Describing county-level clustering patterns of suicide among Veterans Health Administration patients and all American adults, 2018–2019, using exploratory spatial data analysis

IF 3.6 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology Pub Date : 2025-10-01 Epub Date: 2025-08-19 DOI:10.1016/j.annepidem.2025.08.014

A.R. Cunningham , V. Lebakula , A.G. Cosby , A. Kapadia , J. Trafton , A. Peluso

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引用次数: 0

Abstract

Purpose

Veterans account for 7 % of the adult American population but nearly 14 % of the country’s adult suicides. With a distinct geodemographic profile, veterans represent an important subpopulation for spatial analysis, and their access to Veterans Health Administration (VHA) care can make them a uniquely reachable group for policy interventions and research. Better understanding of VHA patterns in context can inform prevention strategies.

Methods

Hotspot analysis, a type of exploratory spatial data analysis (ESDA), was used to identify county-level clusters with high or low empirical Bayesian smoothed suicide rates among VHA patients in 2018–2019. A parallel analysis was conducted for all American adults. Clusters were then described using county-level characteristics previously linked to suicide prevalence.

Results

Clusters among VHA patients and the general population often overlapped and shared similar features. Cold spots were associated with lower elevations, higher incomes, and higher education levels, whereas hotspots were associated with higher elevations. All cold spots in the general population and most clusters among VHA patients occurred in metropolitan areas, however VHA hotspots also occurred in metropolitan areas.

Conclusions

Juxtaposing VHA and general adult ESDA results elucidates patterns of VHA suicides in context, highlighting spatial clusters as targets for interventions and research.

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利用探索性空间数据分析描述2018-2019年退伍军人健康管理局患者和所有美国成年人自杀的县级聚类模式

退伍军人占美国成年人口的7% %，但却占美国成年自杀人数的14% %。退伍军人具有独特的地理人口特征，是空间分析的重要亚人群，他们获得退伍军人健康管理局（VHA）的护理可以使他们成为政策干预和研究的独特群体。更好地了解VHA模式可以为预防策略提供信息。方法采用探索性空间数据分析（ESDA）方法，对2018-2019年VHA患者经验贝叶斯平滑自杀率高或低的县级聚类进行分析。对所有美国成年人进行了平行分析。然后使用以前与自杀流行率相关的县级特征来描述集群。结果VHA患者与普通人群的聚类经常重叠，并具有相似的特征。冷点与低海拔、高收入和高教育水平相关，而热点与高海拔相关。一般人群的冷点和VHA患者的聚集性主要集中在大都市地区，但VHA热点也集中在大都市地区。结论将VHA和一般成人ESDA结果并置，阐明了VHA自杀的模式，突出了空间集群作为干预和研究的目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.40

自引率

1.80%

发文量

207

审稿时长

59 days

期刊介绍： The journal emphasizes the application of epidemiologic methods to issues that affect the distribution and determinants of human illness in diverse contexts. Its primary focus is on chronic and acute conditions of diverse etiologies and of major importance to clinical medicine, public health, and health care delivery.