、失业率、自有住房和单身家庭被视为集水区水平的暴露。主要结果和指标（ICD-10编码F20-F33），非情感性精神病（ICD-10编码F20-F29），和情感性精神病（ICD-10编码F30-F33），经操作标准检查表确认。（1196名女性和1578名男性;中位年龄为30.5岁[四分位距为23.0-41.0岁]），在1290万人-年的风险中确定了精神障碍的偶发病例（粗发病率，21.4/100 000人年; 95% CI，19.4-23.4/100 000人年）。共有2183例患者（78.7%）患有非情感性精神障碍。在对年龄、性别和种族/少数民族状态进行直接标准化后，所有精神病性障碍的发生率变化为8倍，从西班牙圣地亚哥的6.0（95% CI，3.5-8.6）/10万人-年至法国巴黎的46.1（95% CI，37.3-55.0）/10万人-年。少数种族/族裔群体的发病率升高（发病率比，1.6; 95%CI，1.5-1.7），18 - 24岁男性的发病率最高，在拥有更多自住房屋的集水区较低（发病率比，0.8; 95%CI，0.7-0.8）。在非情感性精神病中也观察到类似的模式;情感性精神病的发病率较低与较高的地区失业率有关（发生率比，0.3; 95%CI，0.2-0.5）。结论和相关性该研究证实了精神障碍风险的显著异质性，包括年轻男性，种族/民族少数，以及自有住房比例较低的地区。
IMPORTANCE Psychotic disorders contribute significantly to the global disease burden, yet the latest international incidence study of psychotic disorders was conducted in the 1980s.OBJECTIVES To estimate the incidence of psychotic disorders using comparable methods across 17 catchment areas in 6 countries and to examine the variance between catchment areas by putative environmental risk factors.DESIGN, SETTING, AND PARTICIPANTS An international multisite incidence study (the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions) was conducted from May 1, 2010, to April 1, 2015, among 2774 individuals from England (2 catchment areas), France (3 catchment areas), Italy (3 catchment areas), the Netherlands (2 catchment areas), Spain (6 catchment areas), and Brazil (1 catchment area) with a first episode of nonorganic psychotic disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F20-F33) confirmed by the Operational Criteria Checklist. Denominator populations were estimated using official national statistics.EXPOSURES Age, sex, and racial/ethnic minority status were treated as a priori confounders. Latitude, population density, percentage unemployment, owner-occupied housing, and single-person households were treated as catchment area-level exposures.MAIN OUTCOMES AND MEASURES Incidence of nonorganic psychotic disorders (ICD-10 codes F20-F33), nonaffective psychoses (ICD-10 codes F20-F29), and affective psychoses (ICD-10 codes F30-F33) confirmed by the Operational Criteria Checklist.RESULTS A total of 2774 patients (1196 women and 1578 men; median age, 30.5 years [interquartile range, 23.0-41.0 years]) with incident cases of psychotic disorders were identified during 12.9 million person-years at risk (crude incidence, 21.4 per 100 000 person-years; 95% CI, 19.4-23.4 per 100 000 person-years). A total of 2183 patients (78.7%) had nonaffective psychotic disorders. After direct standardization for age, sex, and racial/ethnic minority status, an 8-fold variation was seen in the incidence of all psychotic disorders, from 6.0 (95% CI, 3.5-8.6) per 100 000 person-years in Santiago, Spain, to 46.1 (95% CI, 37.3-55.0) per 100 000 person-years in Paris, France. Rates were elevated in racial/ethnic minority groups (incidence rate ratio, 1.6; 95% CI, 1.5-1.7), were highest for men 18 to 24 years of age, and were lower in catchment areas with more owner-occupied homes (incidence rate ratio, 0.8; 95% CI, 0.7-0.8). Similar patterns were observed for nonaffective psychoses; a lower incidence of affective psychoses was associated with higher area-level unemployment (incidence rate ratio, 0.3; 95% CI, 0.2-0.5).CONCLUSIONS AND RELEVANCE This study confirmed marked heterogeneity in risk for psychotic disorders by person and place, including higher rates in younger men, racial/ethnic minorities, and areas characterized by a lower percentage of owner-occupied houses.