Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985–1994

Abstract

We estimated risk of suicide in adults in New South Wales (NSW) by sex, country of birth and rural/urban residence, after adjusting for age; we also examined youth suicide (age 15–24 years). The study population was the entire population of NSW, Australia, aged ≥15 years during the period 1985–1994. Poisson regression was used to examine the relationship between predictor variables and the risk of suicide, with the focus on migrant status and area of residence. A significantly higher risk of suicide was found in male migrants from Northern Europe and Eastern Europe/former USSR, compared to Australian-born males; a significantly lower suicide risk occurred in males from Southern Europe, the Middle East and Asia. In female migrants, those from UK/Eire, Northern Europe, Eastern Europe/former USSR and New Zealand exhibited a significantly higher risk of suicide compared to Australian-born females. A significantly lower risk of suicide occurred in females from the Middle East. Male migrants overall were at significantly lower risk of suicide than the Australian-born, while female migrants overall had a significantly higher risk of suicide than Australian-born females. Among migrant males overall, the rural–urban suicide risk differential was significantly higher for those living in non-metropolitan areas (RR=1.9; 95% CI: 1.7–2.1). Suicide risk was significantly higher in non-metropolitan male immigrants from the UK/Eire (RR=1.4; 95% CI: 1.1–1.7), Southern Europe (RR=1.7; 95% CI: 1.2–2.4), Northern/Western Europe (1.5; 95% CI: 1.2–1.9), the Middle East (RR=3.8; 95% CI: 1.9–7.8), New Zealand (RR=1.4; 95% CI: 1.0–1.8) and `other' (RR=2.6; 95% CI: 1.9–3.5), when compared to their urban counterparts. There was no statistically significant difference in suicide risk between rural and urban Australian-born males. For female suicide, significantly lower risk was found in female immigrants living in non-metropolitan areas who were from Northern/Western Europe (RR=0.7; 95% CI: 0.4–0.96), as well as the Australian-born (RR=0.7; 95% CI: 0.6–0.8), when compared to their urban counterparts. The non-metropolitan/metropolitan relative risk for suicide in female migrants overall was not significantly different from one. Among male youth there was a significantly higher suicide risk in non-metropolitan areas, with a relative risk estimate of 1.4 for Australian-born youth (95% CI: 1.2–1.5) and 1.7 for migrant youth (95% CI: 1.2–2.4), when compared with metropolitan counterparts. We conclude that suicide among migrant males living in non-metropolitan areas accounts for most of the excess of male suicide in rural NSW, and the significantly lower risk of suicide for non-metropolitan Australian-born women does not apply to migrant women.