Neighbourhood deprivation in relation to psychiatric disorders among asthma patients: a nationwide cohort study
Jing Li, Hui Qiao, Kristina Sundquist, Jan Sundquist, Yu Hong Zhang, Hui Fang Yang, Xin Jun LiAbstract
Aim
Although asthma is strongly associated with elevated psychiatric morbidity, the extent to which neighbourhood deprivation is associated with psychiatric disorder risk in this population remains insufficiently understood. This study aims to examine whether neighbourhood deprivation is associated with the incidence of psychiatric disorders among adults with asthma, and whether these associations vary by sex and psychiatric disorder subtype.
Methods
Using nationwide Swedish registers (1997–2018), we identified 393,061 adults aged 25–64 years with asthma and followed them for incident psychiatric disorders. Neighbourhood deprivation was assessed at baseline and categorized into low, moderate and high levels. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and were stratified by sex and psychiatric disorder subtype.
Results
During the follow-up period, 207,900 individuals (68,327 men and 139,573 women) developed psychiatric disorders. The incidence of psychiatric disorders increased progressively with higher levels of neighbourhood deprivation. In the fully adjusted models, compared with those living in low-deprivation areas, men in moderate and high deprivation areas had 11% (HR, 1.11; 95% CI, 1.08–1.13) and 31% (HR, 1.31; 95% CI, 1.27–1.35) higher hazards, respectively, while women had 10% (HR, 1.10; 95% CI, 1.08–1.11) and 22% (HR, 1.22; 95% CI, 1.19–1.25) higher hazards. Disorder-specific analyses revealed particularly strong associations for developmental delay (HR = 2.82), pervasive developmental disorder (HR = 1.96), schizophrenia (HR = 1.79) and substance use disorder (HR = 1.71). Women consistently showed higher cumulative incidence than men across all deprivation levels.
Conclusions
Neighbourhood deprivation was associated with higher psychiatric morbidity among individuals with asthma. These findings suggest the importance of integrating respiratory and mental healthcare with structural interventions targeting socio-economic disadvantage to help reduce inequalities in psychiatric outcomes.