Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA.
Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
J Am Med Dir Assoc. 2021 Nov;22(11):2337-2343.e3. doi: 10.1016/j.jamda.2021.02.008. Epub 2021 Mar 12.
Residential long-term care (LTC) facilities may be key settings for the prevention of suicide among older adults; however, little is known about the relationship between statewide policies determining characteristics of LTC facilities and suicide mortality. The primary goal of this study was to evaluate the association between state policies regarding availability, regulation, and cost of LTC and suicide mortality among adults aged 55 and older in the United States over a 5-year period.
Longitudinal ecological study.
LTC residents from 16 states reporting mortality data to the National Violent Death Reporting System (NVDRS) from 2010 to 2015.
We linked suicide data from the NVDRS and data sources on LTC services and regulations for 16 states. We applied a natural language-processing algorithm to identify suicide deaths related to LTC. We used fixed effect regression models to assess whether state variation in LTC characteristics is related to variation in the rate of suicide (both overall and related to LTC) among older adults.
There were 25,040 suicides among those aged 55 and older reported to the NVDRS during the study period; 382 suicides were determined to be associated with LTC in some manner. After adjusting for state-level characteristics, greater average nursing home capacity was significantly associated with increase in the cumulative incidence of suicide related to LTC (β = 0.087, SE = 0.026, P < .01), but not overall suicide incidence. Neither cost nor regulation measures were significantly associated with state-level LTC-related suicide incidence.
State-level variations in LTC facility capacity are related to variation in LTC-related suicide incidence among older adults. Given the challenges of preventing suicide among older adults through facility- or individual-level interventions, policies governing the features and provision of LTC services may therefore serve as a means for public health suicide prevention.
长期居住的养老院（LTC）可能是预防老年人自杀的关键场所；然而，关于确定养老院特征的州政策与自杀死亡率之间的关系知之甚少。本研究的主要目的是评估美国 55 岁及以上成年人在 5 年内，关于 LTC 服务的可及性、监管和成本的州政策与自杀死亡率之间的关系。
纵向生态研究。
2010 年至 2015 年期间，向国家暴力死亡报告系统（NVDRS）报告死亡率数据的来自 16 个州的 LTC 居民。
我们将 NVDRS 的自杀数据与 16 个州的 LTC 服务和法规数据来源相联系。我们应用自然语言处理算法来识别与 LTC 相关的自杀死亡。我们使用固定效应回归模型来评估 LTC 特征的州间差异是否与老年人自杀率（包括总体自杀率和与 LTC 相关的自杀率）的变化相关。
在研究期间，向 NVDRS 报告的 55 岁及以上人群中有 25040 人自杀；有 382 人自杀被确定与 LTC 有某种关系。在调整了州级特征后，更大的平均疗养院容量与 LTC 相关的自杀累积发生率的增加显著相关（β=0.087，SE=0.026，P<0.01），但与总体自杀发生率无关。成本和监管措施均与州级 LTC 相关的自杀发生率无显著相关性。
LTC 设施容量的州级差异与老年人 LTC 相关自杀发生率的变化有关。鉴于通过设施或个人干预措施预防老年人自杀的挑战，因此管理 LTC 服务的特征和提供的政策可能成为公共卫生预防自杀的一种手段。
