1999-2015年天津市自杀死亡率变化趋势分析

摘要

Objective To explore the trends and distribution of suicide between genders,ages and urban-rural areas from 1999 to 2015 in Tianjin,and provide basis for prevention and control of suicide.Methods Suicide mortality data in 1999-2015 were obtained from Tianjin population based mortality surveillance system operated by the Tianjin Centers for Disease Control and Prevention (CDC),and population data of permanent residents were from Tianjin Municipal Public Security Bureau.Standardized mortality rates were calculated for suicide,adjusted for age and gender by using the year 2000 world standard population.Joinpoint regression and Cochran-Armitage trend were used to determine the statistical significance of differences in mortality trends.Results Suicide mortality in Tianjin was observed from year 1999 to 2015 with the crude mortality rate of 4.76/100 000 to 4.07/100 000.Adjusted suicide mortality rate from 1999 to 2006 was 4.28/100 000 to 2.59/100 000,indicating an decreased trend (Z=-9.37,P＜0.01) with an annual percent change (APC) of-7.80％.Adjusted suicide mortality rate was increased from 2006 to 2015:2.59/100 000 to 3.00/100 000 (Z=2.15,P=-0.032),and APC was 1.54％.Adjusted suicide mortality rate of male was declined from 1999 to 2007:4.77/100000 to 2.86/100000 (Z=-7.43,P＜0.01,APC=-6.89％),and increased from 2007 to 2015:2.86/100 000 to 3.49/100 000 (Z=3.13,P=0.002,APC=3.44％).Adjusted suicide mortality rate of female was declined from 1999 to 2006:3.79/100 000 to 2.04/100 000 (Z=-6.85,P＜ 0.01,APC=-7.82％),and flatted from 2006 to 2015:2.04/100 000 to 2.50/100 000 (Z=-0.16,P=0.871).The suicide standardized mortality rate of male was generally higher than that of female during the 17 years.The suicide mortality rate increased with age.Adjusted suicide mortality rate in urban was declined from 1999 to 2007:3.09/100 000 to 1.94/100 000 (Z=-5.45,P＜0.01,APC=-6.15％),and flatted from 2007 to 2015:1.94/100000 to 2.44/100000 (Z=1.43,P=0.154).Adjusted suicide mortality rate in rural was declined from 1999 to 2005:5.65/100 000 to 3.03/100 000 (Z=-7.55,P＜0.01,APC=-9.70％),and increased from 2005 to 2015:3.03/100 000 to 3.73/100 000 (Z=2.69,P=0.007,APC=1.71％).Except in the year of 2005,the suicide mortality rate was significantly higher in rural residents than in urban residents during this study period (P＜0.05).The proportions of method of suicide including hanging,poisoning with pesticides,dumping from a height,drowning,poisoning with drugs and sharp instrument injury were 32.09％,28.30％,12.88％,8.87％,6.81％ and 2.93％ respectively.Hanging was the predominant method of suicide among male or in urban area.Poisoning with pesticides was a major problem,notably among female or in rural area.Drowning and poisoning with drugs was much common among female than male (P＜0.01).Dumping from a height and drowning was much common in urban than rural (P＜0.01).Conclusions The suicide mortality in Tianjin decreased dramatically from 1999 to 2006,and increased slightly from 2006 to 2015,and male and rural residents have higher suicide mortality.The methods of suicide were different between male and female,and between urban and rural areas.Further efforts of lifestyles improvement,primary prevention,restricting access to the means of suicide and first-aid treatment for suicide are needed to reduce suicide and mortality in Tianjin.%目的 了解1999-2015年天津市居民自杀死亡率及其变化趋势,探讨其在不同特征人群中的特点,为自杀的预防控制提供依据.方法 采用天津市疾病预防控制中心收集的1999-2015年天津市居民全死因监测数据,统计天津市居民自杀死亡率,比较不同年龄、性别以及地区之间自杀死亡率的差异,并分析其变化趋势.采用2000年世界标准人口计算年龄别、性别标化死亡率.采用Joinpoint回归和Cochran-Armitage趋势检验进行趋势分析.结果 1999-2015年天津市自杀粗死亡率为4.76～4.07/10万.1999-2006年自杀标化死亡率为4.28～2.59/10万,呈下降趋势(Z=-9.37,P＜0.01),年度变化百分比(annual percent change,APC)为-7.80％;2006-2015年自杀标化死亡率为2.59～3.00/10万,呈上升趋势(Z=2.15,P=0.032),APC为1.54％.1999-2007年男性自杀标化死亡率为4.77～2.86/10万,呈下降趋势(Z=-7.43,P＜0.01),APC为-6.89％;2007-2015年男性自杀标化死亡率为2.86～3.49/10万,呈上升趋势(Z=3.13,P=0.002),APC为3.44％.1999-2006年女性自杀标化死亡率为3.79～2.04/10万,呈下降趋势(Z=-6.85,P＜0.01),APC为-7.82％;2006-2015年女性自杀标化死亡率为2.04～2.50/10万,呈平稳趋势(Z=-0.16,P=0.871).1999-2015年男性自杀标化死亡率总体高于女性.随着年龄升高,自杀死亡率逐渐升高.1999-2007年城市自杀标化死亡率为3.09～1.94/10万,呈下降趋势(Z=-5.45,P＜0.01),APC为-6.15％;2007-2015年城市自杀标化死亡率为1.94～2.44/10万,呈平稳趋势(Z=1.43,P=0.154).1999-2005年农村自杀标化死亡率为5.65～3.03/10万,呈下降趋势(Z=-7.55,P＜0.01),APC为-9.70％;2005-2015年农村自杀标化死亡率为3.03～3.73/10万,呈上升趋势(Z=2.69,P=0.007),APC为1.71％.除2005年,农村各年份标化死亡率高于城市(P＜0.05).天津自杀死亡方式前6位分别为自缢(32.09％)、服用农药(28.30％)、跳楼(12.88％)、自溺(8.87％)、服用药物(6.81％)和锐器伤(2.93％).自缢为男性、城市最主要的自杀方式,服用农药为女性、农村最主要的自杀方式.女性自溺及服用药物自杀的比例高于男性(P＜0.05).城市地区跳楼、自溺所占构成明显高于农村地区(P＜0.01).结论 1999-2015年天津市居民自杀死亡率呈1999-2006年明显下降,2006-2015年微弱上升的阶段性特点;男性自杀死亡率高于女性,农村高于城市;男女之间、城乡之间自杀死亡的方式不同.应根据人群不同特点,采取有针对性的干预措施,促进健康生活方式,加强自杀的一级预防,加强可预防自杀工具管理,加强自杀院前急救,减少自杀的死亡.