1. Suicide Trends 1950-2002 Margaret Warner Manon Boudreault Lois A. Fingerhut Office of Analysis and Epidemiology APHA Washington DC 2004 National Center for Health Statistics

2. Introduction Suicide was the 11 th leading cause of death in 2002. Suicide rates have declined since 1950. YearRate*Rank, cause of death** 200210.9 11th 1990 12.5 8th 1950 13.2 12th * Age-adjusted, per 100,000 resident population. ** Ranking is based on number of deaths (as opposed to rates).

3. Methods  Mortality data from the National Vital Statistics System 1950-2002  Resident populations from the US Census Bureau used to calculate rates  ICD external cause codes for suicide: ICD-10 1999-02*U03,X60-X84,Y87.0 ICD-9 1979-98E950-E959 ICD-81968-78E950-E959 ICD-71958-67E963, E970-E979 ICD-61949-57E963, E970-E979

4.  For data years 1995-2001, the Dept. of Agriculture urban-rural continuum codes were used to differentiate between five levels of urbanization. Detail available with handouts.  The average annual percent changes in suicide rates were estimated using negative binomial regression models.  Where specified, rates were age-adjusted to the year 2000 standard population.

5.  The ICD-9 and ICD-10 external cause of injury mortality matrices were used to classify the mechanism of suicide.  The comparability ratio (CR) for suicide between ICD-9 and ICD-10 was 1.00.  The three leading mechanisms of suicide, firearm, poisoning and suffocation also had CR’s of 1.00.

6.  From 1950 to 1980, suicide rates among those ages 15-34 years increased and rates among those 45 and older decreased. Since 1980, the patterns have been less defined.  Between 1994-95 and 2001-02 suicide rates by single year of age decreased among those younger than 38 years; increased among people 39-59 years and decreased among people 60 years and older  Firearms are the leading suicide mechanism followed by poisoning and suffocation. Highlights: Age and Mechanism

7.  Firearm suicide rates declined among all age and sex groups. Among persons 65 years and older, the 3 leading mechanism-specific suicide rates also declined.  Among 10-14 and 15-19 year olds, overall suicide rates decreased. With the decline in suicide by firearm, suicide by suffocation (hanging) became the leading mechanism for males and females 10-14 years and for females 15-19 years. Highlights: 1995-2002

8. Highlights: Urbanization  Suicide rates are higher in counties that are less populated and lower in counties that are more populated.  In 2001, as the level of urbanization decreases the percent of suicides involving firearms increases. A similar pattern was seen in1995.

9. Suicide rate by age and year of death 1950-2000 Deaths per 100,000 population Year of death Age at death (years) 65+ 45-64 35-44 25-34 15-24

10. Suicide rates by single year of age: 1994-95 and 2000-2002 Deaths per 100,000 population

11. Suicide rates by mechanism among those 10 years of age and over: 1980-2002 Deaths per 100,000 population Year Firearm Suffocation Poisoning Other

12. Average annual percent change in rates by mechanism, sex and age: 1995-2002 10-14 15-19 20-64 65+ Male Female change 10-14 15-19 20-64 65+ ns ns: Average annual percent change is not significantly different from 0. Poisoning not shown, unstable rates for all years. ns

13. Suicide rates, ages10-14 years: 1995-2002 Males Females Deaths per 100,000 pop AllSuffocationFirearm Unstable rate based on 20 or fewer deaths

14. Suicide rates, ages 15-19 years: 1995-2002 Males Females Deaths per 100,000 pop PoisoningAllSuffocationFirearm

15. Suicide rates,15 years of age and over by urbanization level: 1995-2001 Least Most Large Medium Small Non-micropolitan Micropolitan Decedent’s County of Residence Metropolitan Non- metropolitan County Population Deaths per 100,000 population (age-adjusted) Year of Death

16. Mechanism of suicide, 15 years of age and over by urbanization level: 2001 Firearm Suffocation Poisoning Non-Micropolitan Micropolitan Large MediumSmall Metropolitan Non-metropolitan Decedent’s County of Residence

17. For additional questions e-mail Margaret Warner at MWarner@cdc.gov Manon Boudreault at MBoudreault @cdc.gov Lois Fingerhut at LFingerhut@cdc.gov