美国紧急医疗系统职业人群中的自杀问题。
Suicide Among the Emergency Medical Systems Occupation in the United States.
机构信息
University of Arizona College of Medicine-Phoenix, Department of Emergency Medicine, Phoenix, Arizona.
Mayo Clinic Florida, Department of Emergency Medicine, Jacksonville, Florida.
出版信息
West J Emerg Med. 2021 Jan 20;22(2):326-332. doi: 10.5811/westjem.2020.10.48742.
INTRODUCTION
Suicide claimed 47,173 lives in 2017 and is the second leading cause of death for individuals 15-34 years old. In 2017, rates of suicide in the United States (US) were double the rates of homicide. Despite significant research funding toward suicide prevention, rates of suicide have increased 38% from 2009 to 2017. Recent data suggests that emergency medical services (EMS) workers are at a higher risk of suicidal ideation and suicide attempts compared to the general public. The objective of this study was to determine the proportionate mortality ratio (PMR) of suicide among firefighters and emergency medical technicians (EMT) compared to the general US working population.
METHODS
We analyzed over five million adult decedent death records from the National Occupational Mortality Surveillance database for 26 states over a 10-year non-consecutive period including 1999, 2003-2004, and 2007-2013. Categorizing firefighters and EMTs by census industry and occupation code lists, we used the underlying cause of death to calculate the PMRs compared to the general US decedent population with a recorded occupation.
RESULTS
Overall, 298 firefighter and 84 EMT suicides were identified in our study. Firefighters died in significantly greater proportion from suicide compared to the US.working population with a PMR of 172 (95% confidence interval [CI], 153-193, P<0.01). EMTs also died from suicide in greater proportion with an elevated PMR of 124 (95% CI, 99-153), but this did not reach statistical significance. Among all subgroups, firefighters ages 65-90 were found to have the highest PMR of 234 (95% CI, 186-290), P<0.01) while the highest among EMTs was in the age group 18-64 with a PMR of 126 (95% CI, 100-156, P<0.05).
CONCLUSION
In this multi-state study, we found that firefighters and EMTs had significantly higher proportionate mortality ratios for suicide compared to the general US working population. Firefighters ages 65-90 had a PMR more than double that of the general working population. Development of a more robust database is needed to identify EMS workers at greatest risk of suicide during their career and lifetime.
引言
2017 年，自杀导致 47173 人死亡，是 15-34 岁人群的第二大死因。2017 年，美国的自杀率是凶杀率的两倍。尽管在预防自杀方面投入了大量研究资金，但自 2009 年以来，自杀率仍上升了 38%。最近的数据表明，与普通公众相比，急救医疗服务（EMS）工作者自杀意念和自杀企图的风险更高。本研究的目的是确定与一般美国工作人群相比，消防员和急救医疗技术员（EMT）的自杀比例。
方法
我们分析了来自国家职业死亡率监测数据库的超过 500 万例成人死亡记录，这些记录来自 26 个州，时间跨度为 10 年，不连续。通过普查行业和职业代码列表对消防员和 EMT 进行分类，我们使用根本死因来计算与记录职业的一般美国死亡人群相比的比例死亡率（PMR）。
结果
在我们的研究中，共发现 298 名消防员和 84 名 EMT 自杀。与美国一般工作人群相比，消防员自杀的比例明显更高，PMR 为 172（95%置信区间[CI]，153-193，P<0.01）。EMT 也因自杀而死亡的比例更高，PMR 为 124（95%CI，99-153），但这没有达到统计学意义。在所有亚组中，年龄在 65-90 岁的消防员发现 PMR 最高，为 234（95%CI，186-290），P<0.01），而 EMT 中最高的是 18-64 岁年龄组，PMR 为 126（95%CI，100-156，P<0.05）。
结论
在这项多州研究中，我们发现消防员和 EMT 与一般美国工作人群相比，自杀的比例死亡率明显更高。年龄在 65-90 岁的消防员的 PMR 是一般工作人群的两倍多。需要建立一个更强大的数据库，以确定在其职业生涯和一生中自杀风险最高的 EMS 工作人员。
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