We investigated whether associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs, including schizophrenia and bipolar disorder) is accounted for by social drift or social causation. We extracted primary and secondary care electronic health records from 2004 to 2015 from a population of 3.9 million. We identified prevalent and incident individuals with SMIs and their level of deprivation and urbanicity using the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator. The presence of social drift was determined by whether odds ratios (ORs) from logistic regression is greater than the incidence rate ratios (IRRs) from Poisson regression. Additionally, we performed longitudinal analysis to measure the proportion of change in deprivation level and rural/urban residence 10 years after an incident diagnosis of SMI and compared it to the general population using standardised rate ratios (SRRs). Prevalence and incidence of SMIs were significantly associated with deprivation and urbanicity (all ORs and IRRs significantly >1). ORs and IRRs were similar across all conditions and cohorts (ranging from 1.1 to 1.4). Results from the longitudinal analysis showed individuals with SMIs are more likely to move compared to the general population. However, they did not preferentially move to more deprived or urban areas. There was little evidence of downward social drift over a 10-year period. These findings have implications for the allocation of resources, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.

中文翻译：

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地区剥夺、城市化、严重的精神疾病和社会漂移——使用常规收集的初级和二级保健数据的基于人群的关联研究

我们调查了区域剥夺、城市化和严重精神疾病（SMI，包括精神分裂症和双相情感障碍）风险升高之间的关联是否是由社会漂移或社会因果关系引起的。我们从 2004 年到 2015 年从 390 万人口中提取了初级和二级保健电子健康记录。我们使用威尔士多重剥夺指数 (WIMD) 和城市/农村指标确定了患有 SMI 的普遍和偶发个体及其剥夺和城市化水平。社会漂移的存在取决于逻辑回归的优势比 (OR) 是否大于泊松回归的发生率比 (IRR)。此外，我们进行了纵向分析，以测量 SMI 事件诊断 10 年后贫困水平和农村/城市居民的变化比例，并使用标准化比率 (SRR) 将其与一般人群进行比较。SMI 的流行和发生率与贫困和城市化显着相关（所有 OR 和 IRR 显着 >1）。所有条件和队列的 OR 和 IRR 相似（范围从 1.1 到 1.4）。纵向分析的结果显示，与一般人群相比，患有 SMI 的个体更有可能移动。然而，他们并没有优先迁移到更贫困或城市地区。几乎没有证据表明在 10 年期间社会向下漂移。这些发现对资源分配有影响，