EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, Porto 4050-600, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, Porto 4050-600, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal.
Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal; Hospital de Cascais, Dr. José de Almeida, Portugal.
J Affect Disord. 2021 Aug 1;291:65-75. doi: 10.1016/j.jad.2021.04.048. Epub 2021 May 3.
Suicide is a potentially preventable cause of death. Epidemiology might help to identify death determinants and to monitor prevention strategies. Few studies address secular trends in suicide deaths, and even fewer describe trend-changes in relation to data collection/registration bias. Moreover, suicide is admittedly underreported. It is crucial to validate results in the context of other external causes of death trends, such as unintentional and undetermined intent deaths. We aimed to explore trends in suicide and other external causes of death in Portugal from the inception of registries until 2018, considering breaks in series.
We collected data from all available official primary sources. We calculated cause-specific age-standardized death rates (SDR) by sex for ages equal or higher than 15 years with reference to the European Standard Population. We considered suicide (S), undetermined intent deaths (UnD), accidents (Accs), and all causes of death (ttMty). A time-series structural analysis was executed.
Suicide and other external causes of death rates were consistently higher in males than females. A global decline of deaths by suicide, undetermined intention and unintentional is observable. Breakpoints in years 1930, 1954, 1982, 2000-2001 were associated with major changes in deaths registration procedures or methodology.
The epidemiology of suicide in Portugal has changed over 106 years. However, adjusted data and consideration of bias reduce trends fluctuation. Trend changes are akin to specific changes in methodology of death registry. Suicide surveillance will improve with more reliable and stable procedures.
自杀是一种潜在可预防的死亡原因。流行病学可以帮助确定死亡决定因素并监测预防策略。很少有研究涉及自杀死亡的长期趋势，更少的研究描述与数据收集/登记偏差有关的趋势变化。此外，自杀的报告确实不足。在其他外部原因死亡趋势的背景下验证结果至关重要，例如意外和无法确定意图的死亡。我们旨在探讨从登记册开始到 2018 年葡萄牙自杀和其他外部原因死亡的趋势，同时考虑到系列的中断。
我们从所有可用的官方初级来源收集数据。我们计算了特定于原因的年龄标准化死亡率（SDR），按性别计算，年龄等于或高于 15 岁，参考欧洲标准人口。我们考虑了自杀（S）、无法确定意图的死亡（UnD）、事故（Accs）和所有死亡原因（ttMty）。执行了时间序列结构分析。
自杀和其他外部原因的死亡率在男性中始终高于女性。可以观察到自杀、无法确定意图和意外死亡的全球下降。1930 年、1954 年、1982 年、2000-2001 年的断点与死亡登记程序或方法的重大变化有关。
葡萄牙的自杀流行病学在 106 多年来发生了变化。然而，调整后的数据和对偏差的考虑减少了趋势波动。趋势变化类似于死亡登记处方法的具体变化。随着更可靠和稳定的程序，自杀监测将得到改善。
