Suicide Case-Fatality Rates in the United States, 2007 to 2014 A Nationwide Population-Based Study
Suicide Case-Fatality Rates in the United States, 2007 to 2014 A Nationwide Population-Based Study
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DOI：
10.7326/m19-1324
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发表时间：
2019-12-17
影响因子：
39.2
通讯作者：
Miller, Matthew
中科院分区：
文献类型：
--
作者：
Conner, Andrew;Azrael, Deborah;Miller, Matthew
背景：自杀病死率（CFR）——致命的自杀行为的比例——取决于自杀行为中使用的方法的分布以及特定方法的死亡概率（特定方法的 CFR）。目的：根据人口特征估计整体和特定方法的自杀 CFR 以及自杀行为中使用的方法的分布。设计：横断面研究。背景：美国，2007 年至 2014 年。参与者：自杀5 岁或以上人群的死亡（国家人口动态统计系统中的 n = 309 377 条记录）和需要在急诊科 (ED) 治疗的非致命性自杀未遂（全国急诊科样本中的 n = 1 791 638 条记录）或住院治疗（全国[全国]住院病人样本中的 n = 1 556 871 条记录）。 测量：总体和特定方法的自杀死亡和非致命自杀企图率按性别、年龄组、地区和城市化程度划分的病死率以及所用方法的分布。结果：总体而言，8.5% 的自杀行为是致命的（男性为 14.7%，女性为 3.3%；15 至 24 岁人群为 3.4%，年龄 >= 65 岁人群为 35.4%）。药物中毒占行为的59.4%，但仅占死亡的13.5%；持枪和上吊仅占行为的 8.8%，但却占死亡的 75.3%。枪支是最致命的方法（89.6%的枪支自杀行为导致死亡），其次是溺水（56.4%）和上吊（52.7%）。男性和老年人的特定方法病死率较高。方法的分布因人口群体而异。局限性：结果基于导致急诊就诊、住院或死亡的自杀行为。因此，报告的 CFR 比包含未导致急诊就诊的非致命企图的数据要大。结论：性别之间、年龄组、地区和城市化之间总体自杀 CFR 的差异很大程度上是由自杀行为所用方法的分布来解释的。
Background: The suicide case-fatality rate (CFR)-the proportion of suicidal acts that are fatal-depends on the distribution of methods used in suicidal acts and the probability of death given a particular method (method-specific CFR).Objective: To estimate overall and method-specific suicide CFRs and the distribution of methods used in suicidal acts by demographic characteristics.Design: Cross-sectional study.Setting: United States, 2007 to 2014.Participants: Suicide deaths (n = 309 377 records from the National Vital Statistics System) and nonfatal suicide attempts requiring treatment in an emergency department (ED) (n = 1 791 638 records from the Nationwide Emergency Department Sample) or hospitalization (n = 1 556 871 records from the National [Nationwide] Inpatient Sample) among persons aged 5 years or older.Measurements: Rates of suicide deaths and nonfatal suicide attempts, overall and method-specific CFRs, and distribution of methods used, by sex, age group, region, and urbanization.Results: Overall, 8.5% of suicidal acts were fatal (14.7% for males vs. 3.3% for females; 3.4% for persons aged 15 to 24 years vs. 35.4% for those aged >= 65 years). Drug poisoning accounted for 59.4% of acts but only 13.5% of deaths; firearms and hanging accounted for only 8.8% of acts but 75.3% of deaths. Firearms were the most lethal method (89.6% of suicidal acts with a firearm resulted in death), followed by drowning (56.4%) and hanging (52.7%). Method-specific CFRs were higher for males and older persons. The distribution of methods varied across demographic groups.Limitations: Results are based on suicidal acts resulting in an ED visit, a hospitalization, or death. Consequently, the reported CFRs are larger than they would have been had the data included nonfatal attempts that did not result in an ED visit.Conclusion: Variation in overall suicide CFR between sexes and across age groups, regions, and urbanization is largely explained by the distribution of methods used in suicidal acts.