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Meta-Analysis
. 2019 Jan 3;18(1):2.
doi: 10.1186/s12939-018-0881-2.

Urban-rural inequalities in suicide among elderly people in China: a systematic review and meta-analysis

Meizhi Li  1   2 , Srinivasa Vittal Katikireddi  3
Affiliations
Meta-Analysis

Urban-rural inequalities in suicide among elderly people in China: a systematic review and meta-analysis

Meizhi Li et al. Int J Equity Health. .

Abstract

Background: China has an unusual pattern of suicides, with overall suicide rates in rural areas higher than urban areas. While suicide rates have decreased dramatically, older people increasingly contribute to the overall burden of suicide. However, it is unclear if elderly people within rural areas experience greater suicide risk than those in urban areas. We aimed to systematically review the incidence of suicide in rural and urban China among the elderly (aged over 60 years), with a view to describing the difference in rates between rural and urban areas and trends over time.

Methods: Chinese and English language articles were searched for using four databases: EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (EBSCOhost) and CNKI (in Chinese). Articles describing completed suicide among elderly people in both rural and urban areas in mainland China were included. The adapted Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. One reviewer (ML) assessed eligibility, performed data extraction and assessed risk of bias, with areas of uncertainty discussed with the second reviewer (SVK). Random effects meta-analysis was conducted. Suicide methods in different areas were narratively summarised.

Results: Out of a total 3065 hits, 24 articles were included and seven contributed data to meta-analysis. The sample size of included studies ranged from 895 to 323.8 million. The suicide rate in the general population of China has decreased in recent decades over previous urban and rural areas. Suicide rates amongst the elderly in rural areas are higher than those in urban areas (OR = 3.35; 95% CI of 2.48 to 4.51; I2 = 99.6%), but the latter have increased in recent years. Insecticide poisoning and hanging are the most common suicide methods in rural and urban areas respectively. Suicide rates for these two methods increase with age, being especially high in elderly people.

Conclusions: The pattern of suicide in China has changed in recent years following urbanisation and aging. Differences in suicide rates amongst the elderly exist between rural and urban areas. Addressing the high suicide rate amongst the elderly in rural China requires a policy response, such as considering measures to restrict access to poisons.

Keywords: Aged; China; Disparities; Elderly; Geographic patterns; Inequalities; Rural; Suicide; Urban.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection
Fig. 2
Fig. 2
A forest plot of completed suicide amongst elderly people in rural areas compared to urban areas
Fig. 3
Fig. 3
A forest plot of sub-group analysis according to category of ages
Fig. 4
Fig. 4
A forest plot of sub-group analysis according to category of score after critical appraisal
Fig. 5
Fig. 5
A forest plot of sub-group analysis according to category of study period
Fig. 6
Fig. 6
A forest plot of sub-group analysis according to category of region level
Fig. 7
Fig. 7
Suicide rates among elderly people over time in rural and urban China
Fig. 8
Fig. 8
Suicide rates among elderly people over time in rural and urban China, stratified by gender
Fig. 9
Fig. 9
The ratio of elderly suicide rates in rural areas compared to urban areas over time
See this image and copyright information in PMC

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