Page Andrew, Morrell Stephen, Taylor Richard, Carter Greg, Dudley Michael
School of Population Health, Public Health Building, University of Queensland, Herston (QLD), 4006, Brisbane, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2006 Nov;41(11):911-7. doi: 10.1007/s00127-006-0112-9. Epub 2006 Sep 1.
This study investigated secular trends in socio-economic status (SES) differentials in Australian suicide (1979-2003), which includes overall declines in male suicide from 1998.
Suicide rates were stratified by approximate equal-population quintiles of area-based SES for the period 1979-2003 and examined across five quinquennia, centred on each Australian Census from 1981 to 2001, to determine if (1) SES differentials in suicide have persisted over time, and (2) if SES differentials have widened or narrowed. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth, and urban-rural residence using Poisson regression models, and secular changes in SES differentials were assessed using trend tests on suicide rate ratios (low to high SES quintiles).
Socio-economic status (SES) differentials persisted across the study period for both males and females after adjusting for the effects of age, migrant status, and urban-rural residence, with the largest differences between low and high SES groups evident in males, and especially young males (20-34 years). For males, suicide rates increased significantly in all SES groups until 1998, before diverging significantly in the most recent 5-year period, particularly in younger males (P<0.0001). In young males, suicide rates in the most recent period increased in the low SES group from 44.8 in 1994-1998 to 48.6 in 1999-2003 (an 8% increase). In contrast, suicide rates in the middle SES group decreased from a peak of 37.3 to 33.5 (a 10% decrease), and in the high SES group from a peak of 33.0 to 27.9 (a 15% decrease). A similar statistically significant divergence of a lesser magnitude was also evident in all age males and younger females (20-34 years).
This study shows that SES differentials in suicide persisted in Australia for most of the period 1979-2004. The decline in suicide in young males in the most recent quinquennium was limited to middle and high SES groups, while the low SES group displayed a continued increase. The continued increase in suicide in low SES males has implications for social and economic intervention and suicide control programs.
本研究调查了澳大利亚自杀事件中社会经济地位（SES）差异的长期趋势（1979 - 2003年），其中包括自1998年以来男性自杀率的总体下降情况。
1979 - 2003年期间，自杀率按基于地区的SES大致相等人口五分位数进行分层，并在以1981年至2001年每次澳大利亚人口普查为中心的五个五年期内进行考察，以确定（1）自杀的SES差异是否随时间持续存在，以及（2）SES差异是扩大还是缩小。使用泊松回归模型对自杀率（每10万人）进行性别、年龄、出生国家和城乡居住情况的混杂因素调整，并使用自杀率比（低SES五分位数至高SES五分位数）的趋势检验评估SES差异的长期变化。
在调整年龄、移民身份和城乡居住情况的影响后，社会经济地位（SES）差异在整个研究期间对男性和女性均持续存在，低SES组和高SES组之间的最大差异在男性中明显，尤其是年轻男性（20 - 34岁）。对于男性，直到1998年所有SES组的自杀率均显著上升，之后在最近的5年期间出现显著分化，特别是在年轻男性中（P<0.0001）。在年轻男性中，最近时期低SES组的自杀率从1994 - 1998年的44.8上升至1999 - 2003年的48.6（上升8%）。相比之下，中等SES组的自杀率从峰值37.3降至33.5（下降10%），高SES组从峰值33.0降至27.9（下降15%）。在所有年龄段男性和年轻女性（20 - 34岁）中也明显存在类似但程度较小的统计学显著差异。
本研究表明，1979 - 2004年的大部分时间里，澳大利亚自杀的SES差异持续存在。最近一个五年期内年轻男性自杀率的下降仅限于中等和高SES组，而低SES组则持续上升。低SES男性自杀率的持续上升对社会和经济干预以及自杀控制项目具有启示意义。
