Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-2021

BackgroundRisk of suicide is complex and often a result of multiple interacting factors. It is vital research identifies predictors of suicide to provide a strong evidence base for targeted interventions. MethodsUsing linked Census and population level mortality data we estimated rates of suicide across different groups in England and Wales and examine which factors are independently associated with the risk of suicide. FindingsThe highest rates of suicide were amongst those who reported an impairment affecting their day-to-day activities, those who were long term unemployed or never had worked, or those who were single or separated. Rates of suicide were highest in the White and Mixed/multiple ethnic groups compared to other ethnicities, and in people who reported a religious affiliation compared with those who had no religion. Comparison of minimally adjusted models (predictor, sex and age) with fully-adjusted models (sex, age, ethnicity, region, partnership status, religious affiliation, day-to-day impairments, armed forces membership and socioeconomic status) identified key predictors which remain important risk factors after accounting for other characteristics; day-to-day impairments were still found to increase the incidence of suicide relative to those whose activities were not impaired after adjusting for employment status. Overall, rates of suicide were higher in men compared to females across all ages, with the highest rates in 40-to-50-year-olds. InterpretationThe findings of this work provide novel population level insights into the risk of suicide by sociodemographic characteristics. Understanding the interaction between key risk factors for suicide has important implications for national suicide prevention strategies. FundingThis study received no specific funding. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSPrevious studies have identified key risk factors for suicide; being male and being aged 40 to 50 years of age have the highest rates of suicide. Suicide is a major public health concern, with prevention strategies imperative to minimising events. Added value of this studyFor the first time we make population level estimates of suicide rates in England and Wales using death registration data linked to 2011 Census. Furthermore, we calculate incidence rate ratios for fully adjusted models which provide novel insights into the interplay between different risk factors. For instance, we see that people who report having day-to-day impairments risk of suicide is 2- to 3-times higher for men and women respectively compared to people who do not report day-to-day impairments, after adjusting for other characteristics such as socioeconomic status which are likely associated with impairments. Implications of this studyUnderstanding the groups most at risk of suicide is imperative for national suicide prevention strategies. This work provides novel population level insights into the risk of suicide by sociodemographic characteristics.