Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
JAMA Pediatr. 2020 Mar 1;174(3):287-294. doi: 10.1001/jamapediatrics.2019.5678.
Suicide is the second leading cause of death among youths aged 10 to 19 years in the United States, with rates nearly doubling during the past decade. Youths in impoverished communities are at increased risk for negative health outcomes; however, the association between pediatric suicide and poverty is not well understood.
To assess the association between pediatric suicide rates and county-level poverty concentration.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional study examined suicides among US youths aged 5 to 19 years from January 1, 2007, to December 31, 2016. Suicides were identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes from the Centers for Disease Control and Prevention's Compressed Mortality File. Data analysis was performed from February 1, 2019, to September 10, 2019.
County poverty concentration and the percentage of the population living below the federal poverty level. Counties were divided into 5 poverty concentration categories: 0% to 4.9%, 5.0% to 9.9%, 10.0% to 14.9%, 15.0% to 19.9%, and 20.0% or more of the population living below the federal poverty level.
The study used a multivariable negative binomial regression model to analyze the association between pediatric suicide rates and county poverty concentration, reporting adjusted incidence rate ratios (aIRRs) with 95% CIs. The study controlled for year, demographic characteristics of the children who died (age, sex, and race/ethnicity), county urbanicity, and county demographic features (age, sex, and racial composition). Subgroup analyses were stratified by method.
From 2007 to 2016, a total of 20 982 youths aged 5 to 19 years died by suicide (17 760 [84.6%] were aged 15-19 years, 15 982 [76.2%] male, and 14 387 [68.6%] white non-Hispanic). The annual suicide rate was 3.35 per 100 000 youths aged 5 to 19 years. In the multivariable model, compared with counties with the lowest poverty concentration (0%-4.9%), counties with poverty concentrations of 10% or greater had higher suicide rates in a stepwise manner (10.0%-14.9%: aIRR, 1.25 [95% CI, 1.06-1.47]; 15.0%-19.9%: aIRR, 1.30 [95% CI, 1.10-1.54]; and 20.0% or more: aIRR, 1.37 [95% CI, 1.15-1.64]). When stratified by method, firearm suicides had the strongest association with county poverty concentration (aIRR, 1.87; 95% CI, 1.41-2.49) in counties with 20% or higher poverty concentration compared with counties with 0% to 4.9% poverty concentration.
The findings suggest that higher county-level poverty concentration is associated with increased suicide rates among youths aged 5 to 19 years. These findings may guide research into upstream risk factors associated with pediatric suicide to inform suicide prevention efforts.
在美国，自杀是导致 10 至 19 岁青少年死亡的第二大主要原因，在过去十年中，这一比例几乎翻了一番。生活在贫困社区的青少年面临更多的负面健康结果风险；然而，儿科自杀与贫困之间的关联尚未得到充分理解。
评估儿科自杀率与县一级贫困集中程度之间的关系。
设计、地点和参与者：这是一项回顾性、横断面研究，调查了 2007 年 1 月 1 日至 2016 年 12 月 31 日期间美国 5 至 19 岁青少年的自杀情况。自杀病例是通过美国疾病控制与预防中心的压缩死亡率文件中的国际疾病分类、第十次修订版临床修正代码来确定的。数据分析于 2019 年 2 月 1 日至 2019 年 9 月 10 日进行。
县贫困集中程度和生活在联邦贫困线以下的人口比例。各县分为 5 个贫困集中程度类别：0%至 4.9%、5.0%至 9.9%、10.0%至 14.9%、15.0%至 19.9%和 20.0%或以上的人口生活在联邦贫困线以下。
本研究使用多变量负二项回归模型分析儿科自杀率与县贫困集中程度之间的关系，报告了调整后的发病率比（aIRR）及其 95%置信区间。该研究控制了儿童死亡年份（年龄、性别和种族/民族）、县城市性和县人口统计学特征（年龄、性别和种族构成）等因素。亚组分析按方法进行分层。
从 2007 年到 2016 年，共有 20982 名 5 至 19 岁的青少年死于自杀（17760 名[84.6%]年龄在 15 至 19 岁，15982 名[76.2%]男性，14387 名[68.6%]白人非西班牙裔）。每年自杀率为每 100000 名 5 至 19 岁的青少年中有 3.35 人。在多变量模型中，与贫困集中程度最低的县（0%-4.9%）相比，贫困集中程度为 10%或更高的县自杀率呈递增趋势（10.0%-14.9%：aIRR，1.25[95%CI，1.06-1.47]；15.0%-19.9%：aIRR，1.30[95%CI，1.10-1.54]；20.0%或更高：aIRR，1.37[95%CI，1.15-1.64]）。按方法分层时，与 0%至 4.9%贫困集中程度的县相比，枪支自杀与 20%或更高贫困集中程度的县之间的相关性最强（aIRR，1.87；95%CI，1.41-2.49）。
研究结果表明，县一级贫困程度越高，与 5 至 19 岁青少年自杀率升高相关。这些发现可能有助于研究与儿科自杀相关的上游风险因素，为预防自杀工作提供信息。
