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Cited by 319Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseInjury Epidemiology and Prevention

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

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Ivey-Stephenson, Asha Z., Crosby, Alex E., Jack, Shane P. D., Haileyesus, Tadesse, Kresnow-Sedacca, Marcie-jo·2017·MMWR. Surveillance Summaries
DOI 10.15585/mmwr.ss6618a1PMC PMC5829833
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Abstract

PROBLEM/CONDITION: Suicide 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 PERIOD: 2001-2015. DESCRIPTION OF SYSTEM: Mortality 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. RESULTS: Suicide 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. INTERPRETATION: Suicide 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 ACTION: Interventions 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.

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FIGURE 1 Suicide rates* among persons aged ≥10 years, by county urbanization level† — United States, 2001–2015§ * Per 100,000 residents aged ≥10 years, age adjusted to the 2000 U.S. standard population. † Levels of urbanization were collapsed using the 2006 National Center for Health Statistics urban classification scheme. The six classification levels for counties are 1) large central metropolitan (part of a metropolitan statistical area with ≥1 million population and includes a principal city); 2) large fringe metropolitan (part of a metropolitan statistical area with ≥1 million population but does not include a principal city); 3) medium metropolitan (part of a metropolitan statistical area with ≥250,000 but <1 million population); 4) small metropolitan (part of a metropolitan statistical area with <250,000 population); 5) micropolitan (nonmetropolitan) (part of a micropolitan statistical area [has an urban cluster of ≥10,000 but <50,000 population]); and 6) noncore (nonmetropolitan) (not part of a metropolitan or micropolitan statistical area). Large metropolitan includes counties from large central metropolitan and large fringe metropolitan areas. Medium/small metropolitan includes counties from medium metropolitan and small metropolitan areas. Nonmetropolitan includes counties from micropolitan and noncore areas. § Joinpoint regression analysis was used to determine annual percentage change with statistically significant trend (p<0.05). Dots indicate the joinpoints.
FIGURE 1 Suicide rates* among persons aged ≥10 years, by county urbanization level† — United States, 2001–2015§ * Per 100,000 residents aged ≥10 years, age adjusted to the 2000 U.S. standard population. † Levels of urbanization were collapsed using the 2006 National Center for Health Statistics urban classification scheme. The six classification levels for counties are 1) large central metropolitan (part of a metropolitan statistical area with ≥1 million population and includes a principal city); 2) large fringe metropolitan (part of a metropolitan statistical area with ≥1 million population but does not include a principal city); 3) medium metropolitan (part of a metropolitan statistical area with ≥250,000 but <1 million population); 4) small metropolitan (part of a metropolitan statistical area with <250,000 population); 5) micropolitan (nonmetropolitan) (part of a micropolitan statistical area [has an urban cluster of ≥10,000 but <50,000 population]); and 6) noncore (nonmetropolitan) (not part of a metropolitan or micropolitan statistical area). Large metropolitan includes counties from large central metropolitan and large fringe metropolitan areas. Medium/small metropolitan includes counties from medium metropolitan and small metropolitan areas. Nonmetropolitan includes counties from micropolitan and noncore areas. § Joinpoint regression analysis was used to determine annual percentage change with statistically significant trend (p<0.05). Dots indicate the joinpoints.CC BY · PubMed Central
FIGURE 2 Suicide rates* for selected characteristics among persons aged ≥10 years, by county urbanization level — United States, 2001–2015 Abbreviations: AI/AN = American Indian/Alaska Native; NH = non-Hispanic; PI = Pacific Islander. * Per 100,000 residents aged ≥10 years, age adjusted to the 2000 U.S. standard population.
FIGURE 2 Suicide rates* for selected characteristics among persons aged ≥10 years, by county urbanization level — United States, 2001–2015 Abbreviations: AI/AN = American Indian/Alaska Native; NH = non-Hispanic; PI = Pacific Islander. * Per 100,000 residents aged ≥10 years, age adjusted to the 2000 U.S. standard population.CC BY · PubMed Central

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Metadata

Authors
Ivey-Stephenson, A. Z., Crosby, A. E., Jack, S. P. D., Haileyesus, T., & Kresnow-Sedacca, M.-J.
Affiliations
  • National Center for Injury Prevention and Control (US)
  • Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, CDC
Corresponding author
Ivey-Stephenson, Asha Z.
ORCID
Crosby, Alex E.
Venue
MMWR. Surveillance Summaries
Publisher
Centers for Disease Control MMWR Office
Published
2017-10-06
Volume
66
Issue
18
Pages
1-16
ISSN
  • 1545-8636 (ISSN-L)
  • 1546-0738
DOI
10.15585/mmwr.ss6618a1
PMC
PMC5829833
OpenAlex
W2762275952
Cited by
319
References
29
Citations by year
2026: 17 · 2025: 39 · 2024: 29 · 2023: 40 · 2022: 52 · 2021: 49 · 2020: 51 · 2019: 27 · 2018: 13 · 2017: 1
FWCI
31.21
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • MMWR Surveillance Summaries (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Centers for Disease Control and Prevention
  • National Center for Injury Prevention and Control
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
Keywords
suicide, suicide rates, urbanization level, urban-rural differences, sex differences, racial and ethnic disparities, age groups, mechanism of death, firearm suicide, suicide prevention, non-Hispanic blacks, non-Hispanic whites
MeSH terms
Adolescent, Adult, Aged, Cause of Death, Child, Ethnicity, Female, Humans, Male, Middle Aged, Suicide, United States, Urbanization, Age Distribution, Sex Distribution, Racial Groups, Young Adult

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