The University of Chicago, Chicago, Illinois.
Institute for Population and Precision Health, The University of Chicago, Chicago, Illinois.
JAMA Netw Open. 2023 Apr 3;6(4):e239995. doi: 10.1001/jamanetworkopen.2023.9995.
There were over 45 000 suicides in the US in 2020, making suicide the 12th leading cause of death. If social vulnerability is associated with suicide rates, targeted interventions for at-risk segments of the population may reduce US suicide rates.
To determine the association between social vulnerability and suicide in adults.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed 2 county-level social vulnerability measures (the Social Vulnerability Index [SVI] and the Social Vulnerability Metric [SVM]) and US Centers for Disease Control and Prevention-reported county-level suicides from 2016 to 2020. Data were analyzed November and December 2022.
County-level variability in social vulnerability.
The primary outcome measure was number of county-level adult suicides from 2016 to 2020, offset by county adult population during those years. The association between social vulnerability (measured using the SVI and the newly created SVM for 2018) and suicide was modeled using a bayesian-censored Poisson regression model to account for the CDC's suppression of county-level suicide counts of less than 10, adjusted for age, racial and ethnic minority, and urban-rural county characteristics.
From 2016 to 2020, there were a total of 222 018 suicides in 3141 counties. Comparing the least socially vulnerable (0% to 10%) to the most socially vulnerable (90% to 100%) counties, there was a 56% increase in suicide rate (17.3 per 100 000 persons to 27.0 per 100 000 persons) as measured by the SVI (incidence rate ratio, 1.56; 95% credible interval, 1.51-1.60) and an 82% increase in suicide rate (13.8 per 100 000 persons to 25.1 per 100 000 persons) as measured by the SVM (incidence rate ratio, 1.82; 95% credible interval, 1.72-1.92).
This cohort study found that social vulnerability had a direct association with risk for adult suicide. Reducing social vulnerability may lead to life-saving reduction in the rate of suicide.
2020 年，美国有超过 45000 人自杀，使自杀成为第 12 大主要死因。如果社会脆弱性与自杀率有关，那么针对高危人群的有针对性的干预措施可能会降低美国的自杀率。
确定成年人的社会脆弱性与自杀之间的关联。
设计、设置和参与者：本队列研究分析了 2 项县级社会脆弱性指标（社会脆弱性指数[SVI]和社会脆弱性指标[SVM]）和美国疾病控制与预防中心报告的 2016 年至 2020 年县级自杀数据。数据于 2022 年 11 月和 12 月进行分析。
县级社会脆弱性的变异性。
主要结局指标是 2016 年至 2020 年期间，由当年县级成年人口减去的县级成年自杀人数。使用 SVI（2018 年新创建的 SVM）衡量社会脆弱性与自杀之间的关联，采用贝叶斯删失泊松回归模型进行建模，以考虑疾病预防控制中心对少于 10 人的县级自杀人数的抑制，同时调整年龄、种族和民族以及城乡县特征。
2016 年至 2020 年期间，在 3141 个县中共有 222018 例自杀事件。与最不脆弱（0%至 10%）和最脆弱（90%至 100%）的县相比，SVI 衡量的自杀率增加了 56%（每 10 万人中有 17.3 人增加到每 10 万人中有 27.0 人）（发病率比，1.56；95%可信区间，1.51-1.60），SVM 衡量的自杀率增加了 82%（每 10 万人中有 13.8 人增加到每 10 万人中有 25.1 人）（发病率比，1.82；95%可信区间，1.72-1.92）。
本队列研究发现，社会脆弱性与成年人自杀风险直接相关。降低社会脆弱性可能会导致自杀率的救命性降低。
