Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990-2016
Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990-2016
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DOI：
10.1016/s2468-2667(18)30138-5
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发表时间：
2018-10-01
影响因子：
50
通讯作者：
Dandona, Lalit
中科院分区：
文献类型：
--
作者：
Dandona, Rakhi;Kumar, G. Anil;Dandona, Lalit
背景：对印度13亿人口（占全球人口的18%）的次国家级自杀死亡率趋势的系统了解并不容易获得。因此，我们的目的是报告自杀死亡的时间趋势，以及1990年至2016年印度各邦之间自杀死亡分布的异质性。方法作为2016年全球疾病、伤害和风险因素负担研究（GBD）的一部分，我们估计了1990年至2016年印度各邦男女的自杀死亡率（sdr）。我们使用各种数据来源来估计印度的死因特异性死亡率。2000年之前，印度的自杀死亡率估计主要基于GBD协变量。对于每个州，我们计算了2016年全球具有类似GBD社会人口指数的地区观测到的SDR与预期比率（即观测到的-预期比率）；并评估了自杀死亡的年龄分布，以及SDR的男女比例。最后，我们利用1990年至2016年年龄标准化SDR的地点趋势，评估了印度和各州实现2015年至2030年SDR减少三分之一的可持续发展目标（SDG）目标的可能性。我们计算了95%的不确定区间（ui）的点估计。2016年印度共有230 314例（95% UI 194 058-250 260）自杀死亡。印度女性自杀死亡人数占全球自杀死亡人数的比例从1990年的25.3%上升到2016年的36.6%，男性从18.7%上升到24.3%。印度女性的年龄标准化SDR从1990年的20.0 （95% UI 16.5-23.5）下降到2016年的14.7(13.1-16.2)/ 10万，下降了26.7%，但男性的年龄标准化SDR在1990年和2016年是一样的（22.3 [95% UI 14.4-27.4] / 10万）和2016年（21.2[14.6-23.6]/ 10万）。2016年，印度女性的特别提款权比全球平均水平高2.1倍，观察到的预期比率为2.74，各州之间的比率从0.45到4.54不等。2016年，印度男性的特别提款权比全球平均水平高1.4倍，观察到的预期比率为1.31，各州之间的比率从0.40到2.42不等。2016年，特别提款权国家之间的女性差异为10倍，男性差异为6倍。2016年，印度SDR的男女比例为1.34，各邦之间的比例从0.97到4.11不等。2016年，年龄在15-29岁和75岁及以上的女性以及75岁及以上的男性的特别提款权最高。2016年，自杀是印度15-39岁人群的主要死亡原因；71.2%的女性自杀死亡人数和57.7%的男性自杀死亡人数属于这一年龄组。如果观察到2016年的趋势继续下去，印度在2030年实现SDG SDR减排目标的概率为零，占印度人口81.3%的大多数邦的概率低于10%，三个邦的概率为10.3-15.0%，六个邦的概率为25.1-36.7%。印度在全球自杀死亡人数中所占的比例很高，而且还在增加。印度的特别提款权高于其社会人口指数水平的预期，特别是对妇女而言，各邦之间的幅度和男女比例存在很大差异。印度必须制定一项考虑到这些差异的预防自杀战略，以解决这一重大公共卫生问题。版权所有(c) 2018作者。Elsevier Ltd.出版。这是一篇基于CC BY 4.0许可的开放获取文章。
Background A systematic understanding of suicide mortality trends over time at the subnational level for India's 1.3 billion people, 18% of the global population, is not readily available. Thus, we aimed to report time trends of suicide deaths, and the heterogeneity in its distribution between the states of India from 1990 to 2016.Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, we estimated suicide death rates (SDRs) for both sexes in each state of India from 1990 to 2016. We used various data sources for estimating cause-specific mortality in India. For suicide mortality in India before 2000, estimates were based largely on GBD covariates. For each state, we calculated the ratio of the observed SDR to the rate expected in geographies globally with similar GBD Socio-demographic Index in 2016 (ie, the observed-to-expected ratio); and assessed the age distribution of suicide deaths, and the men-to-women ratio of SDR over time. Finally, we assessed the probability for India and the states of reaching the Sustainable Development Goal (SDG) target of a one-third reduction in SDR from 2015 to 2030, using location-wise trends of the age-standardised SDR from 1990 to 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates.Findings There were 230 314 (95% UI 194 058-250 260) suicide deaths in India in 2016. India's contribution to global suicide deaths increased from 25.3% in 1990 to 36.6% in 2016 among women, and from 18.7% to 24.3% among men. Age-standardised SDR among women in India reduced by 26.7% from 20.0 (95% UI 16.5-23.5) in 1990 to 14.7 (13.1-16.2) per 100 000 in 2016, but the age-standardised SDR among men was the same in 1990 (22.3 [95% UI 14.4-27.4] per 100 000) and 2016 (21.2 [14.6-23.6] per 100 000). SDR in women was 2.1 times higher in India than the global average in 2016, and the observed-to-expected ratio was 2.74, ranging from 0.45 to 4.54 between the states. SDR in men was 1.4 times higher in India than the global average in 2016, with an observed-to-expected ratio of 1.31, ranging from 0.40 to 2.42 between the states. There was a ten-fold variation between the states in the SDR for women and six-fold variation for men in 2016. The men-to-women ratio of SDR for India was 1.34 in 2016, ranging from 0.97 to 4.11 between the states. The highest age-specific SDRs among women in 2016 were for ages 15-29 years and 75 years or older, and among men for ages 75 years or older. Suicide was the leading cause of death in India in 2016 for those aged 15-39 years; 71.2% of the suicide deaths among women and 57.7% among men were in this age group. If the trends observed up to 2016 continue, the probability of India achieving the SDG SDR reduction target in 2030 is zero, and the majority of the states with 81.3% of India's population have less than 10% probability, three states have a probability of 10.3-15.0%, and six have a probability of 25.1-36.7%.Interpretation India's proportional contribution to global suicide deaths is high and increasing. SDR in India is higher than expected for its Socio-Demographic Index level, especially for women, with substantial variations in the magnitude and men-to-women ratio between the states. India must develop a suicide prevention strategy that takes into account these variations in order to address this major public health problem. Copyright (c) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.