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Trends of Suicide Mortality and its Disproportion by Income Inequality: Results from Global Burden of Disease Study 2019
25 Pages Posted: 5 Oct 2022
More...Abstract
Background: Understanding how economic and social determinants impact suicide and monitoring the trends in suicide burden over time is necessary for the development and implementation of effective policy and practices that can address social inequalities and prevent suicide at a population level. We aimed to describe the global, regional, and national levels and trends in burden of suicide and to measure how suicide death rate is disproportionately distributed by country’s Gini coefficient or socio-demographic index (SDI).
Methods: In this ecological study, we extracted disaggregated 195 countries’ data of disease burden due to suicide from Global Burden of Diseases, Injuries, and Risk Factors study 2019 and Gini index from the Standardized World Income Inequality Database. We estimated annual average percentage change (AAPC) with joinpoint regression analysis from 1990–2019, and measured suicide disproportion across countries with different Gini coefficient or SDI.
Results: GBD 2019 estimated 759,028 (95% uncertainty interval, 95% UI 685,390 to 831,857) deaths globally from suicide in 2019, along with its 9.4 age-standardised death rate (ASDR) from suicide death per 100,000. In join point regression analysis, the global decreasing trend in ASDR of suicide was shown with its AAPC of -1.67% (-1.85% to -1.50%, p-value < 0.001). The similar trend of decreasing was also shown in other GBD regions. However, some join point periods among 21 GBD regions were not constant in decline of ASDR of suicide, rather, reversed to increase or slowed to decreasing trend within the period occurred economic crisis (High-income Asia Pacific 1995-1999 APC=4.72%, p-value<0.001; South Asia 1995-1999 APC=1.23%, p-value=0.228; High-income North America 2004-2013 APC=0.76%, p-value<0.001; Western Europe 2006-2010 APC=-0.57%, p-value=0.096). The suicide death rate was disproportionately concentrated among countries with higher Gini coefficient (greater income disparities) or with lower SDI. Inequality of suicide according to Gini coefficient increased from 1990 to 2019.
Interpretation: Burden of suicide has been reduced since 1990, but in certain period where economic crisis occurred it increased. Countries’ income inequality and SDI are related with suicide burden. Disproportion of suicide death rate in countries with higher Gini coefficient has been greater since 1990. Social integration through narrowing the income gap in the country could possibly contribute to reducing suicide mortality, and this scheme can be considered when establishing suicide prevention strategies.
Funding Information: None.
Declaration of Interests: All other authors declare no competing interests.
Ethics Approval Statement: This study was approved by the Institutional Review Board of Yonsei University Health System (IRB number: 4-2021-1488) and adhered to the tenets of the Declaration of Helsinki.
Keywords: Global Burden of Disease Study, Suicide, Gini coefficient, Socio-demographic Index, Health inequality measure
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