# Burden, Incidence, and Spatial Distribution of Schizophrenia in Ecuador (2010–2021): A Nationwide Hospital Discharge Analysis

## TL;DR

This study is the first to analyze schizophrenia's incidence, burden, and geographic patterns in Ecuador from 2010 to 2021, revealing disparities and the need for better mental health services.

## Contribution

The study provides the first nationwide assessment of schizophrenia in Ecuador, including its incidence, disease burden, and spatial distribution.

## Key findings

- Schizophrenia in Ecuador has a disease burden of 289.8 DALYs per 100,000 population, higher than comparable settings.
- High-incidence clusters of schizophrenia were identified in Guayas and Pichincha provinces.
- A significant decline in schizophrenia incidence was observed over time, especially during the COVID-19 period.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This study delivers the first nationwide evaluation of schizophrenia incidence, disease burden, and spatial distribution in Ecuador over an 11-year period.The identification of geographic clustering and sex- and age-based diagnostic disparities highlights unequal access to mental health services across the country.

This study delivers the first nationwide evaluation of schizophrenia incidence, disease burden, and spatial distribution in Ecuador over an 11-year period.

The identification of geographic clustering and sex- and age-based diagnostic disparities highlights unequal access to mental health services across the country.

Public health significance—Why is this work of significance to public health?
Schizophrenia accounts for a considerable disease burden (reaching 289.8 DALYs per 100,000 population), exceeding estimates reported in comparable settings and reinforcing its status as a leading contributor to disability.A sustained temporal decline in incidence, notably accentuated during the COVID-19 period, reflects shifts in healthcare utilization and potential system-level barriers to psychiatric care.

Schizophrenia accounts for a considerable disease burden (reaching 289.8 DALYs per 100,000 population), exceeding estimates reported in comparable settings and reinforcing its status as a leading contributor to disability.

A sustained temporal decline in incidence, notably accentuated during the COVID-19 period, reflects shifts in healthcare utilization and potential system-level barriers to psychiatric care.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Findings underline the need to strengthen mental health infrastructure, expand early detection strategies, and reduce stigma to address the treatment gap and resulting disability burden.Spatial concentration of cases provides an evidence-based foundation for strategic resource allocation, informing targeted interventions and region-specific mental health policy planning.

Findings underline the need to strengthen mental health infrastructure, expand early detection strategies, and reduce stigma to address the treatment gap and resulting disability burden.

Spatial concentration of cases provides an evidence-based foundation for strategic resource allocation, informing targeted interventions and region-specific mental health policy planning.

Schizophrenia is a chronic mental disorder affecting approximately 1% of the global population and imposing a significant economic and social burden. In Ecuador, comprehensive data on its incidence, burden, and spatial distribution are scarce. This study aims to estimate the hospital-diagnosed incidence, disease burden, and spatial patterns of schizophrenia in Ecuador using national hospital discharge records from 2010 to 2021. A retrospective observational study was conducted using publicly available hospital discharge records from the Instituto Nacional de Estadística y Censos (INEC). Schizophrenia cases were identified using ICD-10 codes F20–F29. Incidence rates per 100,000 population were estimated with 95% Poisson confidence intervals. Disability-Adjusted Life Years (DALYs) were calculated under three scenarios: no discounting or age weighting, 3%-time discounting, and both. Spatial clusters were identified using SATSCAN software v10.1.2. A total of 10,542 schizophrenia cases were recorded between 2010 and 2021, with an overall incidence rate of 5.36 per 100,000 population (95% CI: 5.26–5.46). Incidence significantly decreased over time (p = 0.029). The estimated burden ranged from 153.05 to 289.78 DALYs per 100,000. High-incidence clusters were identified in Guayas and Pichincha provinces. This study provides the first nationwide assessment of schizophrenia in Ecuador, offering critical insights for health policy development, resource allocation, and improved care strategies.