Page Andrew, Morrell Stephen, Taylor Richard, Dudley Michael, Carter Greg
School of Population Health, University of Queensland, Brisbane, Qld, Australia.
Soc Sci Med. 2007 Aug;65(3):442-53. doi: 10.1016/j.socscimed.2007.03.029. Epub 2007 Apr 26.
This study investigates changes in Australian urban-rural suicide differentials over time in the context of overall declines in (male) suicide in the late 1990s, and determines the extent to which differences in socio-economic status (SES) account for observed urban-rural trends. Suicide data were stratified for the period 1979-2003 by metropolitan, rural and remote areas and examined across five quinquennia, centred on each Australian census from 1981 to 2001. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth and the mediating effects of area SES, using Poisson regression models. Male suicide rates in metropolitan, rural and remote areas diverged significantly over time, especially in young males (15-24 years). Young male suicide rates increased significantly in metropolitan, rural and remote areas over 1979-1998, and in the most recent period (1999-2003) increased further in remote areas from 38.8 (per 100,000) to 47.9 (23% increase). In contrast suicide rates in rural areas decreased from a peak of 27.5 to 19.8 (28% decrease), and in metropolitan areas from a peak of 22.1 to 16.8 (24% decrease). Similar divergence in the 1999-2003 quinquennium, though of a lesser magnitude, was also evident for males aged 25-34 years. Female suicide rates in the earlier part of the period were significantly lower in rural and remote areas than in metropolitan areas, particularly for those aged 25-34 years, then increased in rural and remote areas to converge with female suicide rates in metropolitan areas. Adjusting for SES in addition to age and country-of-birth reduced urban-rural suicide differentials in both males and females, consistent with SES being an intermediary between rural residence and suicide. Nevertheless, urban-rural differences remained statistically significant. These results show that the largest urban-rural male suicide differentials for the 25-year study period occurred in the most recent period (1999-2003), in the context of decreasing male suicide rates overall.
本研究调查了20世纪90年代末(男性)自杀率总体下降背景下澳大利亚城乡自杀差异随时间的变化情况,并确定社会经济地位(SES)差异在多大程度上解释了观察到的城乡趋势。1979 - 2003年期间的自杀数据按大都市、农村和偏远地区进行分层,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。使用泊松回归模型对自杀率(每10万人)进行调整,以消除性别、年龄、出生国家以及地区SES的中介效应的混杂影响。大都市、农村和偏远地区的男性自杀率随时间显著分化,尤其是在年轻男性(15 - 24岁)中。1979 - 1998年期间,大都市、农村和偏远地区的年轻男性自杀率显著上升,在最近时期(1999 - 2003年),偏远地区的自杀率从38.8(每10万人)进一步升至47.9(上升23%)。相比之下,农村地区的自杀率从峰值27.5降至19.8(下降28%),大都市地区从峰值22.1降至16.8(下降24%)。在1999 - 2003年的五年期内,25 - 34岁男性也出现了类似的分化,尽管程度较小。在该时期早期,农村和偏远地区的女性自杀率显著低于大都市地区,特别是25 - 34岁的女性,随后农村和偏远地区的女性自杀率上升,与大都市地区的女性自杀率趋同。除年龄和出生国家外,对SES进行调整后,男性和女性的城乡自杀差异均有所减小,这表明SES是农村居住与自杀之间的一个中介因素。然而,城乡差异在统计学上仍然显著。这些结果表明,在25年的研究期内,最大的城乡男性自杀差异出现在最近时期(1999 - 2003年),而此时男性自杀率总体呈下降趋势。