US Suicide Rates Higher in Less Urban Areas

Megan Brooks

March 16, 2017

Geographic disparity in suicide rates in the United States persists, with higher rates in less urban areas and lower rates in more urban settings, according to data released on Thursday by the US Centers for Disease Control and Prevention (CDC).

During the period 1999-2015, suicide rates across all urbanization levels increased, and the gap in rates between less urban and more urban areas grew over time, particularly during the economic recession in 2007-2008.

"Suicide is a major and continuing public health concern in the United States," write Scott R. Kegler, PhD, and colleagues in the March 17 issue of Morbidity and Mortality Weekly Report. During 1999-2015, roughly 600,000 US residents died by suicide, with the highest annual rate occurring in 2015.

Suicide Rising Everywhere

The CDC researchers used annual county-level mortality data from the National Vital Statistics System and annual county-level population data from the US Census Bureau to analyze trends in suicide by level of urbanization for 1999-2015. The six county classifications for most urban to least urban are large central metro, large fringe metro, medium metro, small metro, micropolitan (town/city), and non-core (rural).

From 1999 to 2015, annual suicide rates gradually increased across all levels of urbanization.

Suicide rates at the beginning of the study period were lowest for more urban counties and highest for less urban ones. This gap steadily widened over time and accelerated in 2007-2008. This might reflect the influence of the economic recession of 2007-2009, which had a disproportionate impact and involved longer recovery times in less urban areas, the researchers note.

More broadly, they say geographic disparities in suicide rates might be associated with suicide risk factors that are "highly prevalent in less urban areas, such as limited access to mental health care, made worse by shortages in behavioral health care providers in these areas and greater social isolation."

Geographic disparities might also reflect the influence of the opioid overdose epidemic, which has disproportionately affected less urban areas, they say, noting that abuse of opioids has been linked to increased risk for suicide.

Men at Highest Risk

The new report provides data on average annual suicide rates overall and by sex, age group, and race/ethnicity for 1999-2007 and 2008-2015.

During both time frames, overall rates of suicide among men were about four times those among women. Rates increased across the two periods for both men (from 21.1 per 100,000 to 23.3) and women (from 5.0 to 6.2). The highest rates were among adults aged 35 to 64 years and those aged 75 years and older. Adults aged 35 to 64 years also had the largest rate increase (from 14.9 to 17.9).

By race/ethnicity, non-Hispanic whites and American Indian/Alaska Natives had the highest rates of suicide, with rates for both groups showing "notable" increases across periods (from 14.9 to 18.1 and from 15.8 to 20.0, respectively), the authors say.

"Just as suicide is not caused by a single factor, research suggests that suicide prevention cannot be achieved with a single strategy," the authors write.

Suicide prevention requires a "broad public health approach at the individual, community, and societal levels. This might include strategies applicable for all communities (eg, strengthening economic support during times of financial hardship and teaching coping and problem-solving skills) along with strategies that address subsets of the population at increased risk, such as rural communities (eg, programs that address provider shortages and promote social connectedness)," they note.

Resources such as the CDC's Preventing Suicide: A Technical Package of Policies, Programs, and Practices can help states and communities prioritize prevention efforts and address "persistent upward trends in suicide rates, the authors note.

MMWR Morb Mortal Wkly Rep. 2017;66:270-273. Full text

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