Poverty and suicide risk in older adults: A retrospective longitudinal cohort study

Objectives: We aimed to identify the impact of poverty on suicide risk in older adults. Method: The data used in this study was obtained from the National Health Insurance Service-Senior claims database from 2002 to 2013. A total of 558 147 individuals were followed for up to 12 years. Poverty was assessed from insurance premium levels, and causes of death were analysed by linking individuals' deaths to the data for causes of death from the National Statistics Office in South Korea. Cox proportional hazard models were used to analyse the associations between poverty and suicide deaths after adjustments for possible confounders. Results: Among 558 147 older adults (aged 60-119 years), the poverty group had an increased risk of suicide compared with the high-income group (adjusted hazard ratio [AHR], 1.34; 95% confidence interval [CI], 1.22-1.47), and poverty-group males had a significantly higher risk of suicide than males in the high-income group (AHR, 1.50; 95% CI, 1.33-1.68). Adults aged 60 to 74 years in the poverty group had a higher risk of suicide than those with a high income in the same age group (AHR, 1.41; 95% CI, 1.27-1.57). However, no statistically significant income gradient was found for females or adults aged 75 years or older. Conclusions: Our findings revealed that poverty is a risk factor for death by suicide in older adults. Suicide prevention strategies for older adults should be specifically tailored by income level.