Spatial patterning, correlates, and inequalities of suicide across 432 neighborhoods in Taipei City, Taiwan

• Main Authors: Chien-Yu Lin, 林倩宇
• Other Authors: 張書森
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/ux9534

碩士 === 國立臺灣大學 === 健康行為與社區科學研究所 === 106 === Introduction: More than half of the world’s population now lives in urban areas. Understanding the spatial distribution of suicide in these settings may inform prevention. Previous analyses of the spatial distribution of suicide in cities were mostly restricted to Western nations. We investigated the spatial patterns of suicide, and factors associated with it’s spatial distribution in Taipei City, Taiwan. Methods: We estimated smoothed standardized mortality ratios for overall suicide and suicide by sex/age group and method (hanging, charcoal burning, jumping, drowning and other methods) across 432 neighborhoods (‘Li’; mean population size: 5,500) in Taipei City, Taiwan (2004–2010) using Bayesian hierarchical models. A range of area-level characteristics including social fragmentation, socioeconomic deprivation, linking social capital, income inequality, and means accessibility indicators were investigated for their associations with neighborhood suicide rates. Results: Overall suicide rates were below average in the city center, whereas above average rates were found in some suburbs. Male suicides of different age groups showed similar geographic patterns, while the geographic distribution of female suicides differed across age groups. After adjusting for all other variables, only two area characteristics were found to be associated with area suicide rates: the proportion of divorced/separated adults (rate ratio [RR] per one standard deviation increase =1.08, 95% confidence interval 1.01-1.16), an indicator of social fragmentation; and median household income (RR=0.80, 95% CrI=0.73-0.86), an indicator of socioeconomic deprivation. Method-specific suicide rates showed similar spatial patterning to that of overall suicide with the only exception of jumping suicide rates, which showed no spatial patterning. In adjusted analyses, neighborhood suicide rates of different methods, except jumping, were associated with median household income (RR ranged 0.64-0.84). Charcoal-burning suicide rates were additionally associated with the proportions of divorced/separated adults (RR=1.12, 95% CrI=1.03-1.23), an indicator of social fragmentation, and single-person households (RR=1.14, 95% CrI=1.03-1.26), an indicator of ease with burning charcoal in the living units. Jumping suicide rates were only associated with the proportion of households living on sixth floor or above (RR= 1.18, 95% CrI=1.05-1.31), an indicator of access to high places. Drowning suicide rates were non-significantly associated with neighborhoods’ adjacency to rivers (RR=1.24, 95% CrI=0.90-1.67). There was a 1.8-fold difference in suicide rates between neighborhood quintiles with the lowest and the highest median household income, with middle-aged males showing the largest gradient (3.2-fold difference). Conclusions: In a densely populated city in Asia, the geography of suicide showed distinct patterns of spatial distribution and associations with socioeconomic and means accessibility factors compared to cities in Western nations. Findings have implications for identifying specific determinants and prevention strategies for suicide in cities.