Steck Nicole, Zwahlen Marcel, Egger Matthias
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland; and School of Social Medicine, University of Bristol, United Kingdom.
Swiss Med Wkly. 2015 Jun 22;145:w14153. doi: 10.4414/smw.2015.14153. eCollection 2015.
The number of suicides assisted by right-to-die associations has increased in recent years in Switzerland. The aim of our study was to compare time trends in rates of assisted and unassisted suicide from 1991-2008.
The Swiss National Cohort is a longitudinal study of mortality in the Swiss population; based on linkage of census data with mortality records up to 2008. The Federal Statistical Office coded suspected assisted suicides from 1998 onwards; and from 2003 onwards right-to-die associations reported the suicides they assisted. We used Poisson regression to analyse trends in rates of suicide per 100'000 person-years, by gender and age groups (15-34, 35-64, 65-94 years).
A total of 7'940'297 individuals and 24'842 suicides were included. In women, rates changed little in the younger age groups but increased in 65-94-year-olds, due to an increase in suicide by poisoning (from 5.1 to 17.2 per 100'000; p <0.001). An increase in suicides by poisoning was also observed in older men (from 8.6 to 18.2; p<0.001). Most suicides by poisoning were assisted. In men, suicide rates declined in all age groups, driven by declines in suicide with firearms.
Research is needed to gain a better understanding of the reasons for the tripling of assisted suicide rates in older women, and the doubling of rates in older men, of attitudes and vulnerabilities of those choosing assisted suicide, and of access to palliative care. Rates of assisted suicide should be monitored; including data on patient characteristics and underlying comorbidities.
近年来，瑞士协助自杀的死亡权利组织的数量有所增加。我们研究的目的是比较1991年至2008年协助自杀和非协助自杀率的时间趋势。
瑞士全国队列是对瑞士人口死亡率的纵向研究；基于人口普查数据与截至2008年的死亡记录的关联。联邦统计局对1998年起疑似协助自杀事件进行编码；自2003年起，死亡权利组织报告他们协助的自杀事件。我们使用泊松回归分析按性别和年龄组（15 - 34岁、35 - 64岁、65 - 94岁）计算的每10万人年自杀率的趋势。
共纳入7940297人及24842例自杀事件。在女性中，较年轻年龄组的自杀率变化不大，但65 - 94岁年龄组的自杀率有所上升，这是由于中毒自杀增加（从每10万人中的5.1例增至17.2例；p < 0.001）。老年男性中中毒自杀也有所增加（从8.6例增至18.2例；p < 0.001）。大多数中毒自杀是协助进行的。在男性中，所有年龄组的自杀率均下降，主要是由于持枪自杀率下降。
需要开展研究以更好地理解老年女性协助自杀率增至三倍、老年男性协助自杀率增至两倍的原因，选择协助自杀者的态度和脆弱性，以及获得姑息治疗的情况。应监测协助自杀率；包括患者特征和潜在合并症的数据。
