title: Overall, gender and social inequalities in suicide mortality in Iran, 2006-2010: a time trend province-level study.
abstract: OBJECTIVE
  Suicide is a major global health problem imposing a considerable burden on populations in terms of disability-adjusted life years. There has been an increasing trend in fatal and attempted suicide in Iran over the past few decades. The aim of the current study was to assess overall, gender and social inequalities across Iran's provinces during 2006-2010.
  
  
  METHODS
  Ecological study.
  
  
  METHODS
  The data on distribution of population at the provinces were obtained from the Statistical Centre of Iran. The data on the annual number of deaths caused by suicide in each province were gathered from the Iranian Forensic Medicine Organization.
  
  
  METHODS
  Suicide mortality rate per 100,000 population was calculated. Human Development Index was used as the provinces' social rank. Gini coefficient, rate ratio and Kunst and Mackenbach relative index of inequality were used to assess overall, gender and social inequalities, respectively. Annual percentage change was calculated using Joinpoint regression.
  
  
  RESULTS
  Suicide mortality has slightly increased in Iran during 2006-2010. There was a substantial and constant overall inequality across the country over the study period. Male-to-female rate ratio was 2.34 (95% CI 1.45 to 3.79) over the same period. There were social inequalities in suicide mortality in favour of people in better-off provinces. In addition, there was an increasing trend in these social disparities over time, although it was not statistically significant.
  
  
  CONCLUSIONS
  We found substantial overall, gender and social disparities in the distribution of suicide mortality across the provinces in Iran. The findings showed that men in the provinces with low socioeconomic status are at higher risk of suicide mortality. Further analyses are needed to explain these disparities.
authors.affiliation: Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden Research Centre for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Aliasghar A
authors.initials: AA
authors.lastname: Kiadaliri
authors.affiliation: Sina Trauma and Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Soheil
authors.initials: S
authors.lastname: Saadat
authors.affiliation: Medical Records Department, Iranian Forensic Medicine Organization, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Shahnavazi
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Hassan
authors.initials: H
authors.lastname: Haghparast-Bidgoli
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D012042:Registries; D012737:Sex Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors
keywords: Iran; Pure inequality; Social inequality; Suicide mortality; Temporal analysis