Abstract
BackgroundThe decreasing suicide rate in China has been regarded as a major contributor to the decline of global suicide rate in the past decade. However, previous estimations on China’s suicide rates might not be accurate, since often they were based on the data from the Ministry of Health’s Vital Registration (“MOH-VR”) System, which is biased towards the better-off population. This study aims to compare suicide data extracted from the MOH-VR System with a more representative mortality surveillance system, namely the Center for Disease Control and Prevention’s Disease Surveillance Points (“CDC-DSP”) System, and update China’s national and subnational suicide rates in the period of 2004–2014.MethodsThe CDC-DSP data are obtained from the National Cause-of-Death Surveillance Dataset (2004–2014) and the MOH-VR data are from the Chinese Health Statistics Yearbooks (2005–2012) and the China Health and Family Planning Statistics Yearbooks (2013–2015). First, a negative binomial regression model was used to test the associations between the source of data (CDC-DSP/MOH-VR) and suicide rates in 2004–2014. Joinpoint regression analyses and Kitagawa’s decomposition method are then applied to analyze the trends of the crude suicide rates.ResultsBoth systems indicated China’s suicide rates decreased over the study period. However, before the two systems merged in 2013, the CDC-DSP System reported significantly higher national suicide rates (IRR = 1.18, 95% Confidence Interval [CI]: 1.13–1.24) and rural suicide rates (IRR = 1.29, 95% CI: 1.21–1.38) than the MOH-VR System. The CDC-DSP System also showed significant reversing points in 2011 (95% CI: 2006–2012) and 2006 (95% CI: 2006–2008) on the rural and urban suicide trends. Moreover, the suicide rates in the east and central urban regions were reversed in 2011 and 2008.ConclusionsThe biased MOH-VR System underestimated China’s national and rural suicide rates. Although not widely appreciated in the field of suicide research, the CDC-DSP System provides more accurate estimations on China’s suicide rates and is recommended for future studies to monitor the reversing trends of suicide rates in China’s more developed areas.
Highlights
The decreasing suicide rate in China has been regarded as a major contributor to the decline of global suicide rate in the past decade
The results of the Negative Binomial Regression (Table 1) showed that with the same controlling time, age group and sex, the CDC-DSP System in general reports significantly higher suicide rates than the Ministry of Health’s Vital Registration (MOH-VR) System (IRR = 1.18, 95% Confidence intervals (CI): 1.13–1.24)
The interaction between residence and data source was significant, which indicates that the CDC-DSP System reports a significantly higher rural suicide rate than the MOH-VR System (IRR = 1.29, 95% Confidence Interval (95% CI): 1.21–1.38)
Summary
The decreasing suicide rate in China has been regarded as a major contributor to the decline of global suicide rate in the past decade. This study aims to compare suicide data extracted from the MOH-VR System with a more representative mortality surveillance system, namely the Center for Disease Control and Prevention’s Disease Surveillance Points (“CDC-DSP”) System, and update China’s national and subnational suicide rates in the period of 2004–2014. 15 years ago, suggested that the effect of the lack of representativeness of the MOH-VR System was not great when compared with the representative CDC-DSP System [8] Both these two systems have changed significantly since (details to be elaborated in the data part) and there is new evidence that areas with lower socioeconomic circumstances (“SEC”) are more likely to have higher suicide rates within both the rural and urban areas in China [19]. Suicide rates reported by the MOH-VR System are compared to those from the CDC-DSP System and their differences examined
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