Centre de recherche du Centre hospitalier de l'Université de Montréal, 1301 rue Sherbrooke Est Montréal, Québec, H2L 1M3, Canada.
BMC Public Health. 2011 Jul 19;11:577. doi: 10.1186/1471-2458-11-577.
Few studies have investigated how area-level deprivation influences the relationship between individual disadvantage and suicide mortality. The aim of this study was to examine individual measures of material and social disadvantage in relation to suicide mortality in Canada and to determine whether these relationships were modified by area deprivation.
Using the 1991-2001 Canadian Census Mortality Follow-up Study cohort (N = 2,685,400), measures of individual social (civil status, family structure, living alone) and material (education, income, employment) disadvantage were entered into Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for male and female suicide mortality. Two indices of area deprivation were computed - one capturing social, and the other material, dimensions - and models were run separately for high versus low deprivation.
After accounting for individual and area characteristics, individual social and material disadvantage were associated with higher suicide mortality, especially for individuals not employed, not married, with low education and low income. Associations between social and material area deprivation and suicide mortality largely disappeared upon adjustment for individual-level disadvantage. In stratified analyses, suicide risk was greater for low income females in socially deprived areas and males living alone in materially deprived areas, and there was no evidence of other modifying effects of area deprivation.
Individual disadvantage was associated with suicide mortality, particularly for males. With some exceptions, there was little evidence that area deprivation modified the influence of individual disadvantage on suicide risk. Prevention strategies should primarily focus on individuals who are unemployed or out of the labour force, and have low education or income. Individuals with low income or who are living alone in deprived areas should also be targeted.
很少有研究调查地区贫困程度如何影响个体劣势与自杀死亡率之间的关系。本研究旨在探讨个体物质和社会劣势指标与加拿大自杀死亡率之间的关系，并确定这些关系是否受地区贫困程度的影响。
使用 1991-2001 年加拿大人口普查死亡率随访研究队列（N=2685400），将个体的社会（婚姻状况、家庭结构、独居）和物质（教育、收入、就业）劣势指标纳入 Cox 比例风险模型，以计算男性和女性自杀死亡率的风险比（HR）和 95%置信区间（CI）。计算了两个地区贫困程度指数 - 一个反映社会维度，另一个反映物质维度 - 并分别针对高贫困程度和低贫困程度运行模型。
在考虑个体和地区特征后，个体社会和物质劣势与更高的自杀死亡率相关，尤其是对于未就业、未婚、受教育程度低和收入低的个体。社会和物质地区贫困与自杀死亡率之间的关联在调整个体劣势后基本消失。在分层分析中，社会贫困地区低收入女性和物质贫困地区独居男性的自杀风险更高，且没有证据表明地区贫困程度存在其他调节作用。
个体劣势与自杀死亡率相关，尤其是对男性而言。除了一些例外，几乎没有证据表明地区贫困程度会改变个体劣势对自杀风险的影响。预防策略应主要针对失业或未就业、受教育程度低或收入低的个体。还应针对贫困地区低收入或独居的个体。
