Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death — United States, 2001–2015

Abstract

Problem/ConditionSuicide is a public health problem and one of the top 10 leading causes of death in the United States. Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas. Understanding demographic trends and mechanisms of death among and within urbanization levels is important to developing and targeting future prevention efforts.Reporting Period2001–2015.Description of SystemMortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates filed in the 50 states and the District of Columbia. NVSS was used to identify suicide deaths, defined by International Classification of Diseases, 10th Revision (ICD-10) underlying cause of death codes X60–X84, Y87.0, and U03. This report examines annual county level trends in suicide rates during 2001–2015 among and within urbanization levels by select demographics and mechanisms of death. Counties were collapsed into three urbanization levels using the 2006 National Center for Health Statistics classification scheme. ResultsSuicide rates increased across the three urbanization levels, with higher rates in nonmetropolitan/rural counties than in medium/small or large metropolitan counties. Each urbanization level experienced substantial annual rate changes at different times during the study period. Across urbanization levels, suicide rates were consistently highest for men and non-Hispanic American Indian/Alaska Natives compared with rates for women and other racial/ethnic groups; however, rates were highest for non-Hispanic whites in more metropolitan counties. Trends indicate that suicide rates for non-Hispanic blacks were lowest in nonmetropolitan/rural counties and highest in more urban counties. Increases in suicide rates occurred for all age groups across urbanization levels, with the highest rates for persons aged 35–64 years. For mechanism of death, greater increases in rates of suicide by firearms and hanging/suffocation occurred across all urbanization levels; rates of suicide by firearms in nonmetropolitan/rural counties were almost two times that of rates in larger metropolitan counties. InterpretationSuicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death.Public Health ActionInterventions to prevent suicides should be ongoing, particularly in rural areas. Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities. In addition, distribution of socioeconomic factors varies in different communities and needs to be better understood in the context of suicide prevention.

Vital Signs:Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015

“…From 1999 to 2015, suicide rates increased among both sexes, all racial/ethnic groups, and all urbanization levels ( 2 , 3 ). Suicide rates have also increased among persons in all age groups <75 years, with adults aged 45–64 having the largest absolute rate increase (from 13.2 per 100,000 persons [1999] to 19.2 per 100,000 [2016]) and the greatest number of suicides (232,108) during the same period ( 1 , 3 ).…”

Rising US Suicides: Achieving Health Equity

“…Within the US, suicide rates are consistently highest in rural areas, followed by medium-sized cities, and lowest in large cities (Figure 2A) [3,[28][29][30][31]. This is true for both men and women and all racial/ethnic groups, with the exception of NHB ( Figure 2B) (and see below) [3].…”

“…In other words, increased suicide rates track closely with increasing rurality (decreasing urbanization). From 2001-2015, suicide rates increased in all urbanization categories, but increased more rapidly in medium/small metro and non-metro/rural areas [3,29], resulting in growing disparities in suicide rates between these regions (Figure 2A).…”

Traumatic Brain Injury–Related Deaths by Race/Ethnicity, Sex, Intent, and Mechanism of Injury — United States, 2000–2017

“…Whereas the rates of TBI-related deaths among whites and blacks were similar from 2001 to 2006, the rates among whites subsequently exceeded those among blacks, presumably related to a 32% increase in TBI-related suicide deaths among whites, from 5.9 per 100,000 during 2006–2008 to 7.8 during 2015–2017. Previous data have documented an increasing prevalence of suicide among whites and AI/ANs ( 6 ). These findings suggest that tailored prevention efforts might be needed to help reduce the prevalence of TBI among different groups at risk for injury.…”