Urban-rural inequalities in suicide among elderly people in China: a systematic review and meta-analysis

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Abstract

Background

China has an unusual pattern of suicides, with overall suicide rates in rural areas higher than urban areas. While suicide rates have decreased dramatically, older people increasingly contribute to the overall burden of suicide. However, it is unclear if elderly people within rural areas experience greater suicide risk than those in urban areas. We aimed to systematically review the incidence of suicide in rural and urban China among the elderly (aged over 60 years), with a view to describing the difference in rates between rural and urban areas and trends over time.

Methods

Chinese and English language articles were searched for using four databases: EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (EBSCOhost) and CNKI (in Chinese). Articles describing completed suicide among elderly people in both rural and urban areas in mainland China were included. The adapted Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. One reviewer (ML) assessed eligibility, performed data extraction and assessed risk of bias, with areas of uncertainty discussed with the second reviewer (SVK). Random effects meta-analysis was conducted. Suicide methods in different areas were narratively summarised.

Results

Out of a total 3065 hits, 24 articles were included and seven contributed data to meta-analysis. The sample size of included studies ranged from 895 to 323.8 million. The suicide rate in the general population of China has decreased in recent decades over previous urban and rural areas. Suicide rates amongst the elderly in rural areas are higher than those in urban areas (OR = 3.35; 95% CI of 2.48 to 4.51; I ² = 99.6%), but the latter have increased in recent years. Insecticide poisoning and hanging are the most common suicide methods in rural and urban areas respectively. Suicide rates for these two methods increase with age, being especially high in elderly people.

Conclusions

The pattern of suicide in China has changed in recent years following urbanisation and aging. Differences in suicide rates amongst the elderly exist between rural and urban areas. Addressing the high suicide rate amongst the elderly in rural China requires a policy response, such as considering measures to restrict access to poisons.

Electronic supplementary material

The online version of this article (10.1186/s12939-018-0881-2) contains supplementary material, which is available to authorized users.

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Most cited references 44

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Suicide rates in China, 1995-99.

Michael R Phillips, Xianyun Li, Yanping Zhang (2002)

A wide range of suicide rates are reported for China because official mortality data are based on an unrepresentative sample and because different reports adjust crude rates in different ways. We aimed to present an accurate picture of the current pattern of suicide in China on the basis of conservative estimates of suicide rates in different population cohorts. Suicide rates by sex, 5-year age-group, and region (urban or rural) reported in mortality data for 1995-99 provided by the Chinese Ministry of Health were adjusted according to an estimated rate of unreported deaths and projected to the corresponding population. We estimated a mean annual suicide rate of 23 per 100,000 and a total of 287,000 suicide deaths per year. Suicide accounted for 3(.)6% of all deaths in China and was the fifth most important cause of death. Among young adults 15-34 years of age, suicide was the leading cause of death, accounting for 19% of all deaths. The rate in women was 25% higher than in men, mainly because of the large number of suicides in young rural women. Rural rates were three times higher than urban rates-a difference that remained true for both sexes, for all age-groups, and over time. Suicide is a major public-health problem for China that is only gradually being recognised. The unique pattern of suicides in China is widely acknowledged, so controversy about the overall suicide rate should not delay the development and testing of China-specific suicide-prevention programmes.

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Suicide rates in China from 2002 to 2011: an update.

Chong-Wen Wang, Cecilia L. W. Chan, Paul S. F. Yip (2014)

The aims of this study were: (1) to present the time trend of suicide rate among people aged 15 or above in China over the period 2002-2011 and (2) to examine the current profile of completed suicides during 2009-2011. Data on suicide rate in 2002-2011 were provided by the Chinese Ministry of Health (MOH). The trends of region-, gender-, and age-specific suicide rates were examined using Poisson regression models. The mean number of completed suicides for each cohort during 2009-2011 was calculated and a mean national suicide rate was estimated. The overall suicide rate decreased significantly over the past decade, but rates in young males and rural older adults did not reduce and in fact increased among older adults in both urban and rural areas towards the end of the study period. For 2009-2011, 44 % of all suicides occurred among those aged 65 or above and 79 % among rural residents. The estimated mean national suicide rate was 9.8 per 100,000 and was slightly higher for males than females. The benefits of economic growth, such as higher employment and more educational opportunities for the rural population in particular, may have contributed to the reduced suicide rate in China. However, the recent rapid changes in socioeconomic conditions could have increased stress levels and resulted in more suicides, especially among the elderly. Despite the significant reduction reported here, the latest figures suggest the declining trend is reversing. It will be important to continue monitoring the situation and to examine how urbanization and economic changes affect the well-being of 1.3 billion Chinese.

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Injury-related fatalities in China: an under-recognised public-health problem.

SY Wang, YH Li, GB Chi … (2008)

The May 2008 earthquake in Wenchuan drew attention to the important but largely unrecognised public-health problem of injury-related mortality and morbidity in China. Injuries account for more than 10% of all deaths and more than 30% of all potentially productive years of life lost due to premature mortality in China. Traffic-related injuries (mainly among cyclists and pedestrians), suicide, drowning, and falls account for 79% of all injury deaths. Rural injury death rates are double those of urban rates and male rates are double those of female rates. Despite an 81% increase in the traffic-related mortality from 1987 to 2006-associated with rapid motorisation-the overall injury mortality decreased by 17%, largely due to a surprising (and unexplained) 57% reduction in the suicide rate. Low-cost prevention measures that are most likely to produce large reductions in injury deaths include enforcement of laws for drinking and driving and for seat belt and helmet use, restriction of access to the most potent pesticides, and teaching children to swim. China needs to improve monitoring of fatal and non-fatal injuries, promote intersectoral collaboration, build institutional capacities, and, most importantly, mobilise community support and political will for investment in prevention.

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Author and article information

Contributors

Meizhi Li:

ORCID: http://orcid.org/0000-0003-4865-3097

limeizhi@csu.edu.cn

Srinivasa Vittal Katikireddi: vittal.katikireddi@glasgow.ac.uk

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-9276

Publication date (Electronic): 3 January 2019

Publication date PMC-release: 3 January 2019

Publication date Collection: 2019

Volume: 18

Electronic Location Identifier: 2

Affiliations

[1 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, Department of Public Health, , University of Glasgow, ; Glasgow, UK

[2 ]ISNI 0000 0004 1803 0208, GRID grid.452708.c, The Second Xiangya Hospital of Central South University, ; Changsha, China

[3 ]ISNI 0000 0001 2193 314X, GRID grid.8756.c, MRC/CSO Social & Public Health Sciences Unit, , University of Glasgow, ; Glasgow, UK

Author information

Meizhi Li http://orcid.org/0000-0003-4865-3097

Article

Publisher ID: 881

DOI: 10.1186/s12939-018-0881-2

PMC ID: 6319001

PubMed ID: 30606191

SO-VID: a3930d49-c607-482a-b274-c44e8e1e8652

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 March 2018

Date accepted : 24 October 2018

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ScienceOpen disciplines: Health & Social care

Keywords: suicide,china,aged,elderly,urban,rural,disparities,inequalities,geographic patterns

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ScienceOpen disciplines: Health & Social care

Keywords: suicide, china, aged, elderly, urban, rural, disparities, inequalities, geographic patterns

Urban-rural inequalities in suicide among elderly people in China: a systematic review and meta-analysis

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China Occupational Medicine

Most cited references 44

Suicide rates in China, 1995-99.

Suicide rates in China from 2002 to 2011: an update.

Injury-related fatalities in China: an under-recognised public-health problem.

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