The Incidence of Nonaffective, Nonorganic Psychotic Disorders in Older People: A Population-based Cohort Study of 3 Million People in Sweden.
Africa
/ ethnology
Aged
Aged, 80 and over
Baltic States
/ ethnology
Bereavement
Cohort Studies
Emigrants and Immigrants
/ statistics & numerical data
Europe
/ ethnology
Female
Finland
/ ethnology
Hearing Loss
/ epidemiology
Humans
Incidence
Income
/ statistics & numerical data
Late Onset Disorders
/ epidemiology
Male
Marital Status
/ statistics & numerical data
Middle Aged
North America
/ ethnology
Proportional Hazards Models
Psychotic Disorders
/ epidemiology
Risk Factors
Russia
/ ethnology
Sex Distribution
Social Isolation
Sweden
/ epidemiology
Vision Disorders
/ epidemiology
Widowhood
/ statistics & numerical data
late-onset
old age psychiatry
schizophrenia
Journal
Schizophrenia bulletin
ISSN: 1745-1701
Titre abrégé: Schizophr Bull
Pays: United States
ID NLM: 0236760
Informations de publication
Date de publication:
11 09 2019
11 09 2019
Historique:
pubmed:
20
10
2018
medline:
11
7
2020
entrez:
20
10
2018
Statut:
ppublish
Résumé
There are limited data on the epidemiology of very late-onset schizophrenia-like psychosis (VLOSLP) and how this relates to potential risk factors including migration, sensory impairment, traumatic life events, and social isolation. We followed up a cohort of 3 007 378 people living in Sweden, born 1920-1949, from their 60th birthday (earliest: January 15, 1980) until December 30 2011, emigration, death, or first recorded diagnosis of nonaffective psychosis. We examined VLOSLP incidence by age, sex, region of origin, income, partner or child death, birth period, and sensory impairments. We identified 14 977 cases and an overall incidence of 37.7 per 100 000 person-years at-risk (95% CI = 37.1-38.3), with evidence that rates increased more sharply with age for women (likelihood ratio test: χ2(6) = 31.56, P < .001). After adjustment for confounders, rates of VLOSLP were higher among migrants from Africa (hazard ratio [HR] = 2.0, 95% CI = 1.4-2.7), North America (HR = 1.4, 95% CI = 1.0-1.9, P = .04), Europe (HR = 1.3, 95% CI = 1.2-1.4), Russian-Baltic regions (HR = 1.6, 95% CI = 1.4-1.9), and Finland (HR = 1.6, 95% CI = 1.5-1.7). VLOSLP risk was highest for those in the lowest income quartile (HR = 3.1, 95% CI = 2.9-3.3). Rates were raised in those whose partner died 2 years before cohort exit (HR = 1.1, 95% CI = 1.0-1.3, P = .02) or whose child died in infancy (HR = 1.2, 95% CI = 1.0-1.4, P = .05), those without a partner (HR = 1.9, 95% CI = 1.8-1.9) or children (HR = 2.4, 95% CI = 2.3-2.5), and those whose child had a psychotic disorder (HR = 2.4, 95% CI = 2.2-2.6). We identified a substantial burden of psychosis incidence in old age, with a higher preponderance in women and most migrant groups. Life course exposure to environmental factors including markers of deprivation, isolation, and adversity were associated with VLOSLP risk.
Sections du résumé
BACKGROUND
There are limited data on the epidemiology of very late-onset schizophrenia-like psychosis (VLOSLP) and how this relates to potential risk factors including migration, sensory impairment, traumatic life events, and social isolation.
METHODS
We followed up a cohort of 3 007 378 people living in Sweden, born 1920-1949, from their 60th birthday (earliest: January 15, 1980) until December 30 2011, emigration, death, or first recorded diagnosis of nonaffective psychosis. We examined VLOSLP incidence by age, sex, region of origin, income, partner or child death, birth period, and sensory impairments.
RESULTS
We identified 14 977 cases and an overall incidence of 37.7 per 100 000 person-years at-risk (95% CI = 37.1-38.3), with evidence that rates increased more sharply with age for women (likelihood ratio test: χ2(6) = 31.56, P < .001). After adjustment for confounders, rates of VLOSLP were higher among migrants from Africa (hazard ratio [HR] = 2.0, 95% CI = 1.4-2.7), North America (HR = 1.4, 95% CI = 1.0-1.9, P = .04), Europe (HR = 1.3, 95% CI = 1.2-1.4), Russian-Baltic regions (HR = 1.6, 95% CI = 1.4-1.9), and Finland (HR = 1.6, 95% CI = 1.5-1.7). VLOSLP risk was highest for those in the lowest income quartile (HR = 3.1, 95% CI = 2.9-3.3). Rates were raised in those whose partner died 2 years before cohort exit (HR = 1.1, 95% CI = 1.0-1.3, P = .02) or whose child died in infancy (HR = 1.2, 95% CI = 1.0-1.4, P = .05), those without a partner (HR = 1.9, 95% CI = 1.8-1.9) or children (HR = 2.4, 95% CI = 2.3-2.5), and those whose child had a psychotic disorder (HR = 2.4, 95% CI = 2.2-2.6).
INTERPRETATION
We identified a substantial burden of psychosis incidence in old age, with a higher preponderance in women and most migrant groups. Life course exposure to environmental factors including markers of deprivation, isolation, and adversity were associated with VLOSLP risk.
Identifiants
pubmed: 30339239
pii: 5136924
doi: 10.1093/schbul/sby147
pmc: PMC6737541
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1152-1160Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K501268/1
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 101272/Z/13/Z
Pays : United Kingdom
Informations de copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Références
J Psychosom Res. 1981;25(2):69-74
pubmed: 7277274
Eur Arch Psychiatry Clin Neurosci. 1994;244(3):126-30
pubmed: 7803525
Br J Psychiatry. 2001 Aug;179:172-4
pubmed: 11483481
Soc Psychiatry Psychiatr Epidemiol. 1995 Jul;30(4):161-4
pubmed: 7491511
Int J Geriatr Psychiatry. 2012 Mar;27(3):240-52
pubmed: 21472779
Epidemiol Psychiatr Sci. 2013 Jun;22(2):131-46
pubmed: 22831843
Br J Psychiatry. 2003 Sep;183:213-9
pubmed: 12948993
Arch Gen Psychiatry. 2010 Sep;67(9):914-22
pubmed: 20819985
Am J Psychiatry. 2005 Sep;162(9):1652-7
pubmed: 16135624
JAMA Psychiatry. 2018 Jan 1;75(1):75-83
pubmed: 29188295
Int J Methods Psychiatr Res. 2013 Mar;22(1):36-45
pubmed: 23456888
Br J Psychiatry. 2010 Sep;197(3):207-11
pubmed: 20807965
BMJ. 2016 Mar 15;352:i1030
pubmed: 26979256
Fam Pract. 2007 Feb;24(1):34-40
pubmed: 17062587
Psychol Med. 2018 Aug;48(11):1775-1786
pubmed: 29198197
Psychosomatics. 2010 Nov-Dec;51(6):458-65
pubmed: 21051676
Am J Psychiatry. 2005 Jan;162(1):12-24
pubmed: 15625195
Lancet. 1974 Oct 12;2(7885):851-4
pubmed: 4137694
Int J Geriatr Psychiatry. 2010 Nov;25(11):1112-8
pubmed: 20029820
Am J Psychiatry. 1989 Dec;146(12):1568-74
pubmed: 2574011
JAMA Psychiatry. 2013 Jan;70(1):22-30
pubmed: 23147713
JAMA Psychiatry. 2014 May;71(5):573-81
pubmed: 24806211
Br J Psychiatry. 1993 May;162:658-64
pubmed: 8149118
Psychol Med. 1991 Aug;21(3):565-75
pubmed: 1946845
Soc Psychiatry Psychiatr Epidemiol. 2002 Nov;37(11):527-31
pubmed: 12395142
N Engl J Med. 1999 Feb 25;340(8):603-8
pubmed: 10029644
Int J Geriatr Psychiatry. 2004 Mar;19(3):286-90
pubmed: 15027045
Acta Psychiatr Scand. 1977 May;55(5):369-80
pubmed: 868568
Am J Psychiatry. 2000 Feb;157(2):172-8
pubmed: 10671383
Int J Geriatr Psychiatry. 2005 Nov;20(11):1046-51
pubmed: 16250076
Br J Psychiatry. 1995 Feb;166(2):205-14
pubmed: 7728365
Am J Public Health. 2007 Oct;97(10):1756-7
pubmed: 17895405
Medicine (Baltimore). 2016 Jan;95(3):e2434
pubmed: 26817875
J Ment Sci. 1961 Jul;107:649-86
pubmed: 13752013
Int J Geriatr Psychiatry. 2009 Jan;24(1):61-7
pubmed: 18561206
Curr Opin Psychiatry. 2007 Jul;20(4):359-64
pubmed: 17551351
Soc Sci Med. 2002 Oct;55(8):1457-70
pubmed: 12231022
PLoS One. 2012;7(3):e31660
pubmed: 22457710
Acta Psychiatr Scand. 2011 Feb;123(2):98-106
pubmed: 20958271
N Engl J Med. 2005 Mar 24;352(12):1190-6
pubmed: 15788495
Schizophr Bull. 1993;19(4):691-700
pubmed: 8303220
Arch Gen Psychiatry. 2006 Mar;63(3):250-8
pubmed: 16520429
BMC Med. 2004 Apr 28;2:13
pubmed: 15115547
Psychol Med. 2009 Oct;39(10):1667-76
pubmed: 19265569
Psychol Med. 2007 Apr;37(4):495-503
pubmed: 17094816
Schizophr Res. 2015 Dec;169(1-3):268-273
pubmed: 26527247
Psychopathology. 1999 Mar-Apr;32(2):60-9
pubmed: 10026450
Psychol Med. 1998 Mar;28(2):351-65
pubmed: 9572092
Acta Psychiatr Scand Suppl. 2007;(436):20-32
pubmed: 18021158
BMC Public Health. 2011 Jun 09;11:450
pubmed: 21658213
J Nerv Ment Dis. 2007 Apr;195(4):315-9
pubmed: 17435481
BMJ Open. 2013 Apr 17;3(4):
pubmed: 23599376
Psychol Med. 1994 May;24(2):397-410
pubmed: 8084935