Machado Daiane Borges, Rasella Davide, Dos Santos Darci Neves
Institute of Collective Health, Federal University of Bahia-UFBA, Rua Basílio da Gama s/n, Canela, 40110-040 Salvador, Bahia, Brazil.
Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama s/n-Canela, 40110-040 Salvador, Bahia, Brazil.
PLoS One. 2015 Apr 30;10(4):e0124934. doi: 10.1371/journal.pone.0124934. eCollection 2015.
To analyze whether income inequality and other social determinants are associated with suicide rate in Brazil.
This study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed.
The Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011-1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948-0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010-1.021).
Income inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population's socioeconomic conditions and reduce income inequality in Brazil, and in other low and middle-income countries, can help to reduce suicide rates.
分析收入不平等及其他社会决定因素是否与巴西的自杀率相关。
本研究使用了2000年至2011年巴西所有5507个城市的面板数据。按性别计算每个城市和年份的自杀率，并按年龄进行标准化。回归模型的自变量包括基尼系数、人均收入、受教育年限达八年及以下的人口百分比、城市化程度、每户平均居民人数、离婚人口百分比、天主教徒、五旬节派和福音派信徒的百分比。对具有固定效应规格的面板数据进行多变量负二项回归。
基尼系数与自杀率呈正相关；率比（RR）为1.055（95%置信区间：1.011 - 1.101）。在其他社会决定因素中，收入与自杀率呈显著负相关（RR：0.968，95%置信区间：0.948 - 0.988），而低水平教育与自杀率呈正相关（RR：1.015，95%置信区间：1.010 - 1.021）。
收入不平等是巴西自杀率的一个社区层面风险因素。收入不平等的降低、人均收入的增加以及未完成基础教育人口百分比的下降，可能抵消了过去十年自杀率的上升。其他变化，如每户平均居民人数的减少，可能促使了自杀率的上升。因此，在巴西以及其他低收入和中等收入国家实施可能改善民众社会经济状况并减少收入不平等的社会政策，有助于降低自杀率。
