Suicide Rates by Industry and Occupation

National Violent Death Reporting System, 32 States, 2016

Cora Peterson, PhD; Aaron Sussell, PhD; Jia Li, MS; Pamela K. Schumacher; Kristin Yeoman, MD; Deborah M. Stone, ScD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(3):57-62. 

In This Article

Abstract and Introduction

Introduction

In 2017, nearly 38,000 persons of working age (16–64 years) in the United States died by suicide, which represents a 40% rate increase (12.9 per 100,000 population in 2000 to 18.0 in 2017) in less than 2 decades.* To inform suicide prevention, CDC analyzed suicide data by industry and occupation among working-age decedents presumed to be employed at the time of death from the 32 states participating in the 2016 National Violent Death Reporting System (NVDRS).†,§ Compared with rates in the total study population, suicide rates were significantly higher in five major industry groups: 1) Mining, Quarrying, and Oil and Gas Extraction (males); 2) Construction (males); 3) Other Services (e.g., automotive repair) (males); 4) Agriculture, Forestry, Fishing, and Hunting (males); and 5) Transportation and Warehousing (males and females). Rates were also significantly higher in six major occupational groups: 1) Construction and Extraction (males and females); 2) Installation, Maintenance, and Repair (males); 3) Arts, Design, Entertainment, Sports, and Media (males); 4) Transportation and Material Moving (males and females); 5) Protective Service (females); and 6) Healthcare Support (females). Rates for detailed occupational groups (e.g., Electricians or Carpenters within the Construction and Extraction major group) are presented and provide insight into the differences in suicide rates within major occupational groups. CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices[1] contains strategies to prevent suicide and is a resource for communities, including workplace settings.

NVDRS combines data on violent deaths, including suicide, from death certificates, coroner/medical examiner reports, and law enforcement reports. Industry and occupation coding experts used CDC's National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System (NIOCCS 3.0) to assign 2010 U.S. Census civilian industry and occupation codes for 20,975 suicide decedents aged 16–64 years from the 32 states participating in the 2016 NVDRS, using decedents' usual industry and occupation as reported on death certificates. Industry (the business activity of a person's employer or, if self-employed, their own business) and occupation (a person's job or the type of work they do) are distinct ways to categorize employment.[2]

Suicide rates were analyzed for industry and occupational groups by sex. Population counts by occupation for rate denominators were states' civilian, noninstitutionalized current job population counts (for persons aged 16–64 years) from the 2016 American Community Survey Public Use Microdata Sample.** Replicate weight standard errors for those counts were used to calculate 95% confidence intervals (CIs) for suicide rates.[3] Rates were calculated by U.S. Census code for major industry groups, major occupational groups, and detailed occupational groups with ≥20 decedents; detailed occupational groups are typically more homogenous in terms of employee income, work environment, and peer group. Rates were not calculated for detailed industry groups because many decedents' industry was classifiable only by major group. The following decedents were excluded from rate calculations: military workers (327); unpaid workers (2,863); those whose other NVDRS data sources (e.g., law enforcement reports) indicated no employment at time of death (i.e., unemployed, disabled, incarcerated, homemaker, or student)[4] (1,783); and those not residing in the analysis states (223). A total of 15,779 decedents, including 12,505 (79%) males and 3,274 (21%) females, were included in the analysis. The analysis was conducted using Stata (version 15, StataCorp) and SAS (version 9.4, SAS Institute) statistical software.

Industry and occupational groups with suicide rates significantly (α = 0.05) higher than the study population (i.e., all industries or occupations: 27.4 males [95% CI = 26.9–27.9] and 7.7 females [95% CI = 7.5–8.0] per 100,000 population) were identified when the group's 95% CI exceeded the study population rate point estimate. Treating the population rate as a constant is reasonable when variance is small and is required for one-sample inference that recognizes the nonindependence of individual industry and occupation groups relative to the study population.

The five major industry groups with suicide rates higher than the study population by sex included 1) Mining, Quarrying, and Oil and Gas Extraction (males: 54.2 per 100,000 civilian noninstitutionalized working population, 95% CI = 44.0–64.3); 2) Construction (males: 45.3, 95% CI = 43.4–47.2); 3) Other Services (e.g., automotive repair; males: 39.1, 95% CI = 36.1–42.0); 4) Agriculture, Forestry, Fishing, and Hunting (males: 36.1, 95% CI = 31.7–40.5); and 5) Transportation and Warehousing (males: 29.8, 95% CI = 27.8–31.9; females: 10.1, 95% CI = 7.9–12.8) (Table 1) (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/84274). The six major occupational groups with higher rates included 1) Construction and Extraction (males: 49.4, 95% CI = 47.2–51.6; females: 25.5, 95% CI = 15.7–39.4); 2) Installation, Maintenance, and Repair (males: 36.9, 95% CI = 34.6–39.3); 3) Arts, Design, Entertainment, Sports, and Media (males: 32.0, 95% CI = 28.2–35.8); 4) Transportation and Material Moving (males: 30.4, 95% CI = 28.8–32.0; females: 12.5, 95% CI = 10.2–14.7); 5) Protective Service (females: 14.0, 95% CI = 9.9–19.2); and 6) Healthcare Support (females: 10.6, 95% CI = 9.2–12.1).

Rates could be calculated for 118 detailed occupational groups for males and 32 for females (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/84275). Some occupational groups with suicide rates significantly higher than those of the study population were only identifiable through observation at the detailed group level (Table 2). Among males, these detailed groups included the following seven groups: 1) Fishing and hunting workers (part of the Farming, Fishing, and Forestry major occupational group); 2) Machinists (Production major group); 3) Welding, soldering, and brazing workers (Production major group); 4) Chefs and head cooks (Food Preparation and Serving Related major group); 5) Construction managers (Management major group); 6) Farmers, ranchers, and other agricultural managers (Management major group); and 7) Retail salespersons (Sales and Related major group). Among females, these detailed groups included the following five groups: 1) Artists and related workers (Arts, Design, Entertainment, Sports, and Media major group); 2) Personal care aides (Personal Care and Service major group); 3) Retail salespersons (Sales and Related major group); 4) Waiters and waitresses (Food Preparation and Serving Related major group); and 5) Registered nurses (Healthcare Practitioners and Technical major group). Groups with highest rate point estimates (e.g., female Artists and related workers and male Fishing and hunting workers) also had wide 95% CIs (Table 2), based on relatively low numbers of decedents and relatively small working populations (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/84275).

*https://www.cdc.gov/injury/wisqars.
https://www.cdc.gov/violenceprevention/nvdrs.
§In 2016, 32 states participated in NVDRS: Alaska, Arizona, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, and Wisconsin. That year, Illinois, Pennsylvania, and Washington each collected data on ≥80% of violent deaths in the state, in accordance with requirements under which the state was funded for NVDRS; therefore, presented data likely underestimate suicide deaths and rates.
https://wwwn.cdc.gov/nioccs3.
**https://www.census.gov/programs-surveys/acs/data/pums.html.

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