Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment

doi:10.1136/bmj.323.7325.1336

BMJ 2001;323:1336 ( 8 December )

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Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment

J Boydell, clinical researcher, ^a J van Os, professor, ^b K McKenzie, clinical researcher, ^a J Allardyce, lecturer, ^c R Goel, research assistant, ^a R G McCreadie, professor, ^c R M Murray, professor of psychiatry. ^a

^a Division of Psychological Medicine, Institute of Psychiatry, Denmark Hill, London SE5 8AF, ^b Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands, ^c Department of Clinical Research, Crichton Royal Hospital, Dumfries DG1 4TG

Correspondence to: J Boydell j.kelly{at}iop.kcl.ac.uk

Objective: To determine whether the incidence of schizophreniaamong people from non-white ethnic minorities is greater in neighbourhoodswhere they constitute a smaller proportion of the totalpopulation.
Design: Ecological design including retrospectivestudy of case records to calculate the incidence of schizophreniain the ethnic minority population across electoral wards and multi-levelanalysis to examine interaction between individuals andenvironment.
Setting: 15 electoral wards in Camberwell, SouthLondon.
Participants: All people aged 16 years and over who hadcontact with psychiatric services during 1988-97.
Main outcome measure: Incidence rates of schizophrenia accordingto Research DiagnosticCriteria.
Results: The incidence of schizophrenia in non-whiteethnic minorities increased significantly as the proportion ofsuch minorities in the local population fell. The incidence rateratio varied in a dose-response fashion from 2.38 (95% confidenceinterval 1.49 to 3.79) in the third of wards where non-white ethnicminorities formed the largest proportion (28-57%) of the localpopulation to 4.4 (2.49 to 7.75) in the third of wards where theyformed the smallest proportion (8-22%).
Conclusion: The incidence of schizophrenia in non-whiteethnic minorities in London is greater when they comprise a smallerproportion of the localpopulation.

What is already known on this topic
An increased incidence of schizophrenia has been reported in several ethnic minorities in the United Kingdom

Biological risk factors do not seem to explain this

Reports from the United States have shown an association between the proportion of an ethnic minority living in an area and their admission rates for mental illness in general

What this study adds
The lower the proportion of non-white ethnic minorities in a local area the higher the incidence of schizophrenia in those minorities

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Rapid Responses:

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