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Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors. J Psychiatr Res 2022; 154:233-241. [PMID: 35961179 DOI: 10.1016/j.jpsychires.2022.07.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82-23.47) for psychiatric illness of any type, 12.59 (8.29-19.12) for mood disorders, 3.91 (2.72-5.59) for unemployment, 3.18 (2.72-3.72) for being separated or divorced, 2.64 (2.26-3.10) for cancer, 2.50 (0.96-6.38) for central nervous system illness, and 2.26 (1.16-4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.
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de Oliveira Santos EG, Vedana KGG, Barbosa IR. Prevalence and factors associated with suicidal ideation among farmers. PLoS One 2022; 17:e0273625. [PMID: 36067161 PMCID: PMC9447890 DOI: 10.1371/journal.pone.0273625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
This study aimed to analyze the prevalence and factors associated with suicidal ideation among farmers. Cross-sectional study carried out between 2019 and 2020 with 450 farmers in Rio Grande do Norte. The prevalence of suicidal ideation was evaluated using the Beck Suicidal Ideation Inventory, and sociodemographic, health, income, work and alcohol abuse variables were analyzed. The Chi-square test was used to compare the proportions of the outcome between the categories of each variable. Poisson regression with robust variance was used to analyze associated factors and estimate prevalence ratios [PR]. The prevalence of suicidal ideation was 12.4% [95%CI 9.69-15.84] and, in the bivariate analysis, it was associated with sociodemographic, health, income and work variables. In the final multivariate model, the variables that remained significant and were associated with a higher prevalence of SI were: female gender [PR = 3.28], diagnosis of mental disorder in the family [PR = 2.37], presence of common mental disorder [PR = 2.50], alcohol abuse [PR = 2.22] and employment relationship-salaried or temporary [R = 1.91]. Thus, suicidal ideation among farmers is mainly associated with health aspects, especially mental health, work and the female sex, and signals the need to strengthen public policies for suicide prevention with the targeting of effective strategies for the farmers.
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Affiliation(s)
| | | | - Isabelle Ribeiro Barbosa
- Graduate Program in Public Health, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Saban M, Myers V, Luxenburg O, Wilf-Miron R. Tipping the scales: a theoretical model to describe the differential effects of the COVID-19 pandemic on mortality. Int J Equity Health 2021; 20:140. [PMID: 34134710 PMCID: PMC8206897 DOI: 10.1186/s12939-021-01470-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in changes in almost every aspect of life. The fatal consequences of the pandemic have been clearly reported, with direct and indirect effects; however, there is some evidence of a positive secondary impact, such as fewer motor accidents, lower influenza burden and reduced air pollution. METHODS/MODEL We present a model to describe the differing effects of the COVID-19 pandemic on mortality, taking into account external pressures and internal resources and their relationship with resilience and health behaviors, which affect mortality risk, inspired by elements of the salutogenic model. Individuals with lower resources and from more deprived communities are likely to be more negatively affected by the external changes occurring, while those with more resources may be more likely to experience the benefits. Both individual and community resources affect coping and influence both mental and physical health. CONCLUSIONS Decision makers should consider ways to incorporate the positive changes which occurred as part of the exit strategy. Societies should invest in building resources to improve both individual and community resilience to help people be better prepared and more able to cope and adapt in times of crisis. Special emphasis should be given to weaker populations most affected by external changes, including older people, low socioeconomic groups, those with mental health issues and minority groups, in order to reduce disparities.
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Affiliation(s)
- Mor Saban
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel.
| | - Vicki Myers
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Rachel Wilf-Miron
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Sackler, Israel
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Hassan WAN, Noaman MM, Khalifa H, Abdelrahman AA, Omar SM. A clinical study of suicide in patients admitted in psychiatry unit in Assiut University. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study was performed for clinical study of suicide including risk factors in psychiatric patients admitted in psychiatric unit of Assiut University Hospital (AUH).
Results
We found that frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. And frequency of suicidal attempts in patients with multiple previous attempts before this one was higher in patients with mood disorders (53.8%) than psychotic and substance-induced disorders (32.3%, 13.8% respectively), with statistically significant difference in patients with MDD as well as there was significant treatment outcome on suicidal behavior.
Conclusion
The frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. There was significant severity of suicidal behavior in patients with psychotic disorders in comparison to patients with substance-induced disorder or mood disorders.
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Kim M, Khang YH, Kang HY, Lim HK. Educational Inequalities in Self-Rated Health in Europe and South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124504. [PMID: 32585895 PMCID: PMC7344822 DOI: 10.3390/ijerph17124504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/06/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022]
Abstract
While numerous comparative works on the magnitude of health inequalities in Europe have been conducted, there is a paucity of research that encompasses non-European nations such as Asian countries. This study was conducted to compare Europe and Korea in terms of educational health inequalities, with poor self-rated health (SRH) as the outcome variable. The European Union Statistics on Income and Living Conditions and the Korea National Health and Nutrition Examination Survey in 2017 were used (31 countries). Adult men and women aged 20+ years were included (207,245 men and 238,007 women). The age-standardized, sex-specific prevalence of poor SRH by educational level was computed. The slope index of inequality (SII) and relative index of inequality (RII) were calculated. The prevalence of poor SRH was higher in Korea than in other countries for both low/middle- and highly educated individuals. Among highly educated Koreans, the proportion of less healthy women was higher than that of less healthy men. Korea’s SII was the highest for men (15.7%) and the ninth-highest for women (10.4%). In contrast, Korea’s RII was the third-lowest for men (3.27), and the lowest among women (1.98). This high-SII–low-RII mix seems to have been generated by the high level of baseline poor SRH.
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Affiliation(s)
- Minhye Kim
- Institute of Health Policy and Management, Seoul National University Medical Research Center, 103 Daehak-ro (Yeongeon-dong) Jongno-gu, Seoul 03080, Korea; (M.K.); (H.-K.L.)
- Ewha Institute for Age Integration Research, Ewha Womans University, SK Telecom building 504-1 ho, Ewhayeodae-gil 52, Seodaemun-gu, Seoul 03760, Korea
- Inequality and Social Policy Institute, Gacheon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, Gyeonggi-do 13120, Korea
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, 103 Daehak-ro (Yeongeon-dong) Jongno-gu, Seoul 03080, Korea; (M.K.); (H.-K.L.)
- Department of Health Policy and Management, College of Medicine, Seoul National University, 103 Daehak-ro (Yeongeon-dong) Jongno-gu, Seoul 03080, Korea;
- Correspondence:
| | - Hee-Yeon Kang
- Department of Health Policy and Management, College of Medicine, Seoul National University, 103 Daehak-ro (Yeongeon-dong) Jongno-gu, Seoul 03080, Korea;
| | - Hwa-Kyung Lim
- Institute of Health Policy and Management, Seoul National University Medical Research Center, 103 Daehak-ro (Yeongeon-dong) Jongno-gu, Seoul 03080, Korea; (M.K.); (H.-K.L.)
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Rasouli N, Malakouti SK, Rezaeian M, Saberi SM, Nojomi M, De Leo D, Ramezani-Farani A. Risk Factors of Suicide Death Based on Psychological Autopsy Method; a Case-Control Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e50. [PMID: 31602433 PMCID: PMC6785207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Investigation in each community can contribute to understanding the key factors involved in suicide death and its prevention. The present study aimed to investigate suicide death risk factors based on psychological autopsy method. METHODS The present case-control study was conducted from April to September 2017, in Tehran, Iran, to compare two groups of people; those who died by suicide and controls (over the age of 18 years). Data were collected by one interviewer via Structured Clinical Interviews (SCID-I), questionnaires used in the SUPREMISS study, and the Dickman impulsivity scale. RESULTS Each group consisted of 40 individuals. There was no significant difference between the case and control groups in terms of all demographic variables except for the level of education (p = 0.06) and occupational status (p = 0.009). The frequency of previous history of suicide attempt (p = 0.001), family history of suicide (p = 0.003), DSM IV Axis I disorders (p = 0.006), and substance and alcohol consumption (p = 0.01) were significantly higher in the case group. The most commonly diagnosed disorders included MDD (45%) and substance use disorders (30%), respectively. The most common methods used in suicide included hanging (32.5%), and Aluminum phosphide poisoning (32.5%) known as rice tablet. The strongest predictor of suicide death was the deceased person's Previous history of suicide attempt (OR= 9.3; p = 0.04), smoking (OR= 6.4; p = 0.006), unemployment (OR= 5; p = 0.02), and DSM IV axis I disorders (OR= 3.8; p = 0.04). CONCLUSION Previous suicide attempt, smoking, unemployment, and suffering from at least one mental disorder were the significant predictors of suicide death. Among mental disorders, major depressive disorder and substance use disorder were the most prevalent mental health problems.
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Affiliation(s)
- Nafee Rasouli
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Kazem Malakouti
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Rezaeian
- Epidemiology and Biostatistics Department, Rafsanjan Medical School, Occupational Environmental Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Seyed Mehdi Saberi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia
| | - Abbas Ramezani-Farani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.,Corresponding author: Abbas Ramezani-Farani; Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran. , Tel: 00989194543139
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López-Contreras N, Rodríguez-Sanz M, Novoa A, Borrell C, Medallo Muñiz J, Gotsens M. Socioeconomic inequalities in suicide mortality in Barcelona during the economic crisis (2006-2016): a time trend study. BMJ Open 2019; 9:e028267. [PMID: 31455702 PMCID: PMC6719772 DOI: 10.1136/bmjopen-2018-028267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aimed to analyse trends in socioeconomic inequalities in suicide mortality in Barcelona before and after the start of the economic crisis that started at the end of 2008, including both individual factors and contextual factors of the deceased's neighbourhood of residence. DESIGN This is a trend study of three time periods: pre-economic crisis (2006-2008), early crisis (2009-2012) and late crisis (2013-2016). SETTING Total Barcelona residents between 2006 and 2016 (≥25 years of age) and death data derived from the Judicial Mortality Registry of Barcelona. PARTICIPANTS 996 deaths by suicide between 2006 and 2016 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES The outcomes were age-standardised suicide mortality rates and the associations (relative and absolute risk) between suicide mortality and individual and contextual characteristics for the three time periods. RESULTS From 2006 to 2008, men with a lower educational level were more likely to commit suicide than better educated men (relative risk (RR)=1.46; 95% CI 1.11 to 1.91). This difference disappeared after the onset of the crisis. We found no differences among women. From 2013 to 2016, suicide risk increased among men living in neighbourhoods with higher unemployment levels (RR=1.57; 95% CI 1.09 to 2.25) and among women living in neighbourhoods with a higher proportion of elderly people living alone (RR=2.13; 95% CI 1.15 to 3.93). CONCLUSIONS We observed risks for suicide among men living in neighbourhoods of Barcelona with higher unemployment levels and among women living in neighbourhoods with a higher proportion of elderly people living alone. Inequalities in suicide mortality according to educational level tended to disappear during the crisis among men. Thus, it is important to continue to monitor suicide determinants especially in times of economic crisis.
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Affiliation(s)
- Natalia López-Contreras
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Àrea de Recerca, Docència i Comunicació, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Ana Novoa
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
- Gerència, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jordi Medallo Muñiz
- Clinical Service, Catalonian Institute of Legal Medicine and Forensic Science, Barcelona, Spain
| | - Mercè Gotsens
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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8
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Alarcão AC, Dell' Agnolo CM, Vissoci JR, Carvalho ECA, Staton CA, de Andrade L, Fontes KB, Pelloso SM, Nievola JC, Carvalho MD. Suicide mortality among youth in southern Brazil: a spatiotemporal evaluation of socioeconomic vulnerability. BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 42:46-53. [PMID: 31433002 PMCID: PMC6986484 DOI: 10.1590/1516-4446-2018-0352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
Objective: To conduct a geospatial analysis of suicide deaths among young people in the state of Paraná, southern Brazil, and evaluate their association with socioeconomic and spatial determinants. Methods: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Data on suicide mortality rates (SMR) were extracted for three age groups (15-19, 20-24, and 25-29 years) from two 5-year periods (1998-2002 and 2008-2012). Geospatial data were analyzed through exploratory spatial data analysis. We applied Bayesian networks algorithms to explore the network structure of the socioeconomic predictors of SMR. Results: We observed spatial dependency in SMR in both periods, revealing geospatial clusters of high SMR. Our results show that socioeconomic deprivation at the municipality level was an important determinant of suicide in the youth population in Paraná, and significantly influenced the formation of high-risk SMR clusters. Conclusion: While youth suicide is multifactorial, there are predictable geospatial and sociodemographic factors associated with high SMR among municipalities in Paraná. Suicide among youth aged 15-29 occurs in geographic clusters which are associated with socioeconomic deprivation. Rural settings with poor infrastructure and development also correlate with increased SMR clusters.
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Affiliation(s)
- Ana C Alarcão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | | | - João R Vissoci
- Departamento de Medicina, UEM, Maringá, PR, Brazil.,Global Neurosurgery and Neuroscience Division, Duke Global Health Institute, Duke University, Durham, North California, USA
| | - Elias C A Carvalho
- Núcleo de Processamento de Dados (NPD), UEM, Maringá, PR, Brazil.,Descoberta de Conhecimento e Aprendizagem de Máquina (DCAM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil.,Programa de Pós-Graduação em Informática (PPGIa), PUCPR, Curitiba, PR, Brazil
| | - Catherine A Staton
- Department of Surgery, Duke Global Health Institute, Duke University, Durham, North California, USA
| | - Luciano de Andrade
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil.,Departamento de Medicina, UEM, Maringá, PR, Brazil
| | - Kátia B Fontes
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | - Sandra M Pelloso
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | - Júlio C Nievola
- Programa de Pós-Graduação em Informática (PPGIa), PUCPR, Curitiba, PR, Brazil
| | - Maria D Carvalho
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
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Age, period, cohort trends of suicide in Japan and Korea (1986-2015): A tale of two countries. Soc Sci Med 2019; 235:112385. [PMID: 31276968 DOI: 10.1016/j.socscimed.2019.112385] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/16/2019] [Accepted: 06/24/2019] [Indexed: 02/04/2023]
Abstract
Japan and South Korea have among the highest suicide rates in the world. However, the age, gender, and time trends in each country differ substantially. Age-Period-Cohort (APC) analysis of suicide rates was conducted to better understand these differences. Using age- and gender-specific data on suicide between 1986 and 2015 in Japan and Korea, we implemented APC analysis to decompose the country-specific trends into age, calendar period, and birth cohort effects. APC analysis revealed three trends: (1) there was a sharp increase in suicide around retirement age in Korea but not in Japan (age effect); (2) there was a dramatic increase in suicide during the three decades of observation in Korea (period effect) whereas rates were more stable in Japan; and (3) the post-War generation in Japan (including baby boomer) had lower rates of suicide compared to generations born before 1916 or after 1961 (birth cohort effect), whereas suicide rate has increased linearly in each generation in Korea. Although Japan & Korea share high suicide rates, our APC analysis suggests divergent causes underlying these trends. Japanese suicide rates plateaued among the cohorts who experienced the post-War rapid economic growth (women born in 1951-1956 and men born in 1916-1961) (birth cohort effect) due to a strong social safety net for this cohort, while suicide rates in Korea continue to rise with each generation and is particularly elevated in post-retirement age. Japan and Korea need to pay more attention to suicide prevention in more recent birth cohorts.
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10
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Park SK, Lee CK, Kim H. Suicide mortality and marital status for specific ages, genders, and education levels in South Korea: Using a virtually individualized dataset from national aggregate data. J Affect Disord 2018; 237:87-93. [PMID: 29803100 DOI: 10.1016/j.jad.2018.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 02/20/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies in Eastern as well as Western countries have shown a relationship between marital status and suicide mortality. However, to date, no Korean study has calculated national suicide rates by marital status for specific genders, ages, and education levels. This study investigated whether the relationship between marital status and suicide differs by age, gender, and educational attainment, and analyzed the effect of marital status on suicide risk after controlling for these socio-demographic variables. METHODS Using national mortality data from 2015, and aggregated census data from 2010 in South Korea, we created a virtually individualized dataset with multiple weighting algorithms, including individual socio-demographic characteristics and suicide rates across the entire population. RESULTS The findings show that the following groups faced the highest relative suicide risks: 1) divorced men of all ages and men aged more than 75 years, particularly divorced men aged more than 75; and 2) never-married men aged 55-64 years, and never-married women of lower education status. LIMITATIONS We did not account for important variables such as mental health, substance abuse, employment insecurity, social integration, perceived loneness, and family income which we were unable to access. CONCLUSIONS This current research extends prior theoretical and methodological work on suicide, aiding efforts to reduce suicide mortality in South Korea.
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Affiliation(s)
- Soo Kyung Park
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Chung Kwon Lee
- Department of Social Welfare, Inha University, Incheon, Republic of Korea.
| | - Haeryun Kim
- Department of Social Welfare, Seoul Women's University, Seoul, Republic of Korea
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11
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Ki M, Seong Sohn E, An B, Lim J. Differentiation of direct and indirect socioeconomic effects on suicide attempts in South Korea. Medicine (Baltimore) 2017; 96:e9331. [PMID: 29390510 PMCID: PMC5758212 DOI: 10.1097/md.0000000000009331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the wide recognition of the inverse association between socioeconomic position (SEP) and suicidal behaviors, its underlying process and potential mediators are little known. This study investigated the pathway from SEP to suicide attempts with attention to potential mediators.From the Korean Health and Nutrition Examination Survey 2007-2013, which is a nationwide cross-sectional survey of the health and nutritional status, a total of 34,565 participants (≥30 years) were included in the analysis. To unfold the pathways linking SEP to suicide attempts, the direct and indirect effects of 3 SEP measures (educational attainment, household income, and occupational group) and 3 mediators (physical illness, mental health problems, and problematic drinking) were differentiated using structured equation model (SEM).Most of direct and indirect effects of educational attainment, household income, and occupational group on suicide attempts were significant; Nonemployment status had the largest total (β = 0.291, P < .01) and direct effects (β = 0.212, P < .01), while educational attainment had the largest indirect effect (β = -0.124, P < .01). Educational attainment was mainly mediated by physical illness and problem drinking, whereas household income and occupational group were mainly mediated by anxious or depressed mood and problem drinking. Physical illness played a major role in explaining suicide attempts, compared to mental health problem and problem drinking.Overall, experience of socioeconomic disadvantage increased suicide attempts independently of mental and physical problems. An extension of suicide prevention program is required for comprehensively targeting people with general problems such as physical illness and low SEP, complemented to narrowly targeting high risk group with, such as mental health problem.
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Affiliation(s)
- Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | | | - Byungduck An
- Department of Psychology and Philosophy, PaiChai University
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
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12
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Bahk J, Lynch JW, Khang YH. Forty years of economic growth and plummeting mortality: the mortality experience of the poorly educated in South Korea. J Epidemiol Community Health 2016; 71:282-288. [PMID: 27707841 DOI: 10.1136/jech-2016-207707] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/06/2016] [Accepted: 09/17/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND South Korea has experienced rapid economic development and a substantial increase in life expectancy in an extremely short period. Whether this rapid development has been able to adequately address inequalities in health in South Korea may have important policy implications. This paper explores long-term trends in inequalities in mortality related to education in South Korea between 1970 and 2010. METHODS We used secondary data on population size and deaths in 1970 and 1980 from a previously published study, and census and death certificate data from Statistics Korea from 1990, 1995, 2000, 2005 and 2010. Trends in age-standardised mortality rates for men and women aged 25-64 according to education, as well as the rate ratio (RR), rate difference (RD), relative index of inequality (RII) and slope index of inequality (SII), were examined over the period 1970-2010. RESULTS Despite overall mortality declines of 70-80% in the past 4 decades, educational inequalities have increased or been stagnant. There was minimal decline in mortality since 1970 in South Koreans with only a primary or lower level of education. The RR and RD between tertiary education and primary or lower education increased over the study period, while the RII and the SII in both genders remained stable. CONCLUSIONS The South Korean experience over the past 40 years suggests that plummeting mortality rates and huge advances in education at the population level do not translate into reduced educational inequalities in mortality.
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Affiliation(s)
- Jinwook Bahk
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
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Associations between marital and educational status and risk of completed suicide in Hungary. J Affect Disord 2016; 190:777-783. [PMID: 26625089 DOI: 10.1016/j.jad.2015.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/13/2015] [Accepted: 11/09/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suicide rates in Hungary are notoriously high. According to the literature, marital and educational status are associated with suicidal behaviour and these associations are somewhat influenced by gender. Since in Hungary these associations have not yet been investigated by means of large-scale multivariate epidemiological studies we aimed to investigate these in the current paper. METHOD Census data on marital and educational status, age and gender from 1980, 1990, 2001 and 2011 were used for the general population. Corresponding data from the same years for suicide victims derived from the Hungarian Demographic Register. Suicide victims younger than 20 years were excluded. Negative binomial regression analyses were used to reveal the effects of the above variables on suicide. All statistical procedures were conducted using Stata 12 software (StataCorp. 2011). RESULTS Female gender, young age, higher educational attainment and marriage were significantly associated with decreased risks of suicide. Intriguingly, effects of educational and marital status on suicide were stronger in males. LIMITATIONS Data on the length of the periods between changes in marital status and suicides were unavailable. Our four categories are not suitable to cover the whole gamut of marital statuses in a modern society (e.g. we did not have a specific category for people living in cohabitation). Ecological study design. CONCLUSION We found that in Hungary between 1980 and 2011 the effects of some frequently investigated societal factors (e.g. educational and marital status) on suicide risk were very similar to those found in the majority of other countries. The effects of studied determinants of suicide have not changed dramatically over the past three decades in Hungary.
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Yoon TH, Noh M, Han J, Jung-Choi K, Khang YH. Deprivation and suicide mortality across 424 neighborhoods in Seoul, South Korea: a Bayesian spatial analysis. Int J Public Health 2015; 60:969-76. [PMID: 26022192 DOI: 10.1007/s00038-015-0694-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES A neighborhood-level analysis of mortality from suicide would be informative in developing targeted approaches to reducing suicide. This study aims to examine the association of community characteristics with suicide in the 424 neighborhoods of Seoul, South Korea. METHODS Neighborhood-level mortality and population data (2005-2011) were obtained to calculate age-standardized suicide rates. Eight community characteristics and their associated deprivation index were employed as determinants of suicide rates. The Bayesian hierarchical model with mixed effects for neighborhoods was used to fit age-standardized suicide rates and other covariates with consideration of spatial correlations. RESULTS Suicide rates for 424 neighborhoods were between 7.32 and 71.09 per 100,000. Ninety-nine percent of 424 neighborhoods recorded greater suicide rates than the Organization for Economic Cooperation and Development member countries' average. A stepwise relationship between area deprivation and suicide was found. Neighborhood-level indicators for lack of social support (residents living alone and the divorced or separated) and socioeconomic disadvantages (low educational attainment) were positively associated with suicide mortality after controlling for other covariates. CONCLUSIONS Finding from this study could be used to identify priority areas and to develop community-based programs for preventing suicide in Seoul, South Korea.
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Affiliation(s)
- Tae-Ho Yoon
- Department of Preventive and Occupational Medicine, Pusan National University School of Medicine, Yangsan, South Korea
| | - Maengseok Noh
- Department of Statistics, Pukyung National University, Busan, South Korea
| | - Junhee Han
- Research and Statistical Support Unit, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea. .,Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
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15
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Glonti K, Gordeev VS, Goryakin Y, Reeves A, Stuckler D, McKee M, Roberts B. A systematic review on health resilience to economic crises. PLoS One 2015; 10:e0123117. [PMID: 25905629 PMCID: PMC4408106 DOI: 10.1371/journal.pone.0123117] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/18/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The health effects of recent economic crises differ markedly by population group. The objective of this systematic review is to examine evidence from longitudinal studies on factors influencing resilience for any health outcome or health behaviour among the general population living in countries exposed to financial crises. METHODS We systematically reviewed studies from six electronic databases (EMBASE, Global Health, MEDLINE, PsycINFO, Scopus, Web of Science) which used quantitative longitudinal study designs and included: (i) exposure to an economic crisis; (ii) changes in health outcomes/behaviours over time; (iii) statistical tests of associations of health risk and/or protective factors with health outcomes/behaviours. The quality of the selected studies was appraised using the Quality Assessment Tool for Quantitative Studies. PRISMA reporting guidelines were followed. RESULTS From 14,584 retrieved records, 22 studies met the eligibility criteria. These studies were conducted across 10 countries in Asia, Europe and North America over the past two decades. Ten socio-demographic factors that increased or protected against health risk were identified: gender, age, education, marital status, household size, employment/occupation, income/ financial constraints, personal beliefs, health status, area of residence, and social relations. These studies addressed physical health, mortality, suicide and suicide attempts, mental health, and health behaviours. Women's mental health appeared more susceptible to crises than men's. Lower income levels were associated with greater increases in cardiovascular disease, mortality and worse mental health. Employment status was associated with changes in mental health. Associations with age, marital status, and education were less consistent, although higher education was associated with healthier behaviours. CONCLUSIONS Despite widespread rhetoric about the importance of resilience, there was a dearth of studies which operationalised resilience factors. Future conceptual and empirical research is needed to develop the epidemiology of resilience.
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Affiliation(s)
- Ketevan Glonti
- ECOHOST—The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vladimir S. Gordeev
- ECOHOST—The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yevgeniy Goryakin
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Aaron Reeves
- Department of Sociology, Oxford University, Oxford, United Kingdom
| | - David Stuckler
- ECOHOST—The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Sociology, Oxford University, Oxford, United Kingdom
| | - Martin McKee
- ECOHOST—The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bayard Roberts
- ECOHOST—The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Lim D, Kong KA, Lee HA, Lee WK, Park SH, Baik SJ, Park H, Jung-Choi K. The population attributable fraction of low education for mortality in South Korea with improvement in educational attainment and no improvement in mortality inequalities. BMC Public Health 2015; 15:313. [PMID: 25880221 PMCID: PMC4425894 DOI: 10.1186/s12889-015-1665-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 03/19/2015] [Indexed: 11/13/2022] Open
Abstract
Background The educational attainment of Koreans has greatly increased, which was expected to reduce the magnitude of the population attributable fraction (PAF) of mortality associated with low education levels. However, increase in the relative risk (RR) of mortality among those with lower educational levels actually increased the PAF. The purpose of this study was to examine the change in the PAF of lower educational levels for mortality in Korea, where educational attainment has improved and is associated with the exacerbation of inequalities in mortality levels. Methods National census data were used to derive educational levels. The mortality-associated RR of lower educational levels was calculated by reference to national census and death certificate data from 1995, 2000, 2005, and 2010. PAFs were calculated for all-cause mortality, malignant neoplasms, cerebrovascular disease, heart disease, and suicide by gender and age group (30–44 and 45–59 years). Results The PAF of low educational level in terms of total mortality has decreased since 1995 in both genders. This trend was more prominent among those aged 30–44 years. However, the PAFs of suicide in younger females (30–44 years) and of cerebrovascular disease in older males (45–59 years) have increased. The RRs of all-cause mortality and those of the four leading causes of death in those with the lowest educational levels have increased, especially in females aged 30–44 years. Conclusions The consistent and sharp increase in the attainment of education has contributed to the reduction in the PAFs of lower education for mortality, despite the fact that mortality inequalities have not improved. Efforts to reduce health inequalities must promote healthy public policy and address public health policies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1665-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dohee Lim
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Kyoung Ae Kong
- Clinical Trial Center, Ewha Womans University Medical Center, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Hye Ah Lee
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Won Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, South Korea.
| | - Su Hyun Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Sun Jung Baik
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
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17
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Glonti K, Gordeev VS, Goryakin Y, Reeves A, Stuckler D, McKee M, Roberts B. A systematic review on health resilience to economic crises. PLoS One 2015. [PMID: 25905629 DOI: 10.1371/jornal.pone.0123117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The health effects of recent economic crises differ markedly by population group. The objective of this systematic review is to examine evidence from longitudinal studies on factors influencing resilience for any health outcome or health behaviour among the general population living in countries exposed to financial crises. METHODS We systematically reviewed studies from six electronic databases (EMBASE, Global Health, MEDLINE, PsycINFO, Scopus, Web of Science) which used quantitative longitudinal study designs and included: (i) exposure to an economic crisis; (ii) changes in health outcomes/behaviours over time; (iii) statistical tests of associations of health risk and/or protective factors with health outcomes/behaviours. The quality of the selected studies was appraised using the Quality Assessment Tool for Quantitative Studies. PRISMA reporting guidelines were followed. RESULTS From 14,584 retrieved records, 22 studies met the eligibility criteria. These studies were conducted across 10 countries in Asia, Europe and North America over the past two decades. Ten socio-demographic factors that increased or protected against health risk were identified: gender, age, education, marital status, household size, employment/occupation, income/ financial constraints, personal beliefs, health status, area of residence, and social relations. These studies addressed physical health, mortality, suicide and suicide attempts, mental health, and health behaviours. Women's mental health appeared more susceptible to crises than men's. Lower income levels were associated with greater increases in cardiovascular disease, mortality and worse mental health. Employment status was associated with changes in mental health. Associations with age, marital status, and education were less consistent, although higher education was associated with healthier behaviours. CONCLUSIONS Despite widespread rhetoric about the importance of resilience, there was a dearth of studies which operationalised resilience factors. Future conceptual and empirical research is needed to develop the epidemiology of resilience.
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Affiliation(s)
- Ketevan Glonti
- ECOHOST-The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vladimir S Gordeev
- ECOHOST-The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yevgeniy Goryakin
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Aaron Reeves
- Department of Sociology, Oxford University, Oxford, United Kingdom
| | - David Stuckler
- ECOHOST-The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Sociology, Oxford University, Oxford, United Kingdom
| | - Martin McKee
- ECOHOST-The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bayard Roberts
- ECOHOST-The Centre of Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
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18
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Clouston SAP, Rubin MS, Colen CG, Link BG. Social inequalities in suicide: the role of selective serotonin reuptake inhibitors. Am J Epidemiol 2014; 180:696-704. [PMID: 25167863 DOI: 10.1093/aje/kwu191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We aimed to examine the relationship between socioeconomic status (SES) and suicide associated with the introduction and diffusion of selective serotonin reuptake inhibitors (SSRIs). Negative binomial regression was used to estimate county-level suicide rates among persons aged 25 years or older using death certificate data collated by the National Center for Health Statistics from 1968 to 2009; SES was measured using the decennial US Census. The National Health and Nutrition Examination Survey and the Medical Expenditure Panel Survey were used to measure SSRI use. Once SSRIs became available in 1988, a 1% increase in SSRI usage was associated with a 0.5% lower suicide rate. Prior to the introduction of SSRIs, SES was not related to suicide. However, with each 1% increase in SSRI use, a 1-standard deviation (SD) higher SES was associated with a 0.6% lower suicide rate. In 2009, persons living in counties with SES 1 SD above the national average were 13.6% less likely to commit suicide than those living in counties with SES 1 SD below the national average--a difference of 1.9/100,000 adults aged ≥25 years. Higher SSRI use was associated with lower suicide rates among US residents aged ≥25 years; however, SES inequalities modified the association between SSRI use and suicide.
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19
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Min JW. Trends in income-related health inequalities in self-assessed health in Korea, 1998-2011. Glob Public Health 2014; 9:1053-66. [PMID: 25096263 DOI: 10.1080/17441692.2014.931448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46-59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46-59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.
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Affiliation(s)
- Jong Won Min
- a School of Social Work , San Diego State University , San Diego , CA , USA
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20
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Jung-Choi K, Khang YH, Cho HJ, Yun SC. Decomposition of educational differences in life expectancy by age and causes of death among South Korean adults. BMC Public Health 2014; 14:560. [PMID: 24897953 PMCID: PMC4061106 DOI: 10.1186/1471-2458-14-560] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/27/2014] [Indexed: 11/17/2022] Open
Abstract
Background Decomposition of socioeconomic inequalities in life expectancy by ages and causes allow us to better understand the nature of socioeconomic mortality inequalities and to suggest priority areas for policy and intervention. This study aimed to quantify age- and cause-specific contributions to socioeconomic differences in life expectancy at age 25 by educational level among South Korean adult men and women. Methods We used National Death Registration records in 2005 (129,940 men and 106,188 women) and national census data in 2005 (15, 215, 523 men and 16,077,137 women aged 25 and over). Educational attainment as the indicator of socioeconomic position was categorized into elementary school graduation or less, middle or high school graduation, and college graduation or higher. Differences in life expectancy at age 25 by educational level were estimated by age- and cause-specific mortality differences using Arriaga’s decomposition method. Results Differences in life expectancy at age 25 between college or higher education and elementary or less education were 16.23 years in men and 7.69 years in women. Young adult groups aged 35–49 in men and aged 25–39 in women contributed substantially to the differences between college or higher education and elementary or less education in life expectancy. Suicide and liver disease were the most important causes of death contributing to the differences in life expectancy in young adult groups. For older age groups, cerebrovascular disease and lung cancer were important to explain educational differential in life expectancy at 25–29 between college or higher education and middle or higher education. Conclusions The contribution of the causes of death to socioeconomic inequality in life expectancy at age 25 in South Korea varied by age groups and differed by educational comparisons. The age specific contributions for different causes of death to life expectancy inequalities by educational attainment should be taken into account in establishing effective policy strategies to reduce socioeconomic inequalities in life expectancy.
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Affiliation(s)
| | | | | | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea.
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21
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Lee J, Lee WY, Noh M, Khang YH. Does a geographical context of deprivation affect differences in injury mortality? A multilevel analysis in South Korean adults residing in metropolitan cities. J Epidemiol Community Health 2014; 68:457-65. [PMID: 24550434 DOI: 10.1136/jech-2013-203082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to examine whether the socioeconomic context of urban areas affects differences in adult mortality from injuries in the districts of all seven South Korean metropolitan cities, after adjusting for individual demographic and socioeconomic indicators. METHODS Two different sets of data were used in this study: (1) the National Death Registration data from 2003 to 2008; and (2) the National Census in 2005. Variables for individual characteristics were gender, age, residential area and educational level. A geographic deprivation index was calculated based on the Carstairs Index. Multilevel Poisson regression models were used to analyse the relationship between area deprivation levels and injury mortality. RESULTS Greater mortality risks of traffic accidents, falls, suicide and all injuries were found in the elderly, the less educated and men, compared with their counterparts. The most deprived districts were at greater risks of death due to traffic accidents (risk ratio (RR)=1.34; 95% CI 1.05 to 1.73), falls (RR=1.63; 95% CI 1.20 to 2.20), suicide (RR=1.09; 95% CI 1.01 to 1.17) and all injuries (RR=1.14; 95% CI 1.07 to 1.22) compared with the least deprived districts, even after individual level socioeconomic variables were controlled for. However, area level deprivation did not show cross level interactions with the individual level education in estimating fatal injury risks. CONCLUSIONS Both contextual and compositional effects of socioeconomic status on injury mortality among urban areas in South Korea should be considered in allocating resources for injury prevention.
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Affiliation(s)
- JeSuk Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, , Seoul, Korea
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Jung-Choi K, Kim YM. Socioeconomic inequalities in health status in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.3.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, Dona-A University College of Medicine, Pusan, Korea
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Khang YH, Lee SI. Health inequalities policy in Korea: current status and future challenges. J Korean Med Sci 2012; 27 Suppl:S33-40. [PMID: 22661869 PMCID: PMC3360172 DOI: 10.3346/jkms.2012.27.s.s33] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 10/16/2011] [Indexed: 11/20/2022] Open
Abstract
In recent years, health inequalities have become an important public health concern and the subject of both research and policy attention in Korea. Government reports, as well as many epidemiological studies, have provided evidence that a wide range of health outcomes and health-related behaviors are socioeconomically patterned, and that the magnitude of health inequalities is even increasing. However, except for the revised Health Plan 2010 targets for health equity, few government policies have explicitly addressed health inequalities. Although a number of economic and social policies may have had an impact on health inequalities, such impact has scarcely been evaluated. In this review, we describe the current status of research and policy on health inequalities in Korea. We also suggest future challenges of approaches and policies to reduce health inequalities and highlight the active and intensive engagement of many policy sectors and good evidence for interventions that will make meaningful reduction of health inequalities possible.
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Affiliation(s)
- Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
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Jung-Choi K, Khang YH, Cho HJ. Changes in contribution of causes of death to socioeconomic mortality inequalities in Korean adults. J Prev Med Public Health 2012; 44:249-59. [PMID: 22143175 PMCID: PMC3249264 DOI: 10.3961/jpmph.2011.44.6.249] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives This study aimed to analyze long-term trends in the contribution of each cause of death to socioeconomic inequalities in all-cause mortality among Korean adults. Methods Data were collected from death certificates between 1990 and 2004 and from censuses in 1990, 1995, and 2000. Age-standardized death rates by gender were produced according to education as the socioeconomic position indicator, and the slope index of inequality was calculated to evaluate the contribution of each cause of death to socioeconomic inequalities in all-cause mortality. Results Among adults aged 25-44, accidental injuries with transport accidents, suicide, liver disease and cerebrovascular disease made relatively large contributions to socioeconomic inequalities in all-cause mortality, while, among adults aged 45-64, liver disease, cerebrovascular disease, transport accidents, liver cancer, and lung cancer did so. Ischemic heart disease, a very important contributor to socioeconomic mortality inequality in North America and Western Europe, showed a very low contribution (less than 3%) in both genders of Koreans. Conclusions Considering the contributions of different causes of death to absolute mortality inequalities, establishing effective strategies to reduce socioeconomic inequalities in mortality is warranted.
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Affiliation(s)
- Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
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