Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death - United States, 2001-2015
Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death - United States, 2001-2015
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DOI：
10.15585/mmwr.ss6618a1
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发表时间：
2017-10-06
影响因子：
24.9
通讯作者：
Kresnow-Sedacca, Marcie-jo
中科院分区：
文献类型：
--
作者：
Ivey-Stephenson, Asha Z.;Crosby, Alex E.;Kresnow-Sedacca, Marcie-jo
问题/状况：自杀是一个公共卫生问题，也是美国十大主要死亡原因之一。自杀率存在很大的地域差异，农村地区的自杀率比更多城市地区的自杀率高得多。了解城市化水平之间和城市化水平内的人口趋势和死亡机制，对于制定和瞄准未来的预防工作非常重要。报告期：2001-2015。系统描述：国家生命统计系统(NVSS)的死亡数据包括从50个州和哥伦比亚特区提交的死亡证明中获得的人口、地理和死因信息。NVSS用于识别自杀死亡，由国际疾病分类第10版(ICD-10)基本死因代码X60-X84、Y87.0和U03定义。这份报告按选定的人口统计数据和死亡机制分析了2001-2015年间城市化水平之间和城市化水平内县级自杀率的年度趋势。根据2006年国家卫生统计中心的分类方案，将县划分为三个城市化水平。结果：三个城市化水平的自杀率都有所上升，非大都市/农村县的自杀率高于中/小或大都市县。在研究期间的不同时期，每个城市化水平都经历了巨大的年增长率变化。在整个城市化水平上，男性和非西班牙裔美国印第安人/阿拉斯加原住民的自杀率始终高于女性和其他种族/族裔群体的自杀率；然而，在更多的大都市县，非西班牙裔白人的自杀率最高。趋势表明，非西班牙裔黑人的自杀率在非城市/农村县最低，在更多的城市县最高。所有年龄段的自杀率在城市化水平上都有所上升，其中35岁-的自杀率最高。在死亡机制方面，在所有城市化水平上，持枪自杀率和上吊/窒息的比率都出现了较大幅度的上升；非城市/农村县的枪支自杀率几乎是大城市县的两倍。解释：非城市/农村县的自杀率始终高于大都市县的自杀率。这些趋势还可以通过性别、种族/民族、年龄组和死亡机制观察到。公共卫生行动：应持续进行预防自杀的干预措施，特别是在农村地区。全面的自杀预防工作可包括利用保护因素和提供创新的预防战略，以增加农村社区获得保健和精神保健的机会。此外，社会经济因素在不同社区的分布各不相同，需要在预防自杀的背景下更好地理解。
Problem/Condition: Suicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts.Reporting Period: 2001-2015.Description of System: Mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60-X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001-2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme.Results: Suicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35-64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties.Interpretation: Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death.Public Health Action: Interventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioeconomic factors varies in different communities and needs to be better understood in the context of suicide prevention.