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Purpose <p>To analyse suicide mortality trends in Andalusia, Spain (2000–2024) through age–period–cohort (APC) decomposition, identify trend change-points, and quantify pandemic-associated excess mortality.</p> Methods <p>This population-based study used Spanish National Statistics Institute data (INE; heading 098, ICD-10 × 60–X84). Age-standardised rates (European Standard Population 2013) were computed by sex. Methods comprised joinpoint regression, Prais–Winsten modelling, an APC model (intrinsic estimator), and a log-linear counterfactual projecting the 2000–2019 trend onto 2020–2024, with quasi-Poisson and age-range sensitivity analyses.</p> Results <p>18,350 suicide deaths were recorded (77.4% male). Crude rates remained stable (EAPC = − 0.12%, <i>p</i> = 0.615) whereas age-standardised rates declined significantly (EAPC = − 0.96%, <i>p</i> &lt; 0.001), revealing demographic masking. Joinpoint regression identified a single change-point reversing the long-term decline, at 2018 for both sexes (EAPC − 1.67% to + 2.65%) and 2019 for men (− 2.01% to + 3.84%); neither post-reversal segment reached significance. The APC model (adults aged 40–84; deviance R² = 0.983) showed an ascending age gradient, a period nadir in 2015–2019, and declining cohort risk. The counterfactual estimated 783 excess deaths during 2020–2024 (O/E = 1.23, 95% CI 1.20–1.27; <i>p</i> &lt; 0.001), concentrated among those aged 15–64.</p> Conclusion <p>The age-standardised decline reached its nadir around 2018–2019 and reversed thereafter; relative to the projected pre-pandemic trend, the pandemic period (2020–2024) showed a sustained excess without attenuation over the five years observed. These findings support age-targeted prevention; provincial heterogeneity warrants formal subnational analyses before recommending geographically differentiated strategies.</p>

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Age–period–cohort effects on suicide mortality in Andalusia, Spain (2000–2024): demographic masking and sustained pandemic excess

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Carlos Romero-Olóriz,
  • Esperanza López Hidalgo,
  • María Victoria Villalba Soria,
  • Miguel Guerrero Díaz

摘要

Purpose

To analyse suicide mortality trends in Andalusia, Spain (2000–2024) through age–period–cohort (APC) decomposition, identify trend change-points, and quantify pandemic-associated excess mortality.

Methods

This population-based study used Spanish National Statistics Institute data (INE; heading 098, ICD-10 × 60–X84). Age-standardised rates (European Standard Population 2013) were computed by sex. Methods comprised joinpoint regression, Prais–Winsten modelling, an APC model (intrinsic estimator), and a log-linear counterfactual projecting the 2000–2019 trend onto 2020–2024, with quasi-Poisson and age-range sensitivity analyses.

Results

18,350 suicide deaths were recorded (77.4% male). Crude rates remained stable (EAPC = − 0.12%, p = 0.615) whereas age-standardised rates declined significantly (EAPC = − 0.96%, p < 0.001), revealing demographic masking. Joinpoint regression identified a single change-point reversing the long-term decline, at 2018 for both sexes (EAPC − 1.67% to + 2.65%) and 2019 for men (− 2.01% to + 3.84%); neither post-reversal segment reached significance. The APC model (adults aged 40–84; deviance R² = 0.983) showed an ascending age gradient, a period nadir in 2015–2019, and declining cohort risk. The counterfactual estimated 783 excess deaths during 2020–2024 (O/E = 1.23, 95% CI 1.20–1.27; p < 0.001), concentrated among those aged 15–64.

Conclusion

The age-standardised decline reached its nadir around 2018–2019 and reversed thereafter; relative to the projected pre-pandemic trend, the pandemic period (2020–2024) showed a sustained excess without attenuation over the five years observed. These findings support age-targeted prevention; provincial heterogeneity warrants formal subnational analyses before recommending geographically differentiated strategies.