Changes in Suicide Rates - United States, 2018-2019 - PubMed (original) (raw)

Changes in Suicide Rates - United States, 2018-2019

Deborah M Stone et al. MMWR Morb Mortal Wkly Rep. 2021.

Abstract

Suicide is the 10th leading cause of death in the United States overall, and the second and fourth leading cause among persons aged 10-34 and 35-44 years, respectively (1). In just over 2 decades (1999-2019), approximately 800,000 deaths were attributed to suicide, with a 33% increase in the suicide rate over the period (1). In 2019, a total of 12 million adults reported serious thoughts of suicide during the past year, 3.5 million planned a suicide, and 1.4 million attempted suicide (2). Suicides and suicide attempts in 2019 led to a lifetime combined medical and work-loss cost (i.e., the costs that accrue from the time of the injury through the course of a person's expected lifetime) of approximately $70 billion (https://wisqars.cdc.gov:8443/costT/). From 2018 to 2019, the overall suicide rate declined for the first time in over a decade (1). To understand how the decline varied among different subpopulations by demographic and other characteristics, CDC analyzed changes in counts and age-adjusted suicide rates from 2018 to 2019 by demographic characteristics, county urbanicity, mechanism of injury, and state. Z-tests and 95% confidence intervals were used to assess statistical significance. Suicide rates declined by 2.1% overall, by 3.2% among females, and by 1.8% among males. Significant declines occurred, overall, in five states. Other significant declines were noted among subgroups defined by race/ethnicity, age, urbanicity, and suicide mechanism. These declines, although encouraging, were not uniform, and several states experienced significant rate increases. A comprehensive approach to prevention that uses data to drive decision-making, implements prevention strategies from CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices with the best available evidence, and targets the multiple risk factors associated with suicide, especially in populations disproportionately affected, is needed to build on initial progress from 2018 to 2019 (3).

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Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Figures

FIGURE 1

FIGURE 1

Suicide* mechanism of injury,† by level of urbanization§ — National Vital Statistics System, United States, 2019 * Suicide deaths were identified by using_International Classification of Diseases, Tenth Revision_underlying cause-of-death codes U03, X60–X84, and Y87.0. † “Other” mechanisms of injury include other land transport, struck by/against, other specified, and unspecified. § Urbanization level of the decedent’s county of residence was categorized by using the 2013 National Center for Health Statistics Urban–Rural Classification Scheme for Counties (

https://www.cdc.gov/nchs/data\_access/urban\_rural.htm

). The classification levels for counties are as follows: 1) large central metropolitan (large central metro): part of a metropolitan statistical area with ≥1 million population and covers a principal city; 2) large fringe metropolitan (large fringe metro): part of a metropolitan statistical area with ≥1 million population but does not cover a principal city; 3) medium metropolitan (medium metro): part of a metropolitan statistical area with ≥250,000 but <1 million population; 4) small metropolitan (small metro): part of a metropolitan statistical area with <250,000 population; 5) micropolitan (nonmetro): part of a micropolitan statistical area (has an urban cluster of ≥10,000 but <50,000 population); and 6) noncore (nonmetro): not part of a metropolitan or micropolitan statistical area.

FIGURE 2

FIGURE 2

Overall age-adjusted rate*,† of suicide,§ by state — National Vital Statistics System, United States, 2018 and 2019 * Age-adjusted death rates per 100,000 population were calculated by using the direct method and the 2000 U.S. standard population. Rates are rounded to one digit. † States with statistically significant changes (p≤0.05); Z-tests were used if the number of deaths was ≥100 in both 2018 and 2019; nonoverlapping confidence intervals based on the gamma method were used if the number of deaths was <100 in 2018 or 2019. States with statistically significant changes were Hawaii, Idaho, Indiana, Massachusetts, Nebraska, North Carolina, and Virginia. § Suicide deaths were identified by using_International Classification of Diseases, Tenth Revision_underlying cause-of-death codes U03, X60–X84, and Y87.0.

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