Trends in suicide by hanging, strangulation, and suffocation in Serbia, 1991-2020: A joinpoint regression and age-period-cohort analysis

Table 1 Suicide mortality by hanging/strangulation/suffocation in Serbia, 1991-2020; number of cases and age standardized rate per 100000 (using World standard population)

Year	All		Males		Females
	Number	ASR	Number	ASR	Number	ASR
1991	978	9.1	690	14.1	288	4.7
1992	1010	9.1	697	13.7	313	5.0
1993	1033	9.2	690	13.6	343	5.4
1994	948	8.5	679	13.3	269	4.3
1995	830	7.4	588	11.4	242	4.0
1996	909	8.3	638	12.6	271	4.5
1997	907	8.1	649	12.6	258	4.0
1998	857	7.6	594	11.6	263	4.2
1999	947	8.2	661	12.7	286	4.3
2000	919	7.7	646	12.1	273	3.9
2001	860	7.4	605	11.4	255	3.9
2002	876	7.4	644	12.0	232	3.3
2003	807	6.9	600	11.5	207	2.9
2004	836	7.1	623	11.6	213	3.2
2005	856	6.9	609	11.0	247	3.2
2006	881	7.3	640	11.7	241	3.3
2007	841	7.0	609	11.1	232	3.3
2008	804	6.9	572	10.6	232	3.4
2009	836	7.1	630	11.6	206	3.1
2010	745	5.9	562	9.7	183	2.4
2011	818	6.8	603	10.9	215	3.1
2012	807	6.7	616	11.1	191	2.7
2013	734	6.1	562	10.1	172	2.5
2014	720	5.9	558	9.9	162	2.2
2015	646	5.4	501	9.0	145	2.1
2016	603	5.2	451	8.4	152	2.2
2017	614	5.1	481	8.7	133	1.9
2018	586	4.8	466	8.2	120	1.7
2019	586	5.1	453	8.5	133	1.9
2020	546	4.5	433	7.6	113	1.7
Overall	24340	7.0	17750	11.1	6590	3.3

ASR: Age-standardized rate.

Table 2 Joinpoint regression analysis¹ of suicide mortality by hanging/strangulation/suffocation in both sexes in Serbia, by age, 1991-2020

Age2	Year 1991		Year 2020		Number of joinpoints	AAPC		Lower 95%CI	Upper 95%CI
	No of cases	rates	No of cases	rates
Age-specific rates3
10-19	9	0.9	4	0.6	0	- 2.71	-4.4		-1.1
20-29	56	5.8	20	2.5	0	- 1.51	-2.4		-0.6
30-39	101	8.4	45	4.7	0	- 1.21	-1.8		-0.6
40-49	133	14.1	69	7.1	0	- 1.51	-2.2		-0.8
50-59	190	17.5	100	10.8	0	- 1.41	-1.8		-1.1
60-69	219	23.7	123	12.4	0	- 2.81	-3.1		-2.4
70-79	161	48.6	107	18.5	0	- 3.51	-4.1		-2.9
80+	109	76.5	78	24.5	0	- 3.41	-3.9		-3.0
Age-standardized rates3
All ages	978	9.1	546	4.5	1	-2.11	-2.4		-1.8

¹Statistically significant trend.

²Joinpoint results are not shown for the subgroups aged < 10 yr, because during the observed period, a total of 2 cases of suicide by hanging/strangulation/suffocation deaths occurred in both sexes.

³Per 100000 people.

AAPC: Average annual percentage change; CI: Confidence interval.

Table 3 Joinpoint analysis: Trends¹ in age-specific suicide mortality rates (per 100000) by hanging/strangulation/suffocation in Serbia, by sexes, 1991-2020

Age2	Males		Females
	Period	APC (95%CI)	Period	APC (95%CI)
10-19	1991-2020	-2.81 (-4.4 to -1.0)	3
20-29	1991-2020	-1.21 (-2.1 to -0.3)	3
30-39	1991-2014	-0.1 (-1.0 to +0.7)	1991-2020	-2.21 (-3.3 to -1.1)
	2014-2020	-7.71 (-13.5 to -1.5)
	Full period4	-1.11 (-1.7 to -0.4)
40-49	1991-2011	+0.3 (-0.9 to +1.4)	1991-2020	-3.21 (-4.4 to -2.1)
	2011-2020	-4.91 (-8.5 to -1.1)
	Full period	-1.01 (-1.7 to -0.2)
50-59	1991-2020	-0.81 (-1.3 to -0.4)	1991-2020	-3.21 (-4.0 to -2.5)
60-69	1991-2020	-2.31 (-2.8 to -1.8)	1991-2008	-2.21 (-3.8 to -0.6)
			2008-2020	-7.61 (-10.1 to -5.0)
			Full period	-4.31 (-5.1 to -3.5)
70-79	1991-2020	-3.11 (-3.6 to -2.5)	1991-2020	-4.71 (-5.5 to -3.9)
80+	1991-2020	-3.21 (-3.7 to -2.7)	1991-2020	-3.81 (-4.9 to -2.8)
All ages	1991-2012	-1.21 (-1.6 to -0.9)	1991-2020	-3.51 (-3.9 to -3.1)
	2012-2020	-3.71 (-5.2 to -2.3)
	Full period	-1.71 (-2.0 to -1.4)

¹Statistically significant trend.

²Joinpoint results are not shown for the subgroups aged < 10 yr, because during the observed period, a total of 1 case of suicide by hanging/ strangulation/suffocation deaths occurred in men and 1 case in women.

³Incalculable: Joinpoint results are not shown because fewer than 10 cases of suicide by hanging/strangulation/suffocation occurred in each of the decennium in any year.

⁴For full period presented average annual percent change.

APC: Annual percent change; CI: Confidence interval.

Table 4 Age, period, and cohort effects on suicide mortality by hanging/strangulation/suffocation in Serbia, by sexes, 1991-2020

Group		Males		Females
		Effect	95%CI	Effect	95%CI
Age	10-14	1.7	0.9–3.1	0.8	0.2–3.1
	15-19	4.4	3.0–6.4	1.6	0.7–3.6
	20-24	8.4	6.3–11.3	2.9	1.6–5.2
	25-29	9.3	7.1–12.1	3.1	1.8–5.2
	30-34	10.8	8.7–13.5	3.7	2.5–5.5
	35-39	12.7	10.5–15.4	4.2	2.9–5.9
	40-44	15.3	12.9–18.2	4.2	3.1–5.9
	45-49	17.4	14.8–20.5	5.1	3.7–6.9
	50-54	21.1	17.1–23.7	5.2	3.8–7.1
	55-59	21.5	17.3–24.3	5.2	3.7–7.1
	60-64	21.4	17.7–25.8	5.2	3.7–7.3
	65-69	21.2	17.3–25.9	5.3	3.7–7.6
	70-74	25.1	20.3–31.0	5.5	3.8–8.0
	75-79	30.8	24.5–38.5	5.7	3.9–8.4
Period	1991-1995	1.1	0.9–1.2	1.3	1.1–1.7
	1996-2000	1.0	0.9–1.2	1.2	1.0–1.5
	2001-2005	1.0	1.0–1.0	1.0	1.0–1.0
	2006-2010	1.0	0.9–1.1	0.9	0.7–1.1
	2011-2015	0.9	0.8–1.0	0.7	0.5–0.9
	2016-2020	0.7	0.6–0.8	0.5	0.4–0.7
Cohort	1916–1920	2.9	2.0–4.3	6.4	3.6–11.3
	1921–1925	2.2	1.7–2.9	4.5	2.9–7.0
	1926–1930	1.9	1.5–2.4	3.3	2.2–4.9
	1931–1935	1.7	1.4–2.1	2.7	1.9–3.9
	1936–1940	1.4	1.2–1.7	2.3	1.6–3.3
	1941–1945	1.2	1.0–1.5	1.9	1.3–2.6
	1946–1950	1.1	0.9–1.3	1.4	1.0–2.0
	1951–1955	1.1	0.9–1.3	1.1	0.8–1.5
	1956–1960	1.1	0.9–1.3	1.1	0.8–1.6
	1961–1965	1.0	1.0–1.0	1.0	1.0–1.0
	1966–1970	0.9	0.8–1.1	0.8	0.5–1.2
	1971–1975	0.9	0.8–1.2	0.6	0.4–0.9
	1976–1980	0.9	0.7–1.1	0.7	0.4–1.1
	1981–1985	0.9	0.7–1.2	0.6	0.4–1.0
	1986–1990	0.8	0.6–1.1	0.4	0.2–0.8
	1991–1995	0.7	0.4–1.0	0.5	0.2–1.1
	1996–2000	0.7	0.4–1.1	0.2	0.1–1.0
	2001–2005	0.6	0.3–1.5	0.1	0.0–4.7
	2006–2010	0.4	0.0–2.9	0.1	0.0–49.4
		Wald Chi-square tests for estimable functions, P value
Net drift		< 0.000		< 0.000
All period rate ratios		< 0.000		< 0.000
All cohort rate ratios		< 0.000		< 0.000
All local drifts		0.092		0.897

CI: Confidence interval.