@article{ref1,
title="Socioeconomic disparities in suicide: causation or confounding?",
journal="PLoS one",
year="2021",
author="Perelman, Julian and Kapadia, Dharmi and Lorant, Vincent",
volume="16",
number="1",
pages="e0243895-e0243895",
abstract="BACKGROUND: Despite an overall reduction in suicide, educational disparities in suicide have not decreased over the last decade. The mechanisms behind educational  disparities in suicide, however, remain unclear: low educational status may increase  the risk of suicide (&quot;causation&quot;) or low educational status and suicide may share  confounders. This paper assesses whether educational disparities in suicide (EDS)  are more likely to be due to causation. <br><br>METHOD: The DEMETRIQ study collected and  harmonized register-based data on mortality follow-up from forty population censuses  from twelve European populations. More than 102,000 suicides were registered over  392 million person-years. Three analyses were carried out. First, we applied an  instrumental variable approach that exploits changes in the legislation on  compulsory educational age to instrument educational status. Second, we analyzed EDS  by age under the hypothesis that increasing EDS over the life cycle supports  causation. Finally, we compared EDS in men and women under the assumption that  greater EDS in women would support causation. <br><br>FINDINGS: The instrumental variable  analysis showed no evidence for causation between higher education and suicide, for  men or women. The life-cycle analysis showed that the decrease of educational  inequalities in suicide between the baseline 1991 period and the 2001 follow-up  period was more pronounced and statistically significant in the first three younger  age groups. The gender analysis indicated that EDS were systematic and greater in  men than in women: the rate ratio of suicide for men with low level of education (RR  = 2.51; 95%CI:2.44-2.58) was higher than the rate ratio in women (RR = 1.32;  95CI%:1.26-1.38). <br><br>INTERPRETATION: Overall, there was little support for the  causation hypothesis, suggesting that the association between education and suicide  is confounded. Educational inequalities in suicide should be addressed in early life  by early targeting of groups who struggle to complete their education and display  higher risk of mental disorder or of mental health vulnerabilities.<p /> <p>Language: en</p>",
language="en",
issn="1932-6203",
doi="10.1371/journal.pone.0243895",
url="http://dx.doi.org/10.1371/journal.pone.0243895"
}