Abstract
PurposeThere are notable geographic variations in incidence rates of suicide both in Japan and globally. Previous studies have found that rurality/urbanity shapes intra-regional differences in suicide mortality, and suicide risk associated with rurality can vary significantly by gender and age. This study aimed to examine spatial patterning of and rural–urban differences in suicide mortality by gender and age group across 1887 municipalities in Japan between 2009 and 2017.MethodsSuicide data were obtained from suicide statistics of the Ministry of Health, Labour and Welfare in Japan. We estimated smoothed standardized mortality ratios for suicide for each of the municipalities and investigated associations with level of rurality/urbanity using Bayesian hierarchical models before and after adjusting for socioeconomic characteristics.ResultsThe results of the multivariate analyses showed that, for males aged 0–39 and 40–59 years, rural residents tended to have a higher suicide risk compared to urban ones. For males aged 60+ years, a distinct rural–urban gradient in suicide risk was not observed. For females aged 0–39 years, a significant association between suicide risk and rurality was not observed, while for females aged 40–59 years and females aged 60 years or above, the association was a U-shaped curve.ConclusionOur results showed that geographical distribution of and rural–urban differences in suicide mortality in Japan differed substantially by gender and age. These findings suggest that it is important to take demographic factors into consideration when municipalities allocate resources for suicide prevention.
Highlights
Suicide is a major public health issue in Japan
This study examined the geographical distribution of suicide risk by gender and age group across 1887 municipalities in Japan, using 2009–2017 mortality data
The most prominently clustered area of high suicide risk was the Tohoku region which is located in the northern part of the Honshu island
Summary
Suicide is a major public health issue in Japan. According to mortality data from vital statistics in Japan [1], the crude suicide rate in 2017 was 16.4 per 100,000 population (23.6 for males and 10.1 for females), making suicide the 9th leading cause of death in Japan. Within the same country, Detailed spatial analyses are considered to be useful for investigating the geographic pattern of suicide [3, 6]. A Bayesian hierarchical Poisson regression model can be used to address this problem of uncertainty in estimates in small-area analyses [7, 8], and has already been used successfully in previous studies on suicide [3,4,5, 9,10,11]. Findings from a study analyzing gender-/age-specific spatial patterning of suicide using data for small geographic units would make it possible to identify regions which warrant particular attention in terms of interventions for suicide prevention, and are important for policy makers and public health officers
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