Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Katsushika-ku, Tokyo, Japan.
Epidemiol Psychiatr Sci. 2024 May 23;33:e30. doi: 10.1017/S2045796024000325.
While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.
Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.
A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3-2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83-7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2-10.5%; RR: 1.56, 95% CI: 1.38-1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2-11.3%; RR: 1.60, 95% CI: 1.42-1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.
Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.
虽然过去的研究表明居住安排与自杀死亡有关，但尚无研究探讨持续的居住安排和居住安排的变化的影响。此外，以前的生存分析研究仅报告了单个危险比（HR），而实际 HR 可能随时间而变化。我们旨在使用因果推理方法解决这些局限性。
使用来自一般日本人群样本的多点数据。参与者在 5 年的时间间隔内两次报告其居住安排。之后，在 14 年内评估自杀死亡、非自杀死亡和全因死亡率。我们使用逆概率加权合并逻辑回归和累积发病率曲线，评估随时间变化的居住安排与自杀死亡的关联。我们还研究了非自杀死亡和全因死亡率，以了解这种关联的背景。使用随机森林插补处理协变量缺失数据。
共分析了 86749 名参与者，基线时的平均年龄（标准差）为 51.7（7.90）。在这 86749 名参与者中，有 306 人在 14 年的随访期间自杀身亡。持续独居与自杀死亡风险增加相关（风险差异 [RD]：1.1%，95%置信区间 [CI]：0.3-2.5%；风险比 [RR]：4.00，95% CI：1.83-7.41）、非自杀死亡（RD：7.8%，95% CI：5.2-10.5%；RR：1.56，95% CI：1.38-1.74）和全因死亡率（RD：8.7%，95% CI：6.2-11.3%；RR：1.60，95% CI：1.42-1.79）在随访结束时。累积发病率曲线显示，这些关联在整个随访过程中是一致的。在所有类型的死亡率中，对于那些开始与他人同住和那些过渡到独居的人，风险增加较小。敏感性分析结果仍然稳健。
持续独居的个体自杀死亡以及非自杀死亡和全因死亡率的风险增加，而改变居住安排的个体的这种影响较弱。
