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Prevalence of schizophrenia in China between 1990 and 2010.

Chan KY, Zhao FF, Meng S, Demaio AR, Reed C, Theodoratou E, Campbell H, Wang W, Rudan I, Global Health Epidemiology Reference Group (GHER - J Glob Health (2015)

Bottom Line: In rural areas, the corresponding rates were 0.37% (0.34-0.40%), 0.43% (0.42-0.44%) and 0.50% (0.47-0.53%).The number of cases rose to 7.16 (6.57-7.75) million in 2010, a 132% increase, while the total population increased by 18%.The contribution of cases from urban areas to the overall burden increased from 27% in 1990 to 62% in 2010.

View Article: PubMed Central - PubMed

Affiliation: Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK ; World Health Organization's Collaborative Centre for Population Health Research and Training ; Nossal Institute for Global Health, University of Melbourne, Australia ; Joint first authors.

ABSTRACT

Background: Dramatic development and changes in lifestyle in many low and middle-income countries (LMIC) over the past three decades may have affected mental health of their populations. Being the largest country and having the most striking record of development, industrialization and urbanization, China provides an important opportunity for studying the nature and magnitude of possible effects.

Methods: We reviewed CNKI, WanFang and PubMed databases for epidemiological studies of schizophrenia in mainland China published between 1990 and 2010. We identified 42 studies that reported schizophrenia prevalence using internationally recognized diagnostic criteria, with breakdown by rural and urban residency. The analysis involved a total of 2 284 957 persons, with 10 506 diagnosed with schizophrenia. Bayesian methods were used to estimate the probability of case of schizophrenia ("prevalence") by type of residency in different years.

Findings: In urban China, lifetime prevalence was 0.39% (0.37-0.41%) in 1990, 0.57% (0.55-0.59%) in 2000 and 0.83% (0.75-0.91%) in 2010. In rural areas, the corresponding rates were 0.37% (0.34-0.40%), 0.43% (0.42-0.44%) and 0.50% (0.47-0.53%). In 1990 there were 3.09 (2.87-3.32) million people in China affected with schizophrenia during their lifetime. The number of cases rose to 7.16 (6.57-7.75) million in 2010, a 132% increase, while the total population increased by 18%. The contribution of cases from urban areas to the overall burden increased from 27% in 1990 to 62% in 2010.

Conclusions: The prevalence of schizophrenia in China has more than doubled between 1990 and 2010, with rates being particularly high in the most developed areas of modern China. This has broad implications, as the ongoing development in LMIC countries may be increasing the global prevalence of schizophrenia.

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Related in: MedlinePlus

PRISMA diagram of the study selection. †The large majority was excluded because they were duplicate returns of the same reference under different search terms or in different databases; the others were excluded because they were irrelevant to the topic of our study, provided no numerical estimates, or studied Chinese populations outside of mainland China. *Reports of the same results in different journals.
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Figure 1: PRISMA diagram of the study selection. †The large majority was excluded because they were duplicate returns of the same reference under different search terms or in different databases; the others were excluded because they were irrelevant to the topic of our study, provided no numerical estimates, or studied Chinese populations outside of mainland China. *Reports of the same results in different journals.

Mentions: The two Chinese databases initially yielded a total of 8642 titles, while PubMed yielded 467. Papers were first excluded on the basis of duplicate publications within and between databases, studies with no numerical estimates, studies of Chinese population outside of mainland China, reviews, and viewpoints, reducing the yield to 122 full–text papers. Further studies were excluded if they reported less than 20 schizophrenia cases, had no clear denominator or were not representative of the general population. In reviewing the methods of each paper further exclusions were made on the basis that the paper did not provide a clear differentiation between rural and urban residents or had failed to specify whether the reported prevalence was lifetime or point prevalence. Finally, after checking the case definition used in each paper, only papers that had applied a ‘gold standard’ case definition were retained (ie, Diagnostic and Statistical Manual of Mental Disorders (DSM)–III or IV, International Classification of Diseases (ICD)–9 or 10, or Chinese Classification of Mental Disorders – CCMD–II and above). Four papers were excluded because they reported only incidence or mortality rates with no prevalence estimates. Direct contact was made with the corresponding authors of 13 of the retained studies to obtain missing information related to the inclusion criteria, thus removing any ambiguities about the studies. Publications from the same field site that reported partial results were merged and counted as one study. Figure 1 shows the PRISMA (acronym for: preferred reporting items for systematic reviews and meta–analyses) diagram illustrating the process of selection of studies.


Prevalence of schizophrenia in China between 1990 and 2010.

Chan KY, Zhao FF, Meng S, Demaio AR, Reed C, Theodoratou E, Campbell H, Wang W, Rudan I, Global Health Epidemiology Reference Group (GHER - J Glob Health (2015)

PRISMA diagram of the study selection. †The large majority was excluded because they were duplicate returns of the same reference under different search terms or in different databases; the others were excluded because they were irrelevant to the topic of our study, provided no numerical estimates, or studied Chinese populations outside of mainland China. *Reports of the same results in different journals.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663755&req=5

Figure 1: PRISMA diagram of the study selection. †The large majority was excluded because they were duplicate returns of the same reference under different search terms or in different databases; the others were excluded because they were irrelevant to the topic of our study, provided no numerical estimates, or studied Chinese populations outside of mainland China. *Reports of the same results in different journals.
Mentions: The two Chinese databases initially yielded a total of 8642 titles, while PubMed yielded 467. Papers were first excluded on the basis of duplicate publications within and between databases, studies with no numerical estimates, studies of Chinese population outside of mainland China, reviews, and viewpoints, reducing the yield to 122 full–text papers. Further studies were excluded if they reported less than 20 schizophrenia cases, had no clear denominator or were not representative of the general population. In reviewing the methods of each paper further exclusions were made on the basis that the paper did not provide a clear differentiation between rural and urban residents or had failed to specify whether the reported prevalence was lifetime or point prevalence. Finally, after checking the case definition used in each paper, only papers that had applied a ‘gold standard’ case definition were retained (ie, Diagnostic and Statistical Manual of Mental Disorders (DSM)–III or IV, International Classification of Diseases (ICD)–9 or 10, or Chinese Classification of Mental Disorders – CCMD–II and above). Four papers were excluded because they reported only incidence or mortality rates with no prevalence estimates. Direct contact was made with the corresponding authors of 13 of the retained studies to obtain missing information related to the inclusion criteria, thus removing any ambiguities about the studies. Publications from the same field site that reported partial results were merged and counted as one study. Figure 1 shows the PRISMA (acronym for: preferred reporting items for systematic reviews and meta–analyses) diagram illustrating the process of selection of studies.

Bottom Line: In rural areas, the corresponding rates were 0.37% (0.34-0.40%), 0.43% (0.42-0.44%) and 0.50% (0.47-0.53%).The number of cases rose to 7.16 (6.57-7.75) million in 2010, a 132% increase, while the total population increased by 18%.The contribution of cases from urban areas to the overall burden increased from 27% in 1990 to 62% in 2010.

View Article: PubMed Central - PubMed

Affiliation: Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK ; World Health Organization's Collaborative Centre for Population Health Research and Training ; Nossal Institute for Global Health, University of Melbourne, Australia ; Joint first authors.

ABSTRACT

Background: Dramatic development and changes in lifestyle in many low and middle-income countries (LMIC) over the past three decades may have affected mental health of their populations. Being the largest country and having the most striking record of development, industrialization and urbanization, China provides an important opportunity for studying the nature and magnitude of possible effects.

Methods: We reviewed CNKI, WanFang and PubMed databases for epidemiological studies of schizophrenia in mainland China published between 1990 and 2010. We identified 42 studies that reported schizophrenia prevalence using internationally recognized diagnostic criteria, with breakdown by rural and urban residency. The analysis involved a total of 2 284 957 persons, with 10 506 diagnosed with schizophrenia. Bayesian methods were used to estimate the probability of case of schizophrenia ("prevalence") by type of residency in different years.

Findings: In urban China, lifetime prevalence was 0.39% (0.37-0.41%) in 1990, 0.57% (0.55-0.59%) in 2000 and 0.83% (0.75-0.91%) in 2010. In rural areas, the corresponding rates were 0.37% (0.34-0.40%), 0.43% (0.42-0.44%) and 0.50% (0.47-0.53%). In 1990 there were 3.09 (2.87-3.32) million people in China affected with schizophrenia during their lifetime. The number of cases rose to 7.16 (6.57-7.75) million in 2010, a 132% increase, while the total population increased by 18%. The contribution of cases from urban areas to the overall burden increased from 27% in 1990 to 62% in 2010.

Conclusions: The prevalence of schizophrenia in China has more than doubled between 1990 and 2010, with rates being particularly high in the most developed areas of modern China. This has broad implications, as the ongoing development in LMIC countries may be increasing the global prevalence of schizophrenia.

Show MeSH
Related in: MedlinePlus