Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-2021

Background: Risk of suicide is complex and often a result of multiple interacting factors. It is vital research identifies predictors of suicide to provide a strong evidence base for targeted interventions. Methods: Using linked Census and population level mortality data we estimated rates of suicide across different groups in England and Wales and examine which factors are independently associated with the risk of suicide. Findings: The highest rates of suicide were amongst those who reported an impairment affecting their day-to-day activities, those who were long term unemployed or never had worked, or those who were single or separated. Rates of suicide were highest in the White and Mixed/multiple ethnic groups compared to other ethnicities, and in people who reported a religious affiliation compared with those who had no religion. Comparison of minimally adjusted models (predictor, sex and age) with fully-adjusted models (sex, age, ethnicity, region, partnership status, religious affiliation, day-to-day impairments, armed forces membership and socioeconomic status) identified key predictors which remain important risk factors after accounting for other characteristics; day-to-day impairments were still found to increase the incidence of suicide relative to those whose activities were not impaired after adjusting for employment status. Overall, rates of suicide were higher in men compared to females across all ages, with the highest rates in 40-to-50-year-olds. Interpretation: The findings of this work provide novel population level insights into the risk of suicide by sociodemographic characteristics. Understanding the interaction between key risk factors for suicide has important implications for national suicide prevention strategies.