Worldwide suicide mortality trends(2000-2019):A joinpoint regression analysis

BACKGROUND Studies exploring suicide mortality on a global scale are sparse,and most evaluations were limited to certain populations.AIM To assess global,regional and national trends of suicide mortality.METHODS Suicide mortality data for the period 2000-2019 were obtained from the mortality database of the World Health Organization and the Global Burden of Disease Study.Age-standardized rates(ASRs;expressed per 100000)were presented.To assess trends of suicide mortality,joinpoint regression analysis was used:The average annual percent change(AAPC)with the corresponding 95%confidence interval(95%CI)was calculated.RESULTS A total of 759028(523883 male and 235145 female)suicide deaths were reported worldwide in 2019.The global ASR of mortality of suicide was 9.0/100000 population in both sexes(12.6 in males vs 5.4 in females).In both sexes,the highest rates were found in the region of Africa(ASR=11.2),while the lowest rates were reported in Eastern Mediterranean(ASR=6.4).Globally,from 2000 to 2019,ASRs of mortality of suicide had a decreasing tendency in both sexes together[AAPC=-2.4%per year;95%CI:(-2.6)-(-2.3)].The region of the Americas experienced a significant increase in suicide mortality over 2000-2019 unlike other regions that had a declining trend.Out of all 133 countries with a decline in suicide mortality,Barbados(AAPC=-10.0%),Grenada(AAPC=-8.5%),Serbia(AAPC=-7.6%),and Venezuela(AAPC=-6.2%)showed the most marked reduction in mortality rates.Out of all 26 countries with a rise in suicide mortality,Lesotho(AAPC=+6.0%),Cyprus(AAPC=+5.1%),Paraguay(AAPC=+3.0%),Saudi Arabia(AAPC=+2.8%),Brunei(AAPC=+2.6%),Greece(AAPC=+2.6%),Georgia(AAPC=+2.1%),and Mexico(AAPC=+2.0%),are among those with the highest increase in mortality.CONCLUSION Decreasing trends in suicide mortality were observed in most countries across the world.Unfortunately,the mortality of suicide showed an increasing trend in a number of populations.Further research should explore the reasons for these unfavorable trends,in order to consider and recommend more efforts for suicide prevention in these countries.

Temporal Trends of Maternal Mortality Due to Obstetric Hemorrhage in Chinese Mainland: Evidence from the Population-Based Surveillance Data Between 2000 and 2019

Objective:To analyze the temporal trends of maternal mortality ratio(MMR)due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019,to identify whether the rate of change has accelerated or slowed down during this period,and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future.Methods:Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019.Maternal death was defined according to the World Health Organization’s criterion.The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases-10.Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable.The MMR and 95%confidence intervals(CI)for regions or causes were estimated by Poisson’s distribution.Joinpoint regression was used to assess the accurate temporal patterns.Results:The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births(95%CI:15.0–22.2)in 2000.It peaked in 2001(22.1 per 100,000 live births,95%CI:18.3–26.4)and was lowest in 2019(1.6 per 100,000 live births,95%CI:1.0–2.3).For specific regions,the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise,followed by a rapid decline,and then a slow decline.For specific causes,no change point was found in joinpoint analysis of the national MMR caused by placenta previa,postpartum uterine atony,and retained placenta(the annual percent change was12.0%,10.5%,and21.0%,respectively).The MMR caused by postpartum hemorrhages(PPH)significantly declined by 8.0%(95%CI:1.9–13.6)per year from 2000 to 2007.The annual percent change of MMR caused by PPH accelerated further to25.0%between 2007 and 2011,and then decreased to7.8%between 2011 and 2019.The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6%(8/105)in 2000 to 14.3%(4/28)in 2019.The changes in the proportion of causes were different for maternal deaths due to PPH.The proportion of postpartum uterine atony increased from 39.0%(41/105)in 2000 to 60.7%(17/28)in 2019,and the proportion of uterine rupture also increased from 12.3%(13/105)in 2000 to 14.3%(4/28)in 2019.However,the proportion of retained placenta decreased from 37.1%(39/105)in 2000 to 7.1%(2/28)in 2019.Conclusion:Over the last 20 years,the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage.However,the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture.China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage,especially for postpartum uterine atony and uterine rupture.