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Does population density and neighborhood deprivation predict schizophrenia? A nationwide Swedish family-based study of 2.4 million individuals
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-6851-3297
Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2015 (English)In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 41, no 2, 494-502 p.Article in journal (Refereed) Published
Abstract [en]

People living in densely populated and socially disorganized areas have higher rates of psychiatric morbidity, but the potential causal status of such factors is uncertain. We used nationwide Swedish longitudinal registry data to identify all children born 1967-1989 (n = 2361585), including separate datasets for all cousins (n = 1715059) and siblings (n = 1667894). The nature of the associations between population density and neighborhood deprivation and individual risk for a schizophrenia diagnosis was investigated while adjusting for unobserved familial risk factors (through cousin and sibling comparisons) and then compared with similar associations for depression. We generated familial pedigree structures using the Multi-Generation Registry and identified study participants with schizophrenia and depression using the National Patient Registry. Fixed-effects logistic regression models were used to study within-family estimates. Population density, measured as ln(population size/km(2)), at age 15 predicted subsequent schizophrenia in the population (OR = 1.10; 95% CI: 1.09; 1.11). Unobserved familial risk factors shared by cousins within extended families attenuated the association (1.06; 1.03; 1.10), and the link disappeared entirely within nuclear families (1.02; 0.97; 1.08). Similar results were found for neighborhood deprivation as predictor and for depression as outcome. Sensitivity tests demonstrated that timing and accumulation effects of the exposures (mean scores across birth, ages 1-5, 6-10, and 11-15 years) did not alter the findings. Excess risks of psychiatric morbidity, particularly schizophrenia, in densely populated and socioeconomically deprived Swedish neighborhoods appear, therefore, to result primarily from unobserved familial selection factors. Previous studies may have overemphasized the etiological importance of these environmental factors.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Oxford University Press, 2015. Vol. 41, no 2, 494-502 p.
Keyword [en]
Schizophrenia, urbanization, socioeconomic factors, multilevel models, confounding factors, quasiexperimental designs
National Category
Medical and Health Sciences Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-54610DOI: 10.1093/schbul/sbu105ISI: 000350979500024PubMedID: 25053652Scopus ID: 2-s2.0-84937203376OAI: oai:DiVA.org:oru-54610DiVA: diva2:1064441
Funder
Swedish Research CouncilWellcome trust
Note

Funding Agencies:

Swedish Council for Working Life and Social Research 

National Institute of Child Health and Human Development 

Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2017-01-19Bibliographically approved

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