Mapping suicide mortality in Ohio: A spatial epidemiological analysis of suicide clusters and area level correlates
Mapping suicide mortality in Ohio: A spatial epidemiological analysis of suicide clusters and area level correlates
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DOI：
10.1016/j.ypmed.2017.10.033
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发表时间：
2018-01-01
影响因子：
5.1
通讯作者：
Root, Elisabeth D.
中科院分区：
文献类型：
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作者：
Fontanella, Cynthia A.;Saman, Daniel M.;Root, Elisabeth D.
以前的研究已经调查了西方和亚洲国家自杀率的空间模式和区域特征之间的联系，但很少在美国进行。本生态学研究的目的是确定俄亥俄州的自杀高危集群，并评估这些集群的区域水平相关性。我们使用贝叶斯条件自回归模型（CAR）估算了2004年至2013年期间的空间平滑标准化死亡率（SMR）。采用空间和时空扫描统计方法在人口普查区水平上检测自杀高危聚类（N = 2952）。采用Logistic回归模型检验区域水平相关因素与自杀群集之间的关系。高危空间聚类共9个（p < 0.05），时空聚类共2个。我们还通过自杀方法确定了几个重要的空间集群。自杀风险在高危区比非高危区高2.1倍（相对危险度从1.22到2.14不等（p < 0.01））。在多变量模型中，与地区自杀率密切相关的因素是社会经济剥夺和较低的提供者密度。在社区一级努力减少贫穷和改善获得保健和精神保健医疗服务的机会，可能是重要的自杀预防战略。
Previous studies have investigated spatial patterning and associations of area characteristics with suicide rates in Western and Asian countries, but few have been conducted in the United States. This ecological study aims to identify high-risk clusters of suicide in Ohio and assess area level correlates of these clusters. We estimated spatially smoothed standardized mortality ratios (SMR) using Bayesian conditional autoregressive models (CAR) for the period 2004 to 2013. Spatial and spatio-temporal scan statistics were used to detect high-risk clusters of suicide at the census tract level (N = 2952). Logistic regression models were used to examine the association between area level correlates and suicide clusters. Nine statistically significant (p < 0.05) high-risk spatial clusters and two space-time clusters were identified. We also identified several significant spatial clusters by method of suicide. The risk of suicide was up to 2.1 times higher in high-risk clusters than in areas outside of the clusters (relative risks ranged from 1.22 to 2.14 (p < 0.01)). In the multivariate model, factors strongly associated with area suicide rates were socio-economic deprivation and lower provider densities. Efforts to reduce poverty and improve access to health and mental health medical services on the community level represent potentially important suicide prevention strategies.