ORIGINAL ARTICLE Sex-specific suicide mortality in the South African urban context: The role of age, race, and geographical location

Aims: This study investigates the importance of sociodemographic and geographical characteristics for suicide risks in the South African urban context. Suicide epidemiology is under-researched in low- and middle-income countries, and such knowledge is important not only for local and national policy, but also for a global understanding of the phenomenon. Methods: Sex-specific crude and adjusted odds ratios (95 % confidence intervals) for suicide by age, race, and city are assessed using logistic regression. Cases aged 45+ years, classified as ‘‘Coloured’ ’ (a category denoting mixed racial origin), and living in Cape Town are used as reference groups. Additionally, the proportion of leading suicide methods within groups was estimated (95 % confidence intervals). Results: For males, compared with each reference group, the odds of suicide are significantly higher during middle adulthood, among Asians and particularly among Whites, and among residents of all but one city. Patterns for women differ in magnitude and distribution. Suicide odds are significantly higher in all age groups, particularly 15–24 years, among Whites, and among residents of all other cities, particularly Nelson Mandela or Buffalo City. Males living in Tshwane and Black females have lower odds of suicide. The distribution of methods across age, race, and city groups varies little for males but substantially for females. Conclusions: Age, race, and city play independent roles in sex-specific suicide rates. As for high-income settings, age, race, method and city are important in sex-specific suicide in the urban South African context. Possible underlying mechanisms deserve greater attention for context-relevant preventive efforts