台灣非戶籍所在縣市自殺死亡的區域社經因素分析

Suicides away from county of residence and their socioeconomic correlates in Taiwan

目標：探討非戶籍地自殺死亡之人口學、社會經濟、與地理因素之影響。方法：橫斷面研究設計，利用2011至2013年全國死因登記，取得戶籍地、死亡地，以及人口學資訊，統計外地自殺人口之特徵與地理分布，並進行縣市社會經濟指標與外地自殺之相關性分析，以及個體與區域二階層變數的多層次模式分析。結果：共有10,474名自殺身亡個案，1,538人（14.7%）死亡地點在原戶籍縣市外，自殺方式吊死或窒息占32.1%。離島（33.3%）、北北基宜（20.4%） 與花東地區（15.8%）之自殺死亡於非戶籍縣市之占比較高。自殺身亡族群年齡24歲以下（OR = 1.31, p < .05）、單身（OR = 1.83, p < .001）或離婚（OR = 1.55, p < .001）、原戶籍地的勞動參與率越低（OR =.87, p < .05），或扶養比越高時（OR = 1.10, p < .05），死於外地的風險越高。性別、年齡、與婚姻狀態與大部分社會經濟指標具有交互作用。結論：非戶籍地自殺死亡凸顯就業機會、高齡人口照顧與居住議題對於心理健康的重要性。（台灣衛誌 2022；41（2）： 156-168）

Objectives: To investigate the influences of demographic, socioeconomic, and geographic factors on nonresident suicides. Methods: In this cross-sectional study, data on demographics, geographical locations of residence, and places of death for 2011–2013 were retrieved from the Taiwanese National Cause-of-Death Register. The odds ratios for nonresident suicides associated with each risk factor were calculated. The correlations of county-level socioeconomic indicators with nonresident suicide data obtained from public government databases were analyzed. Multilevel modeling was used to examine the cross-level interaction effects between individual-level and county-level variables. Results: A total of 10,474 suicide deaths occurred during 2011–2013, of which 1,538 (14.7%) deaths occurred away from the area of residence. The most common suicide methods used were hanging and asphyxiation (32.1%). Among the regions of Taiwan, the offshore islands (33.3%), Taipei and the surrounding area (20.4%), and the Hualien– Taitung area (15.8%) had the highest proportions of nonresident suicides. Age of <25 years (OR = 1.31, p < .05), single and divorced marital status (single: OR = 1.83, p < .001; divorced: OR = 1.55, p < .001), and a lower labor force participation rate (OR = .87, p < .05) and higher dependency ratio (OR = 1.10, p < .05) in the resident area were associated with increased odds of nonresident suicides. Gender, age, and marital status interacted with most of the socioeconomic indicators. Conclusions: Nonresident suicides highlight the effects of employment opportunity, elderly care, and housing issues on public mental health. (Taiwan J Public Health. 2022;41(2):156-168)