Hu Yuhua, Pan Jie, Luo Rui, Yang Qianqian, He Zhiwei, Yuan Hui, Zhou Guangren
School of Public Health, Southeast University, Nanjing, 210009, China.
School of Public Health, Wannan Medical College, Wuhu, 241000, China.
SSM Popul Health. 2023 Jan 13;21:101342. doi: 10.1016/j.ssmph.2023.101342. eCollection 2023 Mar.
China has undergone tremendous social changes in the last few decades. This study aimed to research the trends of the suicide rates from 2002 to 2019, and to differentiate effects attributable to age, period, and cohort by gender and residence in China.
Suicide mortality data were obtained from China's Ministry of Health Vital Registration System. Joinpoint regression model was used to estimate the average annual percentage change (AAPC) of the suicide rates and ratios by gender and residence. The age-period-cohort framework was performed to analyze the underlying mechanisms for suicide mortality trends.
Over the observation period, the significant decrease in suicide mortality rates in China for the economic development and urbanization was observed but to different degrees across gender and regional subgroups. The male-to-female ratio of suicide rates increased year by year (AAPC: 1.9%, 95% CI: 0.2% to 3.7%) while the urban-rural ratio changed little (AAPC: 0.9%, 95% CI: -1.8% to 3.7%). The age-period-cohort analysis revealed a marked increased effect of age and overall decreased effect of both period and cohort on suicide mortality rates. However, the recent cohort has presented an inversely increasing effect.
The suicide rate has fallen sharply in China which has undergone tremendous socioeconomic changes. The varied changes in the suicide rate of different residence-, gender-, and age-groups as well as the age, period, and cohort effect on suicide risk further indicate the relationship of development and the suicide rates may be neither static nor identical on different subgroups in a rapidly changing society.
在过去几十年里，中国经历了巨大的社会变革。本研究旨在探讨2002年至2019年自杀率的变化趋势，并按性别和居住地区分年龄、时期和队列对自杀率的影响。
自杀死亡率数据来自中国卫生部的生命登记系统。采用Joinpoint回归模型估计按性别和居住地划分的自杀率及比率的年均变化百分比（AAPC）。运用年龄-时期-队列框架分析自杀死亡率趋势的潜在机制。
在观察期内，中国自杀死亡率因经济发展和城市化而显著下降，但在不同性别和地区亚组中下降程度不同。自杀率的男女比例逐年上升（AAPC：1.9%，95%CI：0.2%至3.7%），而城乡比例变化不大（AAPC：0.9%，95%CI：-1.8%至3.7%）。年龄-时期-队列分析显示，年龄对自杀死亡率的影响显著增加，时期和队列的总体影响下降。然而，最近的队列呈现出反向增加的影响。
在中国，经历了巨大社会经济变革的情况下，自杀率大幅下降。不同居住地、性别和年龄组的自杀率变化各异，以及年龄、时期和队列对自杀风险的影响，进一步表明在快速变化的社会中，发展与自杀率之间的关系可能既不是静态的，也不是不同亚组相同的。
