The global burden of schizophrenia and the impact of urbanization during 1990-2019: An analysis of the global burden of disease study 2019

Xuanxuan Li; Ning Wei; Jian Song; Jintao Liu; Jiajun Yuan; Rong Song; Li Liu; Lu Mei; Shuangshuang Yan; Yudong Wu; Rubing Pan; Weizhuo Yi; Xiaoyu Jin; Yuxuan Li; Yunfeng Liang; Xiaoni Sun; Jian Cheng; Hong Su

doi:10.1016/j.envres.2023.116305

The global burden of schizophrenia and the impact of urbanization during 1990-2019: An analysis of the global burden of disease study 2019

Environ Res. 2023 Sep 1:232:116305. doi: 10.1016/j.envres.2023.116305. Epub 2023 Jun 1.

Authors

Xuanxuan Li¹, Ning Wei¹, Jian Song¹, Jintao Liu¹, Jiajun Yuan¹, Rong Song¹, Li Liu¹, Lu Mei¹, Shuangshuang Yan¹, Yudong Wu¹, Rubing Pan¹, Weizhuo Yi¹, Xiaoyu Jin¹, Yuxuan Li¹, Yunfeng Liang¹, Xiaoni Sun¹, Jian Cheng¹, Hong Su²

Affiliations

¹ Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China.
² Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, 230032, China. Electronic address: suhong5151@sina.com.

PMID: 37268204
DOI: 10.1016/j.envres.2023.116305

Abstract

Background and hypothesis: The burden of schizophrenia is increasing. Assessing the global distribution of schizophrenia and understanding the association between urbanization factors and schizophrenia are crucial.

Study design: We conducted a two-stage analysis utilizing public data from GBD (global burden of disease) 2019 and the World Bank. First, the distribution of schizophrenia burden at the global, regional, and national levels as well as temporal trends was analyzed. Then, four composite indicators of urbanization (including demographic, spatial, economic, and eco-environment urbanization) were constructed from ten basic indicators. Panel data models were used to explore the relationship between urbanization indicators and the burden of schizophrenia.

Results: In 2019, there were 23.6 million people with schizophrenia, an increase of 65.85% from 1990, and the country with the largest ASDR (age-standardized disability adjusted life years rate) was the United States of America, followed by Australia, and New Zealand. Globally, the ASDR of schizophrenia rose with the sociodemographic index (SDI). In addition, six basic urbanization indicators including urban population proportion, employment in industry/services proportion, urban population density, the population proportion in the largest city, GDP, and PM_2.5 concentration were positively associated with ASDR of schizophrenia, with the largest coefficients being urban population density. Overall, demographic, spatial, economic, and eco-environment urbanization all had positive effects on schizophrenia, and the estimated coefficients indicated that demographic urbanization was the most significant influence.

Conclusions: This study provided a comprehensive description of the global burden of schizophrenia and explored urbanization as a factor contributing to the variation in the burden of schizophrenia, and highlighted policy priorities for schizophrenia prevention in the context of urbanization.

Keywords: GBD; Income level; PM(2.5); Panel data model; Schizophrenia; Urbanization.

MeSH terms

Global Burden of Disease*
Global Health
Humans
Industry
Quality-Adjusted Life Years
Schizophrenia* / epidemiology
Urbanization