Department of Epidemiology, University of Florida, Gainesville, FL32610, USA.
Department of Surgery, School of Medicine, Duke University, Durham, NC27705, USA.
Epidemiol Psychiatr Sci. 2020 Nov 13;29:e180. doi: 10.1017/S204579602000092X.
Suicide emerges as a threat to national health of USA with Whites being at extra risk. More information is needed regarding the increased suicide among Whites to improve national suicide prevention strategies. This study aims to characterise the age pattern of suicide among Whites by suicide methods adjusting for time period and birth cohort.
Suicide mortality data by age of 15-84 years during 1999-2017 were derived from the Wide-Ranging Online Data for Epidemiological Research, prepared by US Center for Disease Control and Prevention. Mortality data for three common suicide methods, firearms, suffocation and poisoning were analysed using the age-period-cohort (APC) model. Period-cohort adjusted mortality rates by age were estimated based on results from APC modelling.
Period-cohort adjusted rates indicated that the overall age pattern for males contained five phases, including three increasing phases (ages 15-20, 30-50 and 65+), connected by two declining phases (ages 20-30 and 50-65); and the age pattern for females was a parabolic with an increasing phase from 15 years of age up to 50, followed by a declining phase after age 50. Furthermore, the age pattern for different suicide methods differed substantially for males, but did not for females. Among males, suicide by firearms contained two rapid increasing phases, one during adolescence and another in older ages; suicide by suffocation showed a high plateau across an age span from 20 to 55 years; and suicide by poisoning followed a parabolic, increasing by age up to 45 before it declined. Age patterns revealed by the unadjusted crude rates were biased because of significant linear period effect and W-shaped cohort effect.
This study is the first to quantify the age patterns of suicide by different methods for US Whites using period-cohort adjusted rates. Study findings provide valid evidence supporting precision interventions to reduce the extra suicide mortality among Whites by targeting specific age ranges with different suicide methods.
自杀已成为美国国家健康的威胁，白人面临更高的风险。需要更多关于白人自杀率上升的信息，以改善国家预防自杀的策略。本研究旨在通过调整时间段和出生队列，描述白人不同自杀方法的年龄模式。
本研究利用美国疾病控制与预防中心编制的广泛在线流行病学研究数据，获取了 1999 年至 2017 年期间年龄在 15-84 岁之间的自杀死亡率数据。采用年龄-时期-队列（APC）模型分析了三种常见自杀方法（枪支、窒息和中毒）的死亡率数据。根据 APC 模型分析结果，估计了按年龄调整的时期-队列调整死亡率。
时期-队列调整后的死亡率表明，男性的总体年龄模式包含五个阶段，包括三个上升阶段（15-20 岁、30-50 岁和 65 岁以上），由两个下降阶段（20-30 岁和 50-65 岁）连接；女性的年龄模式呈抛物线形，从 15 岁开始上升，到 50 岁达到峰值，然后在 50 岁以后下降。此外，不同自杀方法的年龄模式在男性中差异显著，但在女性中没有差异。在男性中，枪支自杀有两个快速上升阶段，一个发生在青春期，另一个发生在老年；窒息自杀在 20-55 岁之间呈现出一个高平台；中毒自杀则呈抛物线形，在 45 岁之前呈上升趋势，然后下降。未调整的粗死亡率所揭示的年龄模式存在偏差，因为存在显著的线性时期效应和 W 形队列效应。
本研究首次使用时期-队列调整后的死亡率，定量描述了美国白人不同自杀方法的年龄模式。研究结果提供了有效的证据，支持通过针对不同自杀方法的特定年龄范围进行精准干预，减少白人自杀死亡率过高的问题。
