Lee Sang-Uk, Oh In-Hwan, Jeon Hong Jin, Roh Sungwon
Department of Mental Health Research, Seoul National Hospital, Seoul, South Korea; Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.
Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.
J Epidemiol. 2017 Jun;27(6):258-264. doi: 10.1016/j.je.2016.06.008. Epub 2017 Mar 15.
The relation of income and socioeconomic status with suicide rates remains unclear. Most previous studies have focused on the relationship between suicide rates and macroeconomic factors (e.g., economic growth rate). Therefore, we aimed to identify the relationship between individuals' socioeconomic position and suicide risk.
We analyzed suicide mortality rates across socioeconomic positions to identify potential trends using observational data on suicide mortality collected between January 2003 and December 2013 from 1,025,340 national health insurance enrollees. We followed the subjects for 123.5 months on average. Socioeconomic position was estimated using insurance premium levels. To examine the hazard ratios of suicide mortality in various socioeconomic positions, we used Cox proportional hazard models.
We found that the hazard ratios of suicide showed an increasing trend as socioeconomic position decreased. After adjusting for gender, age, geographic location, and disability level, Medicaid recipients had the highest suicide hazard ratio (2.28; 95% CI, 1.87-2.77). Among the Medicaid recipients, men had higher hazard ratios than women (2.79; 95% CI, 2.17-3.59 vs. 1.71; 95% CI, 1.25-2.34). Hazard ratios also varied across age groups. The highest hazard ratio was found in the 40-59-year-old group (3.19; 95% CI, 2.31-4.43), whereas the lowest ratio was found in those 60 years and older (1.44; 95% CI, 1.09-1.87).
Our results illuminate the relationship between socioeconomic position and suicide rates and can be used to design and implement future policies on suicide prevention.
收入及社会经济地位与自杀率之间的关系仍不明确。此前大多数研究聚焦于自杀率与宏观经济因素（如经济增长率）之间的关系。因此，我们旨在确定个体社会经济地位与自杀风险之间的关系。
我们分析了不同社会经济地位的自杀死亡率，利用2003年1月至2013年12月期间从1,025,340名参加国民健康保险的人员中收集的自杀死亡率观察数据来确定潜在趋势。我们对这些受试者平均随访了123.5个月。社会经济地位通过保险费水平来估算。为了检验不同社会经济地位下自杀死亡率的风险比，我们使用了Cox比例风险模型。
我们发现，随着社会经济地位的降低，自杀风险比呈上升趋势。在对性别、年龄、地理位置和残疾程度进行调整后，医疗补助接受者的自杀风险比最高（2.28；95%置信区间，1.87 - 2.77）。在医疗补助接受者中，男性的风险比高于女性（2.79；95%置信区间，2.17 - 3.59对1.71；95%置信区间，1.25 - 2.34）。风险比在不同年龄组中也有所不同。最高风险比出现在40 - 59岁年龄组（3.19；95%置信区间，2.31 - 4.43），而最低风险比出现在60岁及以上人群中（1.44；95%置信区间，1.09 - 1.87）。
我们的研究结果阐明了社会经济地位与自杀率之间的关系，可用于设计和实施未来的自杀预防政策。
