Fontanella Cynthia A, Hiance-Steelesmith Danielle L, Phillips Gary S, Bridge Jeffrey A, Lester Natalie, Sweeney Helen Anne, Campo John V
Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus.
College of Social Work, The Ohio State University, Columbus.
JAMA Pediatr. 2015 May;169(5):466-73. doi: 10.1001/jamapediatrics.2014.3561.
Little is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities.
To examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum.
DESIGN, SETTING, AND PARTICIPANTS: Longitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States into distinct groups based on population size and adjacency to metropolitan areas. The population included all suicide decedents aged 10 to 24 years.
Rates of suicide per 100,000 persons.
Across the study period, 66,595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100,000, respectively) and females (4.40 and 2.39 per 100,000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males, suggesting widening rural-urban disparities (1996-1998: adjusted incidence rate ratio [IRR], 0.98; 2008-2010: adjusted IRR, 1.19; difference in IRR, P = .02). Firearm suicide rates declined, and the rates of hanging/suffocation for both males and females increased. However, the rates of suicide by firearm (males: 1996-1998, 2.05; and 2008-2010: 2.69 times higher) and hanging/suffocation (males: 1996-1998, 1.24; and 2008-2010: 1.63 times higher) were disproportionately higher in rural areas, and rural-urban differences increased over time (P = .002 for males; P = .06 for females).
Suicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time. Further research should carefully explore the mechanisms whereby rural residence might increase suicide risk in youth and consider suicide-prevention efforts specific to rural settings.
关于青年自杀的城乡差异的近期趋势，尤其是性别和方法特异性变化，人们了解甚少。记录这些差异的程度对于制定旨在消除地理差异的政策和计划至关重要。
研究美国城乡连续体中青少年和青年的自杀死亡率趋势。
设计、背景和参与者：利用与城乡连续体测量相关的县级国家死亡率数据，分析了1996年1月1日至2010年12月31日期间农村和城市地区自杀率的纵向趋势。该测量根据人口规模和与大都市区的毗邻程度将美国所有3141个县分为不同组。研究人群包括所有10至24岁的自杀死亡者。
每10万人的自杀率。
在研究期间，66595名青年自杀死亡，农村地区的自杀率在男性（分别为每10万人19.93例和10.31例）和女性（分别为每10万人4.40例和2.39例）中几乎是城市地区的两倍。即使在控制了一系列县级变量之后，但男性的城乡自杀差异随时间增加，表明城乡差距在扩大（1996 - 1998年：调整后的发病率比[IRR]，0.98；2008 - 2010年：调整后的IRR，1.19；IRR差异，P = 0.02）。枪支自杀率下降，男性和女性的上吊/窒息率上升。然而，枪支自杀率（男性：1996 - 1998年，2.05倍；2008 - 2010年：高2.69倍）和上吊/窒息率（男性：1996 - 1998年，1.24倍；2008 - 2010年：高1.63倍）在农村地区不成比例地更高，且城乡差异随时间增加（男性P = 0.002；女性P = 0.06）。
无论采用何种方法，农村地区青少年和青年的自杀率均高于城市社区，且城乡差距似乎随时间在扩大。进一步的研究应仔细探讨农村居住可能增加青年自杀风险的机制，并考虑针对农村环境的自杀预防措施。
