Abstract
Studies about suicide worldwide have mainly focused on individual-level psychiatric risk factors. In Brazil, suicide is an important public health problem. Brazil has evidenced important socioeconomic changes over the last decades, leading to decreasing income inequality. However, the impact of income inequality on suicide rate has never been studied in the country.PurposeTo analyze whether income inequality and other social determinants are associated with suicide rate in Brazil.MethodThis study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed.ResultsThe Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011–1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948–0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010–1.021).ConclusionsIncome inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population’s socioeconomic conditions and reduce income inequality in Brazil, and in other low and middle-income countries, can help to reduce suicide rates.
Highlights
Suicide is one of the main causes of death in the world and is an important public health problem
The Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055
Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948–0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010–1.021)
Summary
Suicide is one of the main causes of death in the world and is an important public health problem. With a rate of 16 per 100,000 individuals worldwide, suicide is the cause of one million deaths per year. Brazil is among the top 10 countries in terms of deaths due to suicide [3]. It represents the 3th leading cause of death due to known external causes [4] and the trend shows that this rate has continued to increase in the country over the past years [5]. Individual risk factors alone do not explain regional variations in rates. Data suggest that the particularities of a region at a specific period of time result in higher or lower suicide rates
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