Elsevier

Journal of Affective Disorders

Volume 57, Issues 1–3, January–March 2000, Pages 99-106
Journal of Affective Disorders

Research report
Urban/rural and gender differentials in suicide rates: East and West

https://doi.org/10.1016/S0165-0327(99)00058-0Get rights and content

Abstract

Background: Many epidemiological studies indicate suicide rates are higher for males than females and for urban than rural. Here we re-examine gender, urban and rural differentials in suicide in Australia and Beijing (China). More specifically, to test the two hypotheses (i) that the male to female ratio is larger than one; (ii) that the urban suicide rate is higher than the rural in both places. Methods: Suicide data with information of gender, rural and urban regions for Australia and Beijing (China) for the period of 1991–1996 were used. Ratios between the gender-specific urban and rural suicides rates with the associated confidence intervals were constructed to examine gender, urban and rural differentials in Australia and Beijing. Results: The rural suicide rate in Beijing for both genders was higher than for their urban counterparts. Further, the elderly had the highest suicide rate followed by women aged 20–29. Also, the male to female ratio in China was less than one. In Australia, the rural male suicide rate was higher than the urban whereas the urban female suicide rate was higher than the rural. The male to female ratio was 4 to 1. The differences in rural to urban and male to female ratios between Australia and Beijing are statistically significant. Conclusions: In contrast to the west, male suicide rates are not higher than female rates in China. Urban rates are not necessarily higher than rural rates – not even in a western setting. Cultural factors and regional differences in socio-economic situation are significant in explaining the low gender ratio and the relatively higher suicide rates in rural China. Limitations: The suicide rate in the Beijing region might not exactly reflect the same for the whole of China.

Introduction

Suicide is a very complex phenomenon. Any patterns observed in the past or in the West might not be valid at present or applicable to other non-western countries. There are many differences in suicide rates between East and West. For example, the male to female suicide ratio is higher in western than eastern countries (Yip, 1998a); elderly suicide rates in Asian countries are three times higher than the average while in western countries the elderly suicide rate is higher than the average, but by a much smaller factor (Chi et al., 1997, Yip et al., 1998a). The bi-modal seasonal pattern for female suicides was not found in Hong Kong, Taiwan, Australia and New Zealand (Ho et al., 1997, Yip et al., 1998b, Hakko et al., 1998). Many existing studies of the incidence of suicide in western societies suggest that the suicide rate is higher in urban regions (Garrison, 1992, Pearson, 1993, Cantor and Coory, 1993). In this paper we attempt to test two hypotheses as in Pritchard’s (1996a): (i) the male to female suicide ratio is larger than one; (ii) urban suicide rates are higher than rural rates. We will explore the gender, urban and rural differentials in Beijing (China) and Australia and to highlight the difference between East and West. Also discussed are factors which are common to both places and the extent to which differences in ratios and rates are explained by the cultural differences.

In Australia, 36% of the population live outside the capital cities and about half of that figure can be classified as living in rural areas. Urban and rural populations aged 15 or over in 1996 were 11,872,500 and 2,524,700 respectively. In contrast, 70% of the population of China lives in rural areas. The GDP in rural areas is only one third compared to that of urban areas (China Statistical Yearbook, 1996). In the administrative territory of Beijing (China), where the data for the current paper were sourced, urban and rural populations aged 15 or over in 1996 were 6,042,600 and 2,585,500 respectively. As the capital city surrounded by a number of rural counties Beijing provides an interesting comparison with Australia’s largely urbanised population.

Section snippets

Data and methods

For the purpose of this study, deaths coded in the range E950-E959 of ICD-9 (World Health Organization, 1978) were classified as suicides. For Australia, suicide data for the period of 1991–1996 were made available by the Australian Bureau of Statistics. The ascertainment of death due to unnatural causes is made through the Coroner’s court in Australia and judicial inquiries establish where deaths are due to suicide. In Beijing, all deaths are reported to the Public Security Office for

Age–gender specific rates

Age–gender specific rates for Australia and Beijing for the study period 1991–1996 were given in Fig. 1, Fig. 2. Suicide rates for both genders in Australia and Beijing were quite stable for the six year period. The average suicide rates (aged 15 or over) for Australian males and females were 26.6 and 6.5 per 100,000 respectively for the period. The male to female ratio was 4.1. The corresponding figures for Beijing were 8.9 and 9.4 per 100,000 with the ratio 0.95. In Australia, males of age 75

Discussion

Consistent with international comparisons (Yip, 1997, Pritchard, 1996b, Yip, 1998b, Pritchard, 1992a) and despite some changes in recent decades, the propensity for Australian men to kill themselves continues unabated. Pritchard, 1992a, Pritchard, 1992b has shown that the gap between male and female rates has widened. In Australia gender was a major factor in the incidence of suicide and the rural/urban differential played a role but was less important. In Beijing rural populations suicided

Conclusion

In examining the urban and rural differentials between Beijing and Australia we reject the two hypotheses. We have shown that male to female rate in Beijing is less than one which is unique in world. Also, suicide rates in urban regions are not necessarily larger than their rural counterparts even in a western country like Australia.

Differences in socio-economic conditions in urban and rural settings can explain some of the discrepancies between Australia and Beijing. Gender differentials

Acknowledgments

The authors would like to thank the details comments from the two referees; Australian Bureau of Statistics and the Division of Statistics of the Ministry of Health of People’s Republic of China for supplying the relevant data and Doris Chong in preparing the data. The work is supported by a CRCG and a RGC grant.

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