Health Disparities
Intersecting urbanity level and educational inequalities in suicide mortality by gender and age group in Korea, 2015-2020: an ecological study Ikhan Kim* Ikhan Kim
Background: Among countries in the Organization for Economic Co-operation and Development, South Korea has one of the highest rates of suicide. This study aims to estimate the suicide rate for each of Korea’s 247 districts based on gender, age group, and educational attainment and to determine district-level factors that are associated with the suicide rate.
Methods: To obtain the average number of population and suicide deaths over the period by gender/10 years (30-39,…,80+),/district/education level(middle school or lower, high school, college or higher), we utilized data from South Korea’s population censuses undertaken in 2015 and 2020 as well as death statistics data collected between 2013 and 2022. Using the Bayesian spatio-temporal model, the age-standardized suicide death rates by educational attainment for each district were estimated. Ten district-level variables, including 3 material explanations, 2 social capital explanations, 3 social fragmentation explanations, and 2 healthcare services explanations, were used for the education-level stratified spatial regression analysis.
Results: Low-educated people and rural areas had higher suicide death rates for both males and females. When stratified analysis was done by educational attainment, suicide mortality among males and females with middle school education or less was relatively lower in rural areas than in metropolitan and urban areas, in contrast to other levels of education. In females, this tendency was more pronounced. Suicide mortality among low-educated people, particularly females, was more clearly associated with the social support level. This tendency was driven by relatively young age groups.
Discussion: Contrary to other educational levels, suicide mortality was lower in rural than in metropolitan areas for both males and females with middle school education or less. When making efforts to prevent suicide in the local community, policies based on proportional equity that consider socioeconomic position, including education attainment, should be implemented. This study suggests that community social support can protect the suicide mortality in the low-educated population more than other education groups.
