Urban and rural suicide differentials in migrants and the Australian-born,New South Wales, Australia 1985-1994

We estimated risk of suicide in adults in New South Wales (NSW) by sex, cou ntry of birth and rural/urban residence, after adjusting for age; we also e xamined youth suicide (age 15-24 years). The study population was the entir e population of NSW, Australia, aged greater than or equal to 15 years duri ng the period 1985-1994. Poisson regression was used to examine the relatio nship between predictor variables and the risk of suicide, with the focus o n migrant status and area of residence. A significantly higher risk of suic ide was found in male migrants from Northern Europe and Eastern Europe/form er USSR, compared to Australian-born males; a significantly lower suicide r isk occurred in males from Southern Europe, the Middle East and Asia. In fe male migrants, those from UK/Eire, Northern Europe, Eastern Europe/former U SSR and New Zealand exhibited a significantly higher risk of suicide compar ed to Australian-born females. A significantly lower risk of suicide occurr ed in females from the Middle East. Male migrants overall were at significa ntly lower risk of suicide than the Australian-born, while female migrants overall had a significantly higher risk of suicide than Australian-born fem ales. Among migrant males overall, the rural-urban suicide risk differentia l was significantly higher for those living in non-metropolitan areas (RR = 1.9; 95% CI: 1.7-2.1). Suicide risk was significantly higher in non-metrop olitan male immigrants from the UK/Eire (RR = 1.4; 95% CI: 1.1-1.7), Southe rn Europe (RR = 1.7; 95% CI: 1.2-2.4), Northern/Western Europe (1.5; 95% CI : 1.2-1.9), the Middle East (RR = 3.8; 95% CI: 1.9-7.8), New :Zealand (RR = 1.4; 95% CI: 1.0-1.8) and 'other' (RR = 2.6; 95% CI: 1.9-3.5), when compar ed to their urban counterparts. There was no statistically significant diff erence in suicide risk between rural and urban Australian-born males. For f emale suicide, significantly lower risk was found in female immigrants livi ng in non-metropolitan areas who were from Northern/Western Europe (RR = 0. 7; 95% CI: 0.4-0.96), as well as the Australian-born (RR = 0.7; 95% CI: 0.6 -0.8), when compared to their urban counterparts. The non-metropolitan/metr opolitan relative risk for suicide in female migrants overall was not signi ficantly different from one. Among male youth there was a significantly hig her suicide risk in non-metropolitan areas, with a relative risk estimate o f 1.4 for Australian-born youth (95% CI: 1.2-1.5) and 1.7 for migrant youth (95% CI: 1.2-2.4), when compared with metropolitan counterparts. We conclude that suicide among migrant males living in non-metropolitan are as accounts for most of the excess of male suicide in rural NSW, and the si gnificantly lower risk of suicide for non-metropolitan Australian-born wome n does not apply to migrant women. (C) 1999 Published by Elsevier Science L td. All rights reserved.