Agbayewa M O, Marion S A, Wiggins S
Department of Psychiatry, University of British Columbia, Vancouver.
Can J Psychiatry. 1998 Oct;43(8):829-36. doi: 10.1177/070674379804300808.
The effects of socioeconomic factors on suicide rates in the general population are widely documented. Few of these reports have specifically studied the effects of socioeconomic variables on suicide rates in the elderly population. Elderly persons have the highest suicide rates of any age-group. This group is different from the rest of the population insofar as suicide is concerned. For example, since most elderly persons are no longer in the labour force, it would be expected that they would be affected differently by economic factors such as unemployment. We report the findings of an ecological study of old-age suicide in British Columbia over an 11-year period.
We obtained information on all suicide counts (International Classification of Diseases [ICD-9] codes E590-959) recorded in the 21 health units of British Columbia over the 11-year period from October 1, 1981, to September 30, 1991, from the Division of Vital Statistics of the Province of British Columbia and Statistics Canada. Social, economic, and demographic information for the health units was obtained from census data and included the number of persons per household, proportion of the population that lived in 1-person households, immigration and migration rates for each region, proportion of the population with less than grade 9 education, proportion with less than grade 12 certification, marital status rates, unemployment rates by gender, average household income, average census family income, and labour-force participation rate by gender. We calculated overall and gender-specific suicide rates for elderly persons (65 years and older) and younger populations. Using Poisson regression analyses, we determined the cross-sectional and longitudinal relative risks associated with the socioeconomic variables for the units, and we also examined trends in suicide rates.
There were 4630 suicides in the 11-year period. The mean suicide rate (per 100,000 population) for those over age 9 years was 18.6 (between health unit SD 5.2, 95% confidence interval [CI] = 17.0-20.2). The elderly have a higher suicide rate in every region. The male suicide rates (mean = 26.9, SD 6.4, 95% CI = 24.0-30.0) are higher than female rates (mean = 7.5, SD 1.7, 95% CI = 6.8-8.3) in every region. The factors influencing suicides were different for elderly males and elderly females. In all analyses, suicide rates in elderly females remained essentially stable across age-groups and units and over the years. Elderly male suicide rates varied across units and age-groups and over the years.
Suicide rates are highest in males over age 74 years. There are regional differences in elderly suicide rates and the factors that influence them. Longitudinal and cross-sectional risk factors differ, and there are gender differences in the risk factors. For both elderly males and females, suicide rates appear to be influenced by social factors in the population as a whole, not just in the elderly population. Male and female employment patterns are associated with elderly male suicide rates, even though the latter are not in the labour force. For suicide in elderly women the important factors are population education, income, and migration levels.
社会经济因素对普通人群自杀率的影响已有大量文献记载。但这些报告中很少有专门研究社会经济变量对老年人群自杀率的影响。老年人的自杀率在所有年龄组中是最高的。就自杀而言，这个群体与其他人群不同。例如，由于大多数老年人不再参与劳动力市场，因此预计他们会受到诸如失业等经济因素的不同影响。我们报告了一项对不列颠哥伦比亚省11年间老年人自杀情况的生态学研究结果。
我们从不列颠哥伦比亚省生命统计司和加拿大统计局获取了1981年10月1日至1991年9月30日这11年间不列颠哥伦比亚省21个卫生单位记录的所有自杀案例信息（国际疾病分类[ICD - 9]编码E590 - 959）。卫生单位的社会、经济和人口统计信息来自人口普查数据，包括每户人数、独居人口比例、每个地区的移民和迁移率、受教育程度低于9年级的人口比例、未获得12年级学历证书的人口比例、婚姻状况率、按性别划分的失业率、平均家庭收入、平均普查家庭收入以及按性别划分的劳动力参与率。我们计算了老年人（65岁及以上）和年轻人群体的总体自杀率及按性别划分的自杀率。使用泊松回归分析，我们确定了与各单位社会经济变量相关的横断面和纵向相对风险，并且我们还研究自杀率的趋势。
在这11年期间共有4630起自杀事件。9岁以上人群的平均自杀率（每10万人）为18.6（各卫生单位标准差为5.2，95%置信区间[CI] = 17.0 - 20.2）。每个地区老年人的自杀率都更高。每个地区男性自杀率（平均 = 26.9，标准差6.4，95% CI = 24.0 - 30.0）高于女性自杀率（平均 = 7.5，标准差 = 1.7，95% CI = 6.8 - 8.3）。影响老年男性和老年女性自杀的因素不同。在所有分析中，老年女性的自杀率在不同年龄组、不同单位以及多年间基本保持稳定。老年男性自杀率在不同单位、不同年龄组以及多年间有所不同。
74岁以上男性的自杀率最高。老年自杀率及其影响因素存在地区差异。纵向和横断面风险因素不同，且风险因素存在性别差异。对于老年男性和女性而言，自杀率似乎受到整个人口中的社会因素影响，而不仅仅是老年人群体中的社会因素。男性和女性的就业模式与老年男性自杀率相关，尽管老年男性并不在劳动力市场。对于老年女性自杀而言，重要因素是人口教育、收入和迁移水平。
