Background and Hypothesis Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings. Study Design We used incidence data in people aged 18–64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group. Study Results Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61–0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55–0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02–2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings. Conclusions Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.

中文翻译：

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社会剥夺和大麻使用在解释精神障碍发病率变化中的作用：EU-GEI 研究结果


背景和假设最近的研究结果表明，首发精神障碍（FEP）的发病率因环境水平剥夺和大麻使用而异，但这些因素尚未一起进行调查。我们假设剥夺与 FEP 发病率变化的相关性比不同环境之间每日或高效大麻使用的流行率更为密切。研究设计 我们使用了 EU-GEI 研究 14 个地区 18-64 岁人群的发病率数据。我们估计了对照中每日使用高效大麻的流行率，作为高危人群使用大麻的替代指标；通过链式方程和后分层加权的多重插补分别处理缺失数据和控制代表性。我们在随机截距负二项式回归模型中对 FEP 发生率进行了建模，以调查每个环境中对照、失业和自住情况下大麻使用流行率的关联，并控制了人口密度、年龄、性别和移民/族裔群体。研究结果 较低的自住率与 FEP 增加（调整后发病率比 [aIRR]：0.76，95% CI：0.61–0.95）和非情感性精神病发病率（aIRR：0.68，95% CI：0.55–0.83）独立相关，经过多变量调整后。对照组每日使用大麻的流行率与情感性精神病的发生率相关（aIRR：1.53，95％CI：1.02-2.31）。我们发现 FEP 发病率与失业或高效大麻使用流行率之间没有关联。敏感性分析支持了这些发现。结论 对照组中较低的设定水平业主占有率和每日大麻使用率的增加独立地导致了不同精神障碍发病率的设定水平差异。 减少接触这些有害环境因素的公共卫生干预措施可以降低人群精神障碍的负担。