The long-term changing patterns of suicide mortality in China from 1987 to 2020：continuing urban-rural disparity

Abstract

Abstract Background: Patterns in urban-rural, gender, and age suicide mortalities in China have shown dramatic changes over the past three decades. This study aimed to explore the long-term patterns of suicide mortality in China from 1987 to 2020. Methods: Data on suicide mortality were derived from China's National Health Commission. Joinpoint regression analysis was used to explore changes in trends and age-period-cohort modeling to estimate age, period and cohort effects in suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated. Results: (1) Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987-2020. Rural age-standardized suicide mortality (net drift = -3.41%, p＜0.01) declined to a greater extent than in urban areas (net drift = -7.07%, p＜0.01), whose decline curve could be divided into three substages. Both period and cohort effects regarding rural areas declined more than urban areas; (2) Youngsters aged 20-24 were at the highest suicide risk, and suicide risk gradually increased with age after 60. Females, especially of childbearing age, had higher suicide risk than males, but there existed a trend reversal between genders in groups aged above 50; (3) Gender reversal of suicide risk after age 50 showed different trends in urban and rural areas. The gap in suicide risk between genders widens with age in urban areas, while the gap remains relatively stable in rural areas. Conclusions: Suicide mortality in China continued to decline over the past three decades. Age, gender, and urban-rural disparities in suicide mortality have been continuing but show new patterns. Females of childbearing age and the elderly are at high risk for suicide. The slower decrease, high-risk groups, and the reversing urban-rural gender trends urgently require close attention and more targeted suicide prevention programs.