Background 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.

Methods Based on a large German health claims database (GePaRD), we identified persons aged 0–64 years with treated schizophrenia as those having an inpatient/outpatient ICD-10 diagnosis (F20) and a prescription for a schizophrenia-recommended antipsychotic in the same calendar year. For each year from 2012 to 2021, 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.

Results 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.

Conclusion 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.

OS, BK, and OR are working at an independent, non-profit research institute, the Leibniz Institute for Prevention Research and Epidemiology (BIPS). Unrelated to this study, BIPS occasionally conducts studies financed by the pharmaceutical industry. These are post-authorization safety studies (PASS) requested by health authorities. The design and conduct of these studies as well as the interpretation and publication are not influenced by the pharmaceutical industry. The study presented was not funded by the pharmaceutical industry. MD declares no conflict of interest. CB, RAB and MQ are members of the European Clozapine Task Force, an informal association of European clinicians with an interest in improving access to clozapine for patients with treatment resistant schizophrenia.

This study was supported by a research grant of the Reiss Foundation (EER-2023-06) to RAB.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

In accordance with German data protection regulations, access to the data of the German Pharmacoepidemiological Research Database (GePaRD) is granted only to employees of the Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany, on the BIPS premises and in the context of approved research projects. In Germany, the utilization of health insurance data for scientific research is regulated by the Code of Social Law. All involved health insurance providers as well as the Federal Office for Social Security and the Senator for Health, Women and Consumer Protection in Bremen as their responsible authorities approved the use of GePaRD data for this study. Informed consent for studies based on claims data is required by law unless obtaining consent appears unacceptable and would bias results, which was the case in this study. According to the Ethics Committee of the University of Bremen studies based on GePaRD are exempt from institutional review board review. The datasets used in our study was aggregated/summary data, no individual-level data were used.

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As we are not the owners of the data, we are not legally entitled to grant access to the data of the German Pharmacoepidemiological Research Database. In accordance with German data protection regulations, access to the data is granted only to employees of the Leibniz Institute for Prevention Research and Epidemiology – BIPS on the BIPS premises and in the context of approved research projects. Third parties may only access the data in cooperation with BIPS and after signing an agreement for guest researchers at BIPS.