University of Toronto, University Dr NW, Calgary, AB, T2N 1N4, Canada.
Centre for Addiction and Mental Health, Moscow, Russian Federation.
BMC Psychiatry. 2023 May 17;23(1):345. doi: 10.1186/s12888-023-04805-w.
We previously found an association between rurality and death by suicide, where those living in rural areas were more likely to die by suicide. One potential reason why this relationship exists might be travel time to care. This paper examines the relationship between travel time to both psychiatric and general hospitals and suicide, and then determine whether travel time to care mediates the relationship between rurality and suicide.
This is a population-based nested case-control study. Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital and emergency department visits across Ontario. Suicides were captured using vital statistics. Travel time to care was calculated from the resident's home to the nearest hospital based on the postal codes of both locations. Rurality was measured using Metropolitan Influence Zones.
For every hour in travel time a male resides from a general hospital, their risk of death by suicide doubles (AOR = 2.08, 95% CI = 1.61-2.69). Longer travel times to psychiatric hospitals also increases risk of suicide among males (AOR = 1.03, 95%CI = 1.02-1.05). Travel time to general hospitals is a significant mediator of the relationship between rurality and suicide among males, accounting for 6.52% of the relationship between rurality and increased risk of suicide. However, we also found that there is effect modification, where the relationship between travel time and suicide is only significant among males living in urban areas.
Overall, these findings suggest that males who must travel longer to hospitals are at a greater risk of suicide compared to those who travel a shorter time. Furthermore, travel time to care is a mediator of the association between rurality and suicide among males.
我们之前发现，居住地的农村性与自杀死亡之间存在关联，农村地区的人更有可能自杀。这种关系存在的一个潜在原因可能是就医的交通时间。本文研究了前往精神病医院和综合医院的交通时间与自杀之间的关系，并确定了医疗交通时间是否在农村性与自杀之间的关系中起中介作用。
这是一项基于人群的巢式病例对照研究。数据来自 2007 年至 2017 年，从安大略省卫生信息研究所（ICES）的行政数据库中获得，这些数据库涵盖了安大略省所有医院和急诊部的就诊情况。通过人口统计数据捕捉自杀情况。根据两地的邮政编码，从居民的家到最近的医院计算交通时间。使用大都会影响区衡量农村性。
男性每增加一小时的交通时间，其自杀死亡的风险就会增加一倍（AOR=2.08，95%CI=1.61-2.69）。前往精神病医院的交通时间延长也会增加男性自杀的风险（AOR=1.03，95%CI=1.02-1.05）。男性的居住地与自杀之间的关系是农村性和自杀风险增加之间的一个重要中介，占农村性和自杀风险增加之间关系的 6.52%。然而，我们还发现存在效应修饰，即交通时间与自杀之间的关系仅在居住在城市地区的男性中具有统计学意义。
总体而言，这些发现表明，与交通时间较短的男性相比，需要前往更远医院的男性自杀的风险更高。此外，交通时间是农村性与男性自杀之间关联的一个中介。
