Few studies in the Southeastern U.S. have examined county-level spatial patterning in suicide clusters, and no studies have examined clustering at the census block group. The objective of this retrospective ecological study is to identify high-risk suicide clusters and characterize the community-level factors associated with suicides inside and outside spatial clusters. We used the discrete Poisson SatScan statistic to identify spatial clusters in suicide for North Carolina, 2000–2017. A suicide cluster was defined as a statistically significant cluster of suicide events. Community-level determinants were obtained from the American Community Survey, and logistic regression models were used to examine the association between community-level determinants and suicide clusters. A total of 12 statistically significant high-risk spatial clusters were identified. Clusters were also identified for specific age-demographics, including adolescents ( ). The risk ratios of suicide varied from 1.27 to 2.05 in high-risk clusters, and spatial clustering was positively associated with being male or residence in a rural area. Multivariable logistic regression found strong associations with income, population change, and educational attainment. Our results highlight the significant geographic heterogeneity in suicide across North Carolina and the need for more research that identifies localized suicide clusters for targeted public health interventions.

中文翻译：

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2000年至2017年北卡罗来纳州自杀者和邻里决定因素的空间聚类

在美国东南部，很少有研究调查自杀集群中县级的空间格局，而没有研究调查人口普查区组的集群。这项回顾性生态研究的目的是确定高风险自杀群，并表征与空间群内外的自杀相关的社区层面因素。我们使用离散的Poisson SatScan统计量来确定北卡罗来纳州2000–2017年自杀的空间簇。自杀群被定义为自杀事件的统计显着群。从美国社区调查获得社区级别的决定因素，并使用逻辑回归模型检查社区级别的决定因素与自杀群体之间的关联。总共确定了12个具有统计意义的高风险空间聚类。还针对特定年龄人口统计资料（包括青少年）确定了聚类。在高危人群中自杀的风险比从1.27到2.05不等，空间群集与男性或居住在农村地区呈正相关。多变量logistic回归发现与收入，人口变化和教育程度密切相关。我们的结果强调了北卡罗来纳州自杀的显着地理异质性，以及需要进行更多研究来确定针对本地公共卫生干预措施的局部自杀群体。空间聚集与男性或居住在农村地区呈正相关。多变量logistic回归发现与收入，人口变化和教育程度密切相关。我们的结果强调了北卡罗来纳州自杀的显着地理异质性，以及需要进行更多研究来确定针对本地公共卫生干预措施的局部自杀群体。空间聚集与男性或居住在农村地区呈正相关。多变量logistic回归发现与收入，人口变化和教育程度密切相关。我们的结果强调了北卡罗来纳州自杀的显着地理异质性，以及需要进行更多研究来确定针对本地公共卫生干预措施的局部自杀群体。