Temporal Trends of Suicide Mortality in Mainland China: Results from the Age-Period-Cohort Framework

The aim of this study is to explore the long-term trends of suicide mortality in China. We implemented the age-period-cohort (APC) framework, using data from the Global Burden of Disease Study 2013. Our results showed that the net drift of suicide mortality was -4.727% (95% CI: -4.821% to -4.634%) per year for men and -6.633% (95% CI: -6.751% to -6.515%) per year for women, and the local drift values were below 0 in all age groups (p < 0.01 for all) for both sexes during the period of 1994-2013. Longitudinal age curves indicated that, in the same birth cohort, suicide death risk increased rapidly to peak at the life stage of 20-24 years old and 15-24 years old for men and women, respectively, and then showed a decelerated decline, followed by a rise thereafter after 54 years old for men and a slight one after 69 years old for women. The estimated period and cohort RRs were found to show similar monotonic downward patterns (significantly with p < 0.01 for all) for both sexes, with more quickly decreasing for women than for men during the whole period. The decreasing trend of suicide was likely to be related to the economic rapid growth, improvements in health care, enhancement on the level of education, and increasing awareness of suicide among the public in China. In addition, fast urbanization and the effective control of pesticides and rodenticides might be the special reasons behind these trends we observed in this study.