Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden; Department of Health and Social Behavior and Department of Health Education and Health Sociology, the University of Tokyo, Tokyo, Japan.
Department of Health and Social Behavior and Department of Health Education and Health Sociology, the University of Tokyo, Tokyo, Japan.
Soc Sci Med. 2020 May;253:112958. doi: 10.1016/j.socscimed.2020.112958. Epub 2020 Mar 29.
Contextual factors varying by residence in rural or urban areas may have different effects on the suicide of residents by nativity, but evidence on the urban-rural gap in suicide according to nativity is lacking. This study aims to evaluate the effect of cross-level interaction between nativity and rurality of residence on suicide risk, at two levels of aggregation (municipalities/neighborhoods). Study design was nationwide register-based cohort study in Sweden, 2011-2016. Participants were all residents 20 years or older. We calculated Incidence Rate Ratios comparing suicide incidence by nativity using three-level (individuals, neighborhoods, and municipalities) Poisson regression, stratified by gender. Among men, suicide incidences were the highest among those born in other Nordic countries, followed by those born in Sweden, other European countries, Middle Eastern countries, and the rest of the world. Residing in rural areas was associated with high IRR of suicide regardless of nativity, compared to residing in urban areas. When evaluating rurality at municipality level, we observed an increased suicide risk from living in rural areas in men born in other European (rural-urban ratio of nativity-specific IRRs: 1.39) and other Nordic (1.37) countries, followed by native Swedes (1.22). When evaluating rurality at neighborhood level, rurality was associated with increased suicide risk in men for all nativities, with the foreign-born showing higher risk than the Swedish-born. Individual sociodemographic characteristics explained the excess suicide risk in rural municipalities, but not the excess risk in rural neighborhoods. Among women, urban residents showed higher suicide incidence than rural residents. We found no consistent patterning of interaction with nativities among women. Foreign-born individuals residing in rural municipalities may have less access to economic resources and employment opportunities. Furthermore, ethnic discrimination, stigma, and exclusion from social networks and community may be more common in rural neighborhood contexts, leading to an increased risk of suicide.
居住在农村或城市地区的人群，其所处的环境因素可能会对不同原籍人群的自杀率产生不同的影响。然而，关于不同原籍人群的城乡自杀率差距，目前尚缺乏相关证据。本研究旨在评估原籍与居住地农村/城市分类在自杀风险方面的跨层次交互作用的影响，研究在两个聚合层次（市/社区）上进行。
这是一项在瑞典进行的基于全国登记的队列研究，研究时间为 2011 年至 2016 年。参与者为所有 20 岁及以上的居民。我们使用三级（个体、社区和市）泊松回归分析，按照性别对不同原籍人群的自杀发生率进行比较，并计算了发病率比值比（IRR）。在男性中，自杀发生率最高的是北欧其他国家出生的人，其次是瑞典出生的人、其他欧洲国家出生的人、中东国家出生的人以及其他国家出生的人。与居住在城市地区的人相比，无论原籍如何，居住在农村地区的人自杀的 IRR 都较高。在评估市一级的农村地区时，我们观察到，与居住在城市地区的人相比，出生于其他欧洲国家（农村-城市出生特定 IRR 比值比：1.39）和北欧国家（1.37）、出生于瑞典的男性居住在农村地区时自杀风险增加，出生于其他国家的男性风险最高（1.39）。在评估社区一级的农村地区时，所有原籍的男性自杀风险均与农村地区相关，而外国出生的男性风险高于瑞典出生的男性。个体社会人口统计学特征解释了农村市的过度自杀风险，但不能解释农村社区的过度风险。在女性中，城市居民的自杀发生率高于农村居民。我们没有发现女性中与原籍存在交互作用的一致模式。居住在农村市的外国出生者可能获得的经济资源和就业机会较少。此外，在农村社区环境中，可能更容易出现种族歧视、耻辱感以及被社会网络和社区排斥，从而导致自杀风险增加。
