Presentation Information
[5OlXCzC1-04]Sex differences in the urban-rural disparity in suicide mortality in Japan: a Bayesian spatial epidemiological study of all municipalities nationwide
*Masahide Koda1, Nahoko Harada2 (1. Co-learning Community Healthcare Re-innovation Office, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University (Japan), 2. Department of Nursing Science, Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University (Japan))
Keywords:
Suicide,Urban-rural disparity,Sex differences,Bayesian spatial epidemiology,Sustainable Development Goals
[Background] Approximately 20,000 people die by suicide each year in Japan. Sustainable Development Goal (SDG) 3.4 calls for the promotion of mental health and suicide prevention. Geographic variation in suicide mortality has been documented, but sex-specific patterns in the urban-rural gradient remain poorly characterized. Sex-stratified analysis is needed to inform targeted prevention.
[Methods] We conducted an ecological study of 58,584 suicide deaths (40,286 men, 16,252 women) across all 1,890 municipalities in Japan during 2017-2019, using vital statistics data. The exposure was geographic rurality, measured by the Rurality Index for Japan (RIJ). Area deprivation, measured by the Area Deprivation Index (ADI), was included as a covariate. We fitted Bayesian spatial Poisson models with spatially structured random effects and estimated sex-stratified rate ratios (RRs) for the association between rurality and suicide mortality. The change in RR after ADI adjustment was used to quantify the extent to which area deprivation explained the rurality-suicide association.
[Results] In the overall (non-stratified) analysis, rurality was not associated with suicide mortality (adjusted RR 0.985, 95% credible interval [CrI] 0.965-1.006). In sex-stratified analyses, both men (RR 0.952, 95% CrI 0.925-0.979) and women (RR 0.767, 95% CrI 0.716-0.820) had higher suicide mortality in urban areas. The urban excess was larger in women; suicide risk in urban areas was approximately 1.3 times that in rural areas among women. Area deprivation explained about 20% of the urban excess risk in women. In men, deprivation acted as a suppressor: after ADI adjustment, the urban excess became more apparent.
[Conclusions] Sex-specific concentration of suicide risk in urban areas exists but is masked in non-stratified analysis. The urban excess is larger in women. To achieve SDG 3 (Good Health and Well-being), sex-responsive suicide prevention in urban settings is needed, with particular attention to economic instability, social isolation, and housing insecurity among women.
[Methods] We conducted an ecological study of 58,584 suicide deaths (40,286 men, 16,252 women) across all 1,890 municipalities in Japan during 2017-2019, using vital statistics data. The exposure was geographic rurality, measured by the Rurality Index for Japan (RIJ). Area deprivation, measured by the Area Deprivation Index (ADI), was included as a covariate. We fitted Bayesian spatial Poisson models with spatially structured random effects and estimated sex-stratified rate ratios (RRs) for the association between rurality and suicide mortality. The change in RR after ADI adjustment was used to quantify the extent to which area deprivation explained the rurality-suicide association.
[Results] In the overall (non-stratified) analysis, rurality was not associated with suicide mortality (adjusted RR 0.985, 95% credible interval [CrI] 0.965-1.006). In sex-stratified analyses, both men (RR 0.952, 95% CrI 0.925-0.979) and women (RR 0.767, 95% CrI 0.716-0.820) had higher suicide mortality in urban areas. The urban excess was larger in women; suicide risk in urban areas was approximately 1.3 times that in rural areas among women. Area deprivation explained about 20% of the urban excess risk in women. In men, deprivation acted as a suppressor: after ADI adjustment, the urban excess became more apparent.
[Conclusions] Sex-specific concentration of suicide risk in urban areas exists but is masked in non-stratified analysis. The urban excess is larger in women. To achieve SDG 3 (Good Health and Well-being), sex-responsive suicide prevention in urban settings is needed, with particular attention to economic instability, social isolation, and housing insecurity among women.
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