Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario
Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario
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DOI：
10.1503/cmaj.141420
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发表时间：
2015-06-16
影响因子：
14.6
通讯作者：
Kurdyak, Paul
中科院分区：
文献类型：
--
作者：
Anderson, Kelly K.;Cheng, Joyce;Kurdyak, Paul
背景：有证据表明，移民群体患精神疾病的风险增加，风险水平因原籍国和东道国而异。加拿大缺乏关于移民中精神疾病发病率的证据。我们试图检查安大略省第一代移民和难民中精神分裂症和分裂情感性障碍的发病率，相对于一般人群。方法：我们建立了一个回顾性队列，包括1999年4月1日居住在安大略省的14-40岁的人。以人口为基础的医生账单和医院入院管理数据与加拿大公民和移民部的数据相关联。我们使用泊松回归模型计算了移民和难民群体在10年期间经年龄和性别调整的发病率比（IRRs）和95%置信区间（ci）。结果：在我们的队列中（n = 4 284 694），我们发现加勒比和百慕大移民的精神障碍发生率更高（IRR 1.60, 95% CI 1.29-1.98）。来自北欧（IRR 0.50, 95% CI 0.28-0.91）、南欧（IRR 0.60, 95% CI 0.41-0.90）和东亚（IRR 0.56, 95% CI 0.41-0.78）的移民发病率较低。难民身份是所有移民风险的独立预测因子（IRR 1.27, 95% CI 1.04-1.56），特别是来自东非（IRR 1.95, 95% CI 1.44-2.65）和南亚（IRR 1.51, 95% CI 1.08-2.12）的难民的风险更高。解释：安大略省不同种族亚群的风险差异模式表明，与移民相关的社会心理和文化因素可能会增加精神障碍的风险。一些群体可能面临更大的风险，而另一些群体则受到保护。
Background:Evidence suggests that migrant groups have an increased risk of psychotic disorders and that the level of risk varies by country of origin and host country. Canadian evidence is lacking on the incidence of psychotic disorders among migrants. We sought to examine the incidence of schizophrenia and schizoaffective disorders in first-generation immigrants and refugees in the province of Ontario, relative to the general population.Methods:We constructed a retrospective cohort that included people aged 14-40 years residing in Ontario as of Apr. 1, 1999. Population-based administrative data from physician billings and hospital admissions were linked to data from Citizenship and Immigration Canada. We used Poisson regression models to calculate age- and sex-adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for immigrant and refugee groups over a 10-year period.Results:In our cohort (n = 4 284 694), we found higher rates of psychotic disorders among immigrants from the Caribbean and Bermuda (IRR 1.60, 95% CI 1.29-1.98). Lower rates were found among immigrants from northern Europe (IRR 0.50, 95% CI 0.28-0.91), southern Europe (IRR 0.60, 95% CI 0.41-0.90) and East Asia (IRR 0.56, 95% CI 0.41-0.78). Refugee status was an independent predictor of risk among all migrants (IRR 1.27, 95% CI 1.04-1.56), and higher rates were found specifically for refugees from East Africa (IRR 1.95, 95% CI 1.44-2.65) and South Asia (IRR 1.51, 95% CI 1.08-2.12).Interpretation:The differential pattern of risk across ethnic subgroups in Ontario suggests that psychosocial and cultural factors associated with migration may contribute to the risk of psychotic disorders. Some groups may be more at risk, whereas others are protected.