Hsu Chia-Yueh, Chang Shu-Sen, Lee Esther S T, Yip Paul S F
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Pokfulam, Hong Kong SAR, China; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Pokfulam, Hong Kong SAR, China; Institute of Health Policy and Management, and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
Soc Sci Med. 2015 Apr;130:190-203. doi: 10.1016/j.socscimed.2015.02.019. Epub 2015 Feb 17.
Past urban research on Western nations tends to show high suicide rates in inner city and socioeconomically deprived areas. However, little is known about geographic variations in suicide in non-Western cities. We used Bayesian hierarchical models to estimate smoothed standardised mortality ratios (2005-2010) for suicide in people aged 10 years or above in each geographic unit in Hong Kong at two levels, i.e. large street block (n = 1639; median population = 1860) and small tertiary planning unit group (n = 204; median population = 14,850). We further analysed their associations with a range of area socioeconomic characteristics and a deprivation index. The "city centre" of Hong Kong, a generally non-deprived area, showed mostly below average suicide rates. However, there were high rates concentrating in some socioeconomically deprived, densely populated areas, including some inner city areas, across the city. Males had greater geographic variations in rates than females, except the elderly group. The use of smaller geographic units revealed finer detailed suicide distribution than the use of larger units, and showed that suicide rates were associated with indicators of socioeconomic deprivation (population with non-professional jobs and low median household income), and social fragmentation (proportions of unmarried adults and divorced/separated adults), but not with Gini coefficient. Sex/age groups had different associations with suicide rates. Areas in the most deprived quintile had a suicide rate more than two times higher than the least deprived. The association between suicide and deprivation was stronger in males than females and more marked in the younger populations compared to the elderly. The spatial distribution of suicide in Hong Kong showed distinct patterning and a stronger association with income compared to findings from Western countries. Suicide prevention strategies should consider tackling the marked socioeconomic gradient in suicide and high risk in young and middle-aged males living in deprived areas.
以往针对西方国家的城市研究往往表明,市中心以及社会经济贫困地区的自杀率较高。然而,对于非西方城市自杀情况的地理差异,我们却知之甚少。我们运用贝叶斯分层模型,在两个层面估算了2005年至2010年香港各地理单元中10岁及以上人群自杀的平滑标准化死亡率,即大街道街区(n = 1639;人口中位数 = 1860)和小型三级规划单元组(n = 204;人口中位数 = 14850)。我们进一步分析了它们与一系列地区社会经济特征及贫困指数之间的关联。香港的“市中心”通常是一个非贫困地区,其自杀率大多低于平均水平。然而,全市范围内一些社会经济贫困、人口密集的地区,包括一些市中心区域,自杀率却很高。除老年人群体外,男性自杀率的地理差异比女性更大。使用较小的地理单元揭示出的自杀分布细节比使用较大单元时更精细,并且表明自杀率与社会经济贫困指标(从事非专业工作的人口和低家庭收入中位数)以及社会碎片化指标(未婚成年人和离婚/分居成年人的比例)相关,但与基尼系数无关。性别/年龄组与自杀率的关联各不相同。处于最贫困五分位数的地区自杀率比最不贫困地区高出两倍多。自杀与贫困之间的关联在男性中比在女性中更强,并且在年轻人群体中比老年人群体更明显。与西方国家的研究结果相比,香港自杀的空间分布呈现出明显的模式,且与收入的关联更强。自杀预防策略应考虑应对自杀方面显著的社会经济梯度以及贫困地区年轻和中年男性的高风险问题。