Fanyu Xue1,2, Qinyao Yu1,3,4, Sofia Laila Wik1,5, Minjun Gao1,6, Sze Chai Chan1, Shui Hang Chow1, Claire Chenwen Zhong1, Don Eliseo Lucero-Prisno III7, Martin C. S. Wong1,8, Junjie Huang1,8
1The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China;
2Faculty of Health Sciences, University of Ottawa, Ottawa, Canada;
3Jinan University-University of Birmingham Joint Institute, Jinan University, Guangzhou, China;
4School of Mathematics, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK;
5Karolinska Institute, Solna, Sweden;
6Adam Smith Business School, College of Social Science, University of Glasgow, Glasgow, UK;
7Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK;
8Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Correspondence to: Dr. Junjie Huang, PhD. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Public Health, Prince of Wales Hospital, 5/F, School of Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China. Email: junjie_huang@link.cuhk.edu.hk.
Background: Schizophrenia is a psychiatric syndrome that presents with delusions, disorganized speech, hallucinations, and impaired executive functioning. This study aims to evaluate the disease burden of schizophrenia in low- and middle-income countries (LMICs), considering genders and 11 age groups, assessing disability adjusted life-years (DALYs) rate, incidence rate, prevalence rate, and temporal trends.
Methods: This study utilized data from the Global Burden of Disease (GBD) databases to extract DALYs, incidence rate, and prevalence rate associated with schizophrenia across 173 LMICs or territories from 1990 to 2019. The countries were grouped based on the income classification of the World Bank.
Results: The prevalence rates of schizophrenia for both genders in upper-middle income countries (male: 285 to 359; female: 271 to 341) consistently remained higher than the other two income tiers from 1990 to 2019. Prevalence rates showed a mostly positive correlation with time during this period. The prevalence rate of schizophrenia for males was consistently higher than for females in LMICs from 1990 to 2019. While most trends were increasing, the incidence rates of schizophrenia for both genders in upper-income countries decreased significantly from 2009 to 2019 (male: 20.41 to 18.72; female: 18.40 to 16.32). Burn et al. [2013] found that countries with higher income inequality tend to have a higher incidence rate of schizophrenia. The burden of schizophrenia for all measures is positively correlated with the country’s income tier, and male burden is always higher than female burden regardless of the measure method and income tier. Countries in East and Southeast Asia, and Eastern Europe tend to have the highest burden of schizophrenia, while African countries have the lowest burden. Social isolation is highly related to schizophrenia, so creating a more inclusive and equal society may help reduce its burden. Further research is needed to investigate risk factors and treatments for schizophrenia.
Conclusions: Schizophrenia is a mental health burden that is prevalent in LMICs in East and Southeast Asia, and East Europe, and is positively correlated with the country’s income tier, with males experiencing a consistently higher burden than females, while income inequality and social isolation are contributing factors, necessitating the need for further investigation and a more inclusive society.
Keywords: Schizophrenia; low- and middle-income countries (LMICs); disease burden
