Impact of income inequality and other social determinants on suicide rate in Brazil.
OBJECTIVE
To analyze whether income inequality and other social determinants are associated with suicide rate in Brazil.


METHODS
This study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed.


RESULTS
The Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011-1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948-0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010-1.021).


CONCLUSIONS
Income inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population's socioeconomic conditions and reduce income inequality in Brazil, and in other low and middle-income countries, can help to reduce suicide rates.
Institute of Collective Health, Federal University of Bahia-UFBA, Rua Basílio da Gama s/n, Canela, 40110-040 Salvador, Bahia, Brazil.
Daiane Borges
DB
Machado
Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama s/n-Canela, 40110-040 Salvador, Bahia, Brazil.
Davide
D
Rasella
Institute of Collective Health, Federal University of Bahia-UFBA, Rua Basílio da Gama s/n, Canela, 40110-040 Salvador, Bahia, Brazil.
Darci Neves
DN
Dos Santos
D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D012737:Sex Factors; D012924:Social Conditions; D012959:Socioeconomic Factors; D013405:Suicide