Spatial Clustering of Suicides and Neighborhood Determinants in North Carolina, 2000 to 2017
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Spatial Clustering of Suicides and Neighborhood Determinants in North Carolina, 2000 to 2017 Margaret M. Sugg 1 & Sarah Woolard 1 & Margaret Lawrimore 2 & Kurt D. Michael 3 & Jennifer D. Runkle 1,2 Received: 28 February 2020 / Accepted: 15 September 2020/ # Springer Nature B.V. 2020
Abstract Few studies in the Southeastern U.S. have examined county-level spatial patterning in suicide clusters, and no studies have examined clustering at the census block group. The objective of this retrospective ecological study is to identify high-risk suicide clusters and characterize the community-level factors associated with suicides inside and outside spatial clusters. We used the discrete Poisson SatScan statistic to identify spatial clusters in suicide for North Carolina, 2000–2017. A suicide cluster was defined as a statistically significant cluster of suicide events. Community-level determinants were obtained from the American Community Survey, and logistic regression models were used to examine the association between community-level determinants and suicide clusters. A total of 12 statistically significant high-risk spatial clusters were identified. Clusters were also identified for specific age-demographics, including adolescents (). The risk ratios of suicide varied from 1.27 to 2.05 in high-risk clusters, and spatial clustering was positively associated with being male or residence in a rural area. Multivariable logistic regression found strong associations with income, population change, and educational attainment. Our results highlight the significant geographic heterogeneity in suicide across North Carolina and the need for more research that identifies localized suicide clusters for targeted public health interventions. Keywords Spatial clustering . Suicide . Geographic information systems . Adolescent
suicide
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12061-02009364-1) contains supplementary material, which is available to authorized users.
* Margaret M. Sugg [email protected] Extended author information available on the last page of the article
M. M. Sugg et al.
Introduction Suicide continues to be a leading cause of death among Americans, with county-level rates increasing in nearly every state from 1999 to 2016 (CDC 2019). Suicide risk varies across demographic groupings with significantly higher suicide rates among men and minorities than females and Caucasians (CDC 2019). Multiple risk factors for suicide have been documented in the literature, including pre-existing medical or mental health conditions, prior suicide attempt, substance abuse disorder, family history of mental health disorder, suicide, or abuse, access to firearms in the home, prison or jail sentence, military service, and being between the ages of 15 to 25 or over the age of 60 (National Institute of Mental Health 2019). Regional variations in suicide trends have been observed along the rural-urban continuum, with rural counties having some of the highest suicide rates (CDC 2019)
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