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    • The findings suggest that people who attend

    2018-10-30

    The findings suggest that people who attend college but drop out or earn a vocational AA benefit little with respect to their biological risk profile from their postsecondary schooling. These findings have implications for population health research and also for health policy. About 28% of American adults age 25 and older, or about 54 million people, fall into the subbaccalaureate category (U.S. Census Bureau, 2012). Poorer health than expected among this group must be addressed in health care and educational policy and planning. For population health research, understanding why a large proportion of the adult US population fails to follow the health gradient can provide critical new knowledge toward understanding the relationship between education and health in general.
    Acknowledgment This study was supported by funding from the National Institutes of Health (the National Institute on Aging Grant 5R05AG050130 to Zajacova). The authors also thank the Research Office of the University of Wyoming and the School of Public Health at the University of Michigan-Flint, Department of Public Health and Health Sciences, for financial support to access restricted NHANES data.
    Introduction Suicide is a tragic end of life and a major public health issue that accounted for 804,000 deaths worldwide in 2012 (WHO, 2014). China was the second top contributor to that number, due partly to its large population. Suicide rates have been consistently higher in rural China than in the country\'s urban areas (Liu et al., 2015; Phillips et al., 2002; Wang, Chan, & Yip, 2014). During the inhibitor of catalase 2009–2011, 79% of completed suicides in China occurred among rural residents (Wang et al., 2014) although only about half of the Chinese population lived in rural areas (National Bureau of Statistics of China, 2012). Most suicide research in China has focused on individual-level risk factors (see Li, Li, & Cao, 2012 for a review). The knowledge generated from this line of research, while valuable, has limitations for suicide prevention and may mask plausible fundamental causes of suicide (Rehkopf & Buka, 2006). Some studies have employed aggregate data to identify gender, age, and rural-urban patterns of suicide in China (Liu et al., 2015; Phillips, Li & Zhang, 2002; Wang et al., 2014). One found that counties with higher socioeconomic levels (as measured by the inhabitants\' mean years of education) had lower suicide rates, and that higher proportions of divorced people were associated with lower suicide rates in young females (Liu et al., 2015). Another study found that perceived community stress and problems were correlated with the risk of suicide among rural young adults (Zhang & Wang, 2012). Overall, few studies have examined the influence of neighborhood-level factors on suicide in China. Using data from a nationally representative survey, this ecological study examines the associations between village characteristics that are related to social fragmentation and socioeconomic deprivation and suicide rates in Chinese rural villages.
    Methods
    Results
    Discussion Based on village-level data collected from a national survey in China, we conducted an ecological study of suicide and found that both social fragmentation—indicated by out-migration, in-migration, and ethnic diversity; and socioeconomic deprivation—indicated by infrastructure deficiency and public transit accessibility, are positively associated with suicide rates in Chinese rural villages. The percentage of older adults is also positively associated with suicide rates. Some studies in the West have suggested that social fragmentation is more strongly associated with area suicide rates than socioeconomic deprivation (see Gunnell, 2005). But our findings show that the effects of socioeconomic deprivation remained strong after controlling for social fragmentation indicators whereas the effects of out-migration (a social fragmentation indicator) were greatly reduced after controlling for socioeconomic deprivation indicators. This suggests that socioeconomic deprivation is a strong and robust correlate of suicide in Chinese rural villages. Such findings are consistent with studies conducted in other Asian regions (Chang et al., 2011; Hong & Knapp, 2013; Hsu, Chang, Lee & Yip, 2015). Below we highlight the association between some village characteristics and suicide.