PDF(Pubmed)
Abstract：
UNASSIGNED: Urban-rural differences in schizophrenia risk have been widely evidenced across Western countries. However, explanation of these differences is lacking. We aimed to identify contextual risk factors for schizophrenia that explain urban-rural differences in schizophrenia risk.
UNASSIGNED: Utilizing Danish population-based registers, we partitioned Denmark into 1885 geographic \"neighborhoods\" homogeneously sized in terms of population. Information on the entire Danish population from 1981 to 2016 was used to quantify a spectrum of neighborhood-level domains. We subsequently conducted multilevel survival analyses following persons born in Denmark from 1971 to 1982 for the development of schizophrenia allowing for clustering of people within neighborhoods. We used this method to tease apart the effects of individual, specific, and general contextual risk factors for schizophrenia.
UNASSIGNED: A significant general contextual effect in schizophrenia risk across neighborhoods was estimated (Medium Incidence Rate Ratio (MRR):1.41; 95% CI:1.35-1.48). Most of the specific contextual factors examined were associated with schizophrenia risk. For instance, neighborhood-level proportion of lone adult households (Incidence Rate Ratios (IRR):1.53; 95% CI:1.44-1.63) had largest risk estimate. Adjustment for all individual-level and specific contextual constructs reduced the IRR for urbanicity from 1.98 (95% CI:1.77-2.22) to 1.30 (95% CI:1.11-1.51).
UNASSIGNED: In the largest prospective multilevel survival analyses of schizophrenia risk conducted to date, multiple neighborhood-level characteristics were associated with raised schizophrenia risk, with these contextual factors explaining most of the elevated risk linked with urbanicity. However, the unexplained heterogeneity that was evident in our multilevel models indicates that our understanding of the role of urbanicity in schizophrenia\'s etiology remains incomplete.
UNASSIGNED: Utilizing Danish population-based registers, we partitioned Denmark into 1885 geographic \"neighborhoods\" homogeneously sized in terms of population. Information on the entire Danish population from 1981 to 2016 was used to quantify a spectrum of neighborhood-level domains. We subsequently conducted multilevel survival analyses following persons born in Denmark from 1971 to 1982 for the development of schizophrenia allowing for clustering of people within neighborhoods. We used this method to tease apart the effects of individual, specific, and general contextual risk factors for schizophrenia.
UNASSIGNED: A significant general contextual effect in schizophrenia risk across neighborhoods was estimated (Medium Incidence Rate Ratio (MRR):1.41; 95% CI:1.35-1.48). Most of the specific contextual factors examined were associated with schizophrenia risk. For instance, neighborhood-level proportion of lone adult households (Incidence Rate Ratios (IRR):1.53; 95% CI:1.44-1.63) had largest risk estimate. Adjustment for all individual-level and specific contextual constructs reduced the IRR for urbanicity from 1.98 (95% CI:1.77-2.22) to 1.30 (95% CI:1.11-1.51).
UNASSIGNED: In the largest prospective multilevel survival analyses of schizophrenia risk conducted to date, multiple neighborhood-level characteristics were associated with raised schizophrenia risk, with these contextual factors explaining most of the elevated risk linked with urbanicity. However, the unexplained heterogeneity that was evident in our multilevel models indicates that our understanding of the role of urbanicity in schizophrenia\'s etiology remains incomplete.
摘要：
■精神分裂症风险的城乡差异已在西方国家得到广泛证明。然而,缺乏对这些差异的解释。我们旨在确定精神分裂症的背景危险因素，以解释精神分裂症风险的城乡差异。
■利用丹麦基于人口的登记册，我们将丹麦划分为1885年地理上的“社区”，就人口而言，这些社区的大小是均匀的。1981年至2016年整个丹麦人口的信息用于量化邻域级别的范围。随后，我们对1971年至1982年在丹麦出生的人进行了多水平生存分析，以发展精神分裂症，从而允许社区内的人群聚集。我们用这种方法来梳理个体的影响，具体,和精神分裂症的一般背景危险因素。
■估计了不同社区精神分裂症风险的显著一般背景效应(中等发病率比率(MRR):1.41;95%CI:1.35-1.48)。所检查的大多数特定情境因素与精神分裂症风险相关。例如,社区级的单独成年家庭比例(发病率比率(IRR):1.53;95%CI:1.44-1.63)具有最大的风险估计值.对所有个人水平和特定上下文结构的调整将城市化的IRR从1.98（95％CI：1.77-2.22）降低到1.30（95％CI：1.11-1.51）。
■在迄今为止对精神分裂症风险进行的最大的前瞻性多水平生存分析中，多个邻域水平特征与精神分裂症风险升高相关，这些环境因素解释了大部分与城市化相关的高风险。然而,在我们的多水平模型中明显的无法解释的异质性表明，我们对城市化在精神分裂症病因学中的作用的理解仍然不完整。
■利用丹麦基于人口的登记册，我们将丹麦划分为1885年地理上的“社区”，就人口而言，这些社区的大小是均匀的。1981年至2016年整个丹麦人口的信息用于量化邻域级别的范围。随后，我们对1971年至1982年在丹麦出生的人进行了多水平生存分析，以发展精神分裂症，从而允许社区内的人群聚集。我们用这种方法来梳理个体的影响，具体,和精神分裂症的一般背景危险因素。
■估计了不同社区精神分裂症风险的显著一般背景效应(中等发病率比率(MRR):1.41;95%CI:1.35-1.48)。所检查的大多数特定情境因素与精神分裂症风险相关。例如,社区级的单独成年家庭比例(发病率比率(IRR):1.53;95%CI:1.44-1.63)具有最大的风险估计值.对所有个人水平和特定上下文结构的调整将城市化的IRR从1.98（95％CI：1.77-2.22）降低到1.30（95％CI：1.11-1.51）。
■在迄今为止对精神分裂症风险进行的最大的前瞻性多水平生存分析中，多个邻域水平特征与精神分裂症风险升高相关，这些环境因素解释了大部分与城市化相关的高风险。然而,在我们的多水平模型中明显的无法解释的异质性表明，我们对城市化在精神分裂症病因学中的作用的理解仍然不完整。
