TY - JOUR
T1 - Suicide time-series structural change analysis in Portugal (1913-2018)
T2 - Impact of register bias on suicide trends
AU - Gusmão, Ricardo
AU - Ramalheira, Carlos
AU - Conceição, Virgínia
AU - Severo, Mílton
AU - Mesquita, Edgar
AU - Xavier, Miguel
AU - Barros, Henrique
N1 - Funding Information:
This work is financed by national funds through FCT-Foundation for Science and Technology , I.P., under the project UIDB/04750/2020 .
Publisher Copyright:
© 2021
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background: Suicide is a potentially preventable cause of death. Epidemiology might help to identify death determinants and to monitor prevention strategies. Few studies address secular trends in suicide deaths, and even fewer describe trend-changes in relation to data collection/registration bias. Moreover, suicide is admittedly underreported. It is crucial to validate results in the context of other external causes of death trends, such as unintentional and undetermined intent deaths. We aimed to explore trends in suicide and other external causes of death in Portugal from the inception of registries until 2018, considering breaks in series. Methods: We collected data from all available official primary sources. We calculated cause-specific age-standardized death rates (SDR) by sex for ages equal or higher than 15 years with reference to the European Standard Population. We considered suicide (S), undetermined intent deaths (UnD), accidents (Accs), and all causes of death (ttMty). A time-series structural analysis was executed. Results: Suicide and other external causes of death rates were consistently higher in males than females. A global decline of deaths by suicide, undetermined intention and unintentional is observable. Breakpoints in years 1930, 1954, 1982, 2000-2001 were associated with major changes in deaths registration procedures or methodology. Conclusions: The epidemiology of suicide in Portugal has changed over 106 years. However, adjusted data and consideration of bias reduce trends fluctuation. Trend changes are akin to specific changes in methodology of death registry. Suicide surveillance will improve with more reliable and stable procedures.
AB - Background: Suicide is a potentially preventable cause of death. Epidemiology might help to identify death determinants and to monitor prevention strategies. Few studies address secular trends in suicide deaths, and even fewer describe trend-changes in relation to data collection/registration bias. Moreover, suicide is admittedly underreported. It is crucial to validate results in the context of other external causes of death trends, such as unintentional and undetermined intent deaths. We aimed to explore trends in suicide and other external causes of death in Portugal from the inception of registries until 2018, considering breaks in series. Methods: We collected data from all available official primary sources. We calculated cause-specific age-standardized death rates (SDR) by sex for ages equal or higher than 15 years with reference to the European Standard Population. We considered suicide (S), undetermined intent deaths (UnD), accidents (Accs), and all causes of death (ttMty). A time-series structural analysis was executed. Results: Suicide and other external causes of death rates were consistently higher in males than females. A global decline of deaths by suicide, undetermined intention and unintentional is observable. Breakpoints in years 1930, 1954, 1982, 2000-2001 were associated with major changes in deaths registration procedures or methodology. Conclusions: The epidemiology of suicide in Portugal has changed over 106 years. However, adjusted data and consideration of bias reduce trends fluctuation. Trend changes are akin to specific changes in methodology of death registry. Suicide surveillance will improve with more reliable and stable procedures.
KW - Accidental causes of death
KW - Breakpoints
KW - Epidemiology
KW - Secular trends
KW - Structural change analysis
KW - Suicide
KW - Suicide surveillance
KW - Undetermined deaths
UR - http://www.scopus.com/inward/record.url?scp=85107619727&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2021.04.048
DO - 10.1016/j.jad.2021.04.048
M3 - Article
C2 - 34023749
AN - SCOPUS:85107619727
SN - 0165-0327
VL - 291
SP - 65
EP - 75
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -