Background: Suicide remains a major public health concern worldwide, responsible for more than 700,000 deaths in 2021, accounting for approximately 1.1\% of all global deaths. While many high-income countries have reported declines in age-standardized suicide rates over the past two decades, recent evidence from Spain indicates increasing mortality among women, whereas suicide rates among men have remained relatively stable. To better understand these patterns and their potential underlying determinants, this study examines the spatial and temporal patterns of age-stratified suicide mortality across Spanish provinces from 2010 to 2022, with particular attention to sex-specific differences. Methods: Mixed Poisson models were applied to analyze provincial- and temporal-level suicide mortality rates, stratified by age and sex. The models accounted for spatial and temporal confounding effects and examined associations with various socioeconomic and contextual factors, including rurality and unemployment. Results: Findings highlight the influence of rurality and unemployment on suicide mortality, with distinct gender-specific patterns. A 10$\%$ increase in the proportion of residents living in rural areas was associated with more than a 5$\%$ rise in male suicide mortality, while a 1$\%$ increase in the annual unemployment rate was linked to a 2.4$\%$ increase in female suicide mortality. Although male suicide rates remained consistently higher than female rates, a notable and steady upward trend was observed in female suicide mortality over the study period. Conclusions: The use of sophisticated statistical models permits the detection of underlying patterns, revealing both geographic and temporal disparities in suicide mortality across Spanish provinces.

翻译：背景：自杀仍是全球范围内的重大公共卫生问题，2021年导致超过70万人死亡，约占全球总死亡人数的1.1%。尽管许多高收入国家报告过去二十年年龄标准化自杀率呈下降趋势，但西班牙最新证据显示女性自杀死亡率持续上升，而男性自杀率保持相对稳定。为深入理解这些模式及其潜在决定因素，本研究分析了2010年至2022年西班牙各省份按年龄分层的自杀死亡率时空格局，特别关注性别差异。方法：采用混合泊松模型分析省级和时间层面的自杀死亡率数据，按年龄和性别分层。模型控制了时空混杂效应，并检验了与多项社会经济及环境因素（包括乡村化程度与失业率）的关联性。结果：研究发现乡村化程度与失业率对自杀死亡率的影响存在显著性别差异。乡村地区居民比例每增加10%，男性自杀死亡率上升超过5%；而年度失业率每上升1%，女性自杀死亡率增加2.4%。尽管男性自杀率始终高于女性，但研究期间女性自杀死亡率呈现显著且稳定的上升趋势。结论：通过运用精细统计模型，本研究揭示了西班牙各省份自杀死亡率存在的地理差异与时间异质性。