摘要：Objectives. This study examined rural–urban gradients in US suicide mortality and the extent to which such gradients varied across time, sex, and age. Methods. Using a 10-category rural–urban continuum measure and 1970–1997 county mortality data, we estimated rural–urban differentials in suicide mortality over time by multiple regression and Poisson regression models. Results. Significant rural–urban gradients in age-adjusted male suicide mortality were found in each time period, indicating rising suicide rates with increasing levels of rurality. The gradient increased consistently, suggesting widening rural–urban differentials in male suicides over time. When controlled for geographic variation in divorce rate and ethnic composition, rural men, in each age cohort, had about twice the suicide rate of their most urban counterparts. Observed rural–urban differentials for women diminished over time. In 1995 to 1997, the adjusted suicide rates for young and working-age women were 85% and 22% higher, respectively, in rural than in the most urban areas. Conclusions. The slope of the relationship between rural–urban continuum and suicide mortality varied substantially by time, sex, and age. Widening rural–urban disparities in suicide may reflect differential changes over time in key social integration indicators. (Am J Public Health. 2002;92:1161–1167) Suicide is the eighth leading cause of death in the United States. 1 Although the US ageadjusted suicide mortality rate for men has changed very little over the past 3 decades, national mortality data indicate that the rate has declined fairly consistently among women, at an average rate of 2.25% per year between 1970 and 1997. 2 Social isolation (or lack of social integration) has long been recognized as one of the major determinants of suicide. 3– 12 Although social isolation can be measured at the individual level by such measures as living alone and absence of social support, it can also be considered as a measure of the social environment. 3– 5, 7, 12 Levels of rurality and of urbanization can be viewed as one such macrosocietal measure. 12, 13 A number of studies have shown that rural areas tend to have higher suicide mortality rates than urban areas. 12, 14– 16 Besides physical and social isolation and limited opportunities for social interaction and networks in rural areas, a number of other societal factors, such as unfavorable changes in the demographic structure and socioeconomic and industrial activity that causes social instability and disruption, have been cited as possible reasons for comparatively higher suicide rates in rural areas. 12, 14– 16 The extent to which suicide rates vary in response to the degree of rurality or urbanization has not been well studied. Furthermore, the degree to which rural–urban disparities in US suicide mortality among men and women have changed over time has not been examined. This report empirically examines rural–urban patterns in US suicide mortality and the extent to which rural–urban gradients in male and female suicide mortality have changed, both overall and for those aged 15 to 24, 25 to 64, and 65 years and older, during the period 1970 to 1997.
