This study investigates changes in Australian urban–rural suicide differentials over time in the context of overall declines in (male) suicide in the late 1990s, and determines the extent to which differences in socio-economic status (SES) account for observed urban–rural trends. Suicide data were stratified for the period 1979–2003 by metropolitan, rural and remote areas and examined across five quinquennia, centred on each Australian census from 1981 to 2001. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth and the mediating effects of area SES, using Poisson regression models. Male suicide rates in metropolitan, rural and remote areas diverged significantly over time, especially in young males (15–24 years). Young male suicide rates increased significantly in metropolitan, rural and remote areas over 1979–1998, and in the most recent period (1999–2003) increased further in remote areas from 38.8 (per 100,000) to 47.9 (23% increase). In contrast suicide rates in rural areas decreased from a peak of 27.5 to 19.8 (28% decrease), and in metropolitan areas from a peak of 22.1 to 16.8 (24% decrease). Similar divergence in the 1999–2003 quinquennium, though of a lesser magnitude, was also evident for males aged 25–34 years. Female suicide rates in the earlier part of the period were significantly lower in rural and remote areas than in metropolitan areas, particularly for those aged 25–34 years, then increased in rural and remote areas to converge with female suicide rates in metropolitan areas. Adjusting for SES in addition to age and country-of-birth reduced urban–rural suicide differentials in both males and females, consistent with SES being an intermediary between rural residence and suicide. Nevertheless, urban–rural differences remained statistically significant. These results show that the largest urban–rural male suicide differentials for the 25-year study period occurred in the most recent period (1999–2003), in the context of decreasing male suicide rates overall.
Social Science and Medicine Vol. 65, Issue 3, p. 442-453