Products – Data Briefs – Number 373- August 2020 – CDC

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PDF Version (703 KB) | Visual Abstract
Kristen Pettrone, M.D., M.P.H., and Sally C. Curtin, M.A.
Data from the National Vital Statistics System, Mortality
Suicide has remained the 10th leading cause of death in the United States since 2008, with deaths due to firearms, suffocation (including hangings), and poisoning representing the leading methods of suicide (1,2). There are known differences in suicide rates by sex and geographic distribution (3). This report uses final mortality data from the National Vital Statistics System to present trends in suicide mortality from 2000 through 2018 among all ages by urban–rural classification of the decedent’s county of residence and sex for the leading methods of suicide—firearms, suffocation, and poisoning.
Keywords: intentional self-harm, urban-rural, firearm, suffocation, poisoning, male-female
 
Figure 1. Age-adjusted suicide rates, by urban–rural status: United States, 2000–2018

Figure 1. This is a line chart of urban-rural suicide rates for the United States, 2000–2018.
1Significant increasing trend from 2000 through 2018, with different rates of change over time; p < 0.05.
NOTES: Suicides in all ages are identified using the International Classification of Diseases, 10th Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. Age-adjusted death rates are calculated using the direct method and the 2000 U.S. standard population. Classification of the decedent’s county of residence is based on the 2013 NCHS Urban–Rural Classification Scheme for Counties, available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf. Access data table for Figure 1.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.
 
Figure 2. Age-adjusted suicide rates, by sex and urban–rural status: United States, 2000–2018

Figure 2. This is a line chart of suicide rates by sex and urban-rural status for all ages for the United States, 2000–2018.
1Stable trend from 2000 to 2007; significant increasing trend from 2007 through 2018; p < 0.05.
2Stable trend from 2000 to 2005; significant increasing trend from 2005 to 2016; stable trend from 2016 through 2018; p < 0.05.
3Significant increasing trend from 2000 through 2018; p < 0.05.
4Significant increasing trend from 2000 to 2015, with different rates of change over time; stable trend from 2015 through 2018, p < 0.05.
NOTES: Suicides in all ages are identified using the International Classification of Diseases, 10th Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. Age-adjusted death rates are calculated using the direct method and the 2000 U.S. standard population. Classification of the decedent’s county of residence is based on the 2013 NCHS Urban–Rural Classification Scheme for Counties, available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf. Access data table for Figure 2.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.
 
Figure 3. Age-adjusted suicide rates among males, by leading method and urban–rural status: United States, 2000–2018

Figure 3. This is a line chart of male suicide rates by three leading methods (firearms, suffocation, and poisoning) and urban-rural status for the United States, 2000–2018.
1Stable trend from 2000 to 2006; significant increasing trend from 2006 through 2018; p < 0.05.
2Significant decreasing trend from 2000 to 2006; significant increasing trend from 2006 through 2018; p < 0.05.
3Significant increasing trend from 2000 through 2018, with different rates of change over time; p < 0.05.
4Significant increasing trend from 2000 through 2018; p < 0.05.
5Significant increasing trend from 2000 to 2010; significant decreasing trend from 2010 through 2018; p < 0.05.
6Significant decreasing trend from 2000 through 2018; p < 0.05.
NOTES: Suicides in all ages are identified using the International Classification of Diseases, 10th Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. Age-adjusted death rates are calculated using the direct method and the 2000 U.S. standard population. Classification of the decedent’s county of residence is based on the 2013 NCHS Urban–Rural Classification Scheme for Counties, available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf. Access data table for Figure 3.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.
 
Figure 4. Age-adjusted suicide rates among females, by leading method and urban–rural status: United States, 2000–2018

Figure 4. This is a line chart of female suicide rates by three leading methods (firearms, suffocation, and poisoning) and urban-rural status for the United States, 2000–2018.
1Significant increasing trend from 2000 to 2014, with different rates of change over time; stable trend from 2014 through 2018; p < 0.05.
2Significant increasing trend from 2000 to 2016, with different rates of change over time; significant decreasing trend from 2016 through 2018; p < 0.05.
3Significant increasing trend from 2000 through 2018; p < 0.05.
4Significant decreasing trend from 2000 to 2006; significant increasing trend from 2006 through 2018; p < 0.05.
NOTES: Suicides in all ages are identified using the International Classification of Diseases, 10th Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. Age-adjusted death rates are calculated using the direct method and the 2000 U.S. standard population. Classification of the decedent’s county of residence is based on the 2013 NCHS Urban–Rural Classification Scheme for Counties, available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf. Access data table for Figure 4.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.
 
In 2018, suicide was the 10th leading cause of death (4). Sex and urban–rural disparities in methods of suicide may inform targeted suicide prevention strategies. From 2000 through 2018, differences in suicide rates between rural and urban areas increased. Rural suicide rates increased 48% from 2000 through 2018 compared with a 34% urban rate increase. In rural and urban areas, suicide rates for males remained higher than for females. The rural male suicide rate was 3.8 times higher than the female rate in 2018, and the urban male suicide rate was 3.6 times higher than the female rate. The rural male suicide rate increased 34% from 2007 through 2018 compared with a 17% urban rate increase. The rural female suicide rate nearly doubled from 2000 through 2018 compared with a 51% urban rate increase.
Of the three leading methods of suicide, firearm-related suicide remained the leading method in 2018 among rural males and females (2). The rural firearm-related suicide rate was 63% higher than the urban rate for males and 82% higher for females. Over the 2000 through 2018 period, suffocation-related suicides had the greatest rate of increase, more than doubling in rural areas for males and quadrupling in rural areas for females. By 2018, suffocation was the leading method of suicide for females in urban areas. Poisoning-related suicides decreased overall from 2000 through 2018 for males in both urban and rural areas and from 2015 through 2018 for females in urban areas.
 
Firearms: Includes handguns, rifles, shotguns or other large firearms, or other unspecified firearms.
Poisoning: Includes overdose of medicinal (such as opioids or sedatives) and nonmedicinal substances (such as gases or other toxic materials).
Suffocation: Includes hanging, strangulation, or other means resulting in oxygen deprivation.
 
The National Vital Statistics System’s multiple-cause-of-death mortality files for 2000–2018 for all ages were used for the analysis in this report (5). International Classification of Diseases, 10th Revision (ICD–10) codes were used to identify suicide deaths: U03, X60–84, and Y87.0. Means of suicide deaths were categorized using the underlying cause-of-death ICD–10 codes: firearms (X72–X74), suffocation (X70), and poisoning (X60–X69). Age-adjusted death rates were calculated using the direct method and the 2000 U.S. standard population (6).
Urban–rural categorization was based on the 2013 NCHS Urban–Rural Classification Scheme for Counties (7). This county-level scheme includes six designations from most urban to most rural: large central metro, large fringe metro, medium metro, small metro, micropolitan, and noncore. For the purposes of this study, urban classification included the four metropolitan categories and rural, the micropolitan and noncore designations. Trends in age-adjusted suicide rates were evaluated using the Joinpoint Regression Program (Version 4.7.0.0) (8). Joinpoint uses a least-squares regression analysis to fit a series of joined lines on a log scale. For this study, the minimum number of joints was zero and the maximum number was three. The level of significance for a change in trend was p less than or equal to 0.05. Urban-rural rates were compared using a two-sided z test with a significance level of 0.05.
 
Kristen Pettrone is with the Centers for Disease Control and Prevention’s Epidemic Intelligence Service, assigned to the National Center for Health Statistics (NCHS), Division of Vital Statistics. Sally C. Curtin is with NCHS’ Division of Vital Statistics.
 
 
Pettrone K, Curtin SC. Urban–rural differences in suicide rates, by sex and three leading methods: United States, 2000–2018. NCHS Data Brief, no 373. Hyattsville, MD: National Center for Health Statistics. 2020.
All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
Brian C. Moyer, Ph.D., Director
Amy M. Branum, Ph.D., Acting Associate Director for Science
Steven Schwartz, Ph.D., Director
Isabelle Horon, Dr.P.H., Acting Associate Director for Science

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