Abstract
Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. We used national register data from Chile including all people, 10-65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20-F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18-39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7-19.1]. Multilevel Poisson regression identified a strong age-sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0-59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4-30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.
Highlights
The most recent international meta-analysis on the incidence of psychotic disorders demonstrated substantial variation in rates in studies conducted since 2002 (Jongsma, Turner, Kirkbride, & Jones, 2019)
In the aforementioned international meta-analysis (Jongsma et al, 2019), only 24 of 177 (13.5%) incidence studies conducted between 2002 and 2017 were conducted outside of Europe, North America and Australia. Data from these studies suggested that incidence rates of all psychotic disorders were not demonstrably higher or lower in low- and middle-income countries (LMICs) compared with high-income countries (Jongsma et al, 2019), but comparisons have often been hampered by a lack of reliable epidemiological data (Jablensky et al, 1992)
We identified all individuals registered with a first episode of non-affective psychotic disorders (NAPDs) between 1 January 2005 and 29 August 2018, aged 10– 64-year old, from the Chilean First-Episode of Schizophrenia Programme register
Summary
The most recent international meta-analysis on the incidence of psychotic disorders demonstrated substantial variation in rates in studies conducted since 2002 (Jongsma, Turner, Kirkbride, & Jones, 2019). In the aforementioned international meta-analysis (Jongsma et al, 2019), only 24 of 177 (13.5%) incidence studies conducted between 2002 and 2017 were conducted outside of Europe, North America and Australia Data from these studies suggested that incidence rates of all psychotic disorders were not demonstrably higher or lower in low- and middle-income countries (LMICs) compared with high-income countries (Jongsma et al, 2019), but comparisons have often been hampered by a lack of reliable epidemiological data (Jablensky et al, 1992). The absence of association with population density suggests this risk may be context-dependent
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