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

• Published in: Social science & medicine (1982) Vol. 222; pp. 20 - 34
• Main Authors: Lin, Chien-Yu, Hsu, Chia-Yueh, Gunnell, David, Chen, Ying-Yeh, Chang, Shu-Sen
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2019; Pergamon Press Inc
• Subjects: Adolescent; Adult; Adults; Age differences; Age Distribution; Age groups; Aged; Bayes Theorem; Bayesian analysis; Child; Cities; Deprivation; Deviation; Economic deprivation; Family income; Female; Geographic distribution; Geography; Health Status Disparities; Households; Humans; Income inequality; Inequalities; Inner city; Male; Males; Men; Middle age; Middle Aged; Mortality; Mortality rates; Neighborhoods; Population Density; Population distribution; Residence Characteristics - statistics & numerical data; Risk Factors; Segmentation; Sex Distribution; Social Capital; Social fragmentation; Social inequality; Social isolation; Socioeconomic characteristics; Socioeconomic Factors; Spatial Analysis; Suicide; Suicide - statistics & numerical data; Suicides & suicide attempts; Taiwan - epidemiology; Urban areas; Urban development; Urban population; World population; Young Adult; Taiwan; Cities; Spatial analysis; Suicide; Socioeconomic characteristics; Inequalities
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2018.12.011

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 have largely been conducted in Western nations. We investigated the spatial pattern of suicide and factors associated with its spatial distribution in Taipei City, Taiwan. We estimated smoothed standardized mortality ratios for overall suicide and suicide by sex/age group across 432 neighborhoods (mean population size: 5500) in Taipei City (2004–2010) using Bayesian hierarchical models. A range of area-level characteristics including socioeconomic deprivation, social fragmentation, income inequality, and linking social capital were investigated for their associations with suicide mortality. Overall suicide rates were below average in the city center, whereas above average rates were found in some suburbs. The cartogram highlighted the concentration of suicide burden in one western area of the city. Male suicides demonstrated generally similar spatial patterning across age groups, while the geographic distribution of female suicides differed by age. After adjusting for other variables, 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, 0.73–0.86), an indicator of socioeconomic deprivation. 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). The geography of suicide in Taipei City showed spatial patterning and socioeconomic correlates distinct from cities in Western nations. There is a need for future research to better understand the correlates of change in the geographic distribution of suicide throughout the process of urban development. •Marked variations in suicide were found across neighbourhoods in Taipei City.•Low suicide rates were shown in the city center compared to some suburbs.•Around 60% of the variations could be explained by area characteristics studied.•Income and divorced/separated adults were linked with neighborhood suicide rates.•Socioeconomic inequality in suicide rates was strongest in middle-aged men.