Prevalence and incidence of treated schizophrenia: temporal and regional trends in Germany

Schizophrenia ranks among the top ten causes of disability worldwide. The provision of healthcare services requires estimates on the epidemiology of schizophrenia, but recent data for Germany are lacking. Based on a large German health claims database (GePaRD), we identified persons aged 0-64 years with treated schizophrenia, i.e., persons having at least one inpatient/outpatient ICD-10 diagnosis (F20) with at least one prescription for a schizophrenia-recommended antipsychotic in the same calendar year. For each year from 2012 (eligible persons: 9,589,084) to 2021 (eligible persons: 12,450,531), we calculated the standardized incidence proportion (SIP) and the prevalence of schizophrenia. Analyses were stratified by sex, age, and population density in the region of residence. The SIP of treated schizophrenia remained stable from 2012 to 2017 (46.0-46.5/100,000) and subsequently declined to 41.3/100,000 in 2021, with higher SIP in men (45.3/100,000) than in women (37.1/100,000). In 2021, the SIP was comparable in urban, rural, and sparsely populated rural districts (36.3-38.5/100,000) and higher in large urban cities (48.3/100,000). SIP estimates among children and adolescents (aged 0-17 years) varied between 3.5/100,000 and 4.1/100,000 over the study period. The standardized prevalence of schizophrenia declined from 366.1/100,000 in 2012 to 334.0/100,000 in 2021. Similar to other Western countries, there has been a decline in the incidence and prevalence of schizophrenia in Germany over the last few years. The higher incidence in males and those living in large urban areas highlights the health care needs of these populations.