Abstract：
In 2008, the UK entered a period of economic recession followed by sustained austerity measures. We investigate changes in inequalities by area deprivation and urbanicity in incidence of severe mental illness (SMI, including schizophrenia-related disorders and bipolar disorder) between 2000 and 2017.
We analysed 4.4 million individuals from primary and secondary care routinely collected datasets (2000-2017) in Wales and estimated the incidence of SMI by deprivation and urbanicity measured by the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator respectively. Using linear modelling and joinpoint regression approaches, we examined time trends of the incidence and incidence rate ratios (IRR) of SMI by the WIMD and urban/rural indicator adjusted for available confounders.
We observed a turning point of time trends of incidence of SMI at 2008/2009 where slope changes of time trends were significantly increasing. IRRs by deprivation/urbanicity remained stable or significantly decreased over the study period except for those with bipolar disorder sourced from secondary care settings, with increasing trend of IRRs (increase in IRR by deprivation after 2010: 1.6 % per year, 95 % CI: 1.0 %-2.2 %; increase in IRR by urbanicity 1.0 % per year, 95 % CI: 0.6 %-1.3 %).
There was an association between recession/austerity and an increase in the incidence of SMI over time. There were variations in the effects of deprivation/urbanicity on incidence of SMI associated with short- and long-term socioeconomic change. These findings may support targeted interventions and social protection systems to reduce incidence of SMI.
We analysed 4.4 million individuals from primary and secondary care routinely collected datasets (2000-2017) in Wales and estimated the incidence of SMI by deprivation and urbanicity measured by the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator respectively. Using linear modelling and joinpoint regression approaches, we examined time trends of the incidence and incidence rate ratios (IRR) of SMI by the WIMD and urban/rural indicator adjusted for available confounders.
We observed a turning point of time trends of incidence of SMI at 2008/2009 where slope changes of time trends were significantly increasing. IRRs by deprivation/urbanicity remained stable or significantly decreased over the study period except for those with bipolar disorder sourced from secondary care settings, with increasing trend of IRRs (increase in IRR by deprivation after 2010: 1.6 % per year, 95 % CI: 1.0 %-2.2 %; increase in IRR by urbanicity 1.0 % per year, 95 % CI: 0.6 %-1.3 %).
There was an association between recession/austerity and an increase in the incidence of SMI over time. There were variations in the effects of deprivation/urbanicity on incidence of SMI associated with short- and long-term socioeconomic change. These findings may support targeted interventions and social protection systems to reduce incidence of SMI.
摘要：
目标：2008年，英国进入了经济衰退时期，随后采取了持续的紧缩措施。我们调查了严重精神疾病发病率中区域剥夺和城市化的不平等变化（SMI，包括2000年至2017年间精神分裂症相关疾病和双相情感障碍)。
方法：我们分析了威尔士常规收集的数据集（2000-2017年）的440万初级和二级保健个体，并通过威尔士多重剥夺指数（WIMD）和城市/农村指标测量的剥夺和城市化来估计SMI的发生率。使用线性建模和连接点回归方法，我们通过WIMD和经可能的混杂因素校正的城市/农村指标研究了SMI的发病率和发病率比(IRR)的时间趋势.
结果：我们在2008/2009年观察到SMI发生率的时间趋势的转折点，其中时间趋势的斜率变化显着增加。剥夺/城市化的IRRs在研究期间保持稳定或显著下降，除了那些来自二级保健机构的双相情感障碍患者。随着内部收益率的增加趋势(2010年后按剥夺计算的内部收益率增加：每年1.6%，95%CI：1.0%-2.2%；内部收益率按城市化每年增加1.0%，95%CI：0.6%-1.3%）。
结论：随着时间的推移，衰退/紧缩与SMI发病率增加之间存在关联。剥夺/城市化对短期和长期社会经济变化相关的SMI发生率的影响存在差异。这些发现可能支持有针对性的干预措施和社会保护系统，以减少SMI的发生率。
方法：我们分析了威尔士常规收集的数据集（2000-2017年）的440万初级和二级保健个体，并通过威尔士多重剥夺指数（WIMD）和城市/农村指标测量的剥夺和城市化来估计SMI的发生率。使用线性建模和连接点回归方法，我们通过WIMD和经可能的混杂因素校正的城市/农村指标研究了SMI的发病率和发病率比(IRR)的时间趋势.
结果：我们在2008/2009年观察到SMI发生率的时间趋势的转折点，其中时间趋势的斜率变化显着增加。剥夺/城市化的IRRs在研究期间保持稳定或显著下降，除了那些来自二级保健机构的双相情感障碍患者。随着内部收益率的增加趋势(2010年后按剥夺计算的内部收益率增加：每年1.6%，95%CI：1.0%-2.2%；内部收益率按城市化每年增加1.0%，95%CI：0.6%-1.3%）。
结论：随着时间的推移，衰退/紧缩与SMI发病率增加之间存在关联。剥夺/城市化对短期和长期社会经济变化相关的SMI发生率的影响存在差异。这些发现可能支持有针对性的干预措施和社会保护系统，以减少SMI的发生率。
