Overcoming Standardization: Revealing Hidden Age Patterns of Suicide with Spatiotemporal Models

Abstract: Indirect standardization is widely used in disease mapping to control for confounding, but relies on restrictive assumptions that may bias estimates if violated. Using data on suicide-related emergency calls, this study highlights such limitations and proposes age-structured hierarchical Bayesian models as an alternative. These models incorporate space-time, space-age, and time-age interactions, allowing for more accurate estimation without strong assumptions. The results show improved model fit, especially when including age effects. The best model reveals a rising temporal trend (2017--2022), a nonlinear age pattern, and stronger risk increases among younger individuals compared to older ones.