# Presentation: 371851

**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

##   Introduction

- Suicide was the 11th leading cause of death in 2002.
- Suicide rates have declined since 1950.
- 	Year	Rate*		Rank, cause of death**
- 	2002	10.9 		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).

##   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  	1979-98	E950-E959
- 	ICD-8	1968-78	E950-E959
- 	ICD-7	1958-67	E963, E970-E979
- 	ICD-6	1949-57	E963, E970-E979

- 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.

## 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. 

- 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.

## 
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.

- 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**

- 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 **

##   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.

## Suicide rate by age and year of death1950-2000

**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

**Notes:**
Suicide rates have declined since 1950. 
Year	AADR		Rank cause of death
1950 	13.2 		12th 
1991 	12.3 		8th 
2001	10.7 		11th
Since 1950, rates have increased for those 15-44, and decreased for those older.  Those 65 and over  generally have had higher suicide rates than those younger. 

## Suicide rates by single year of age: 1994-95 and 2000-2002

**Deaths per 100,000 population**

## Suicide rates by mechanism among those 10 years of age and over: 1980-2002

**Deaths per 100,000 population**

- Year

**Firearm**

**Suffocation**

**Poisoning**

**Other**

**Notes:**
Firearms are the leading suicide mechanism.  After 1995, suffocation rates have exceeded poisoning rates.

## 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

- ns

- ns

- ns

- ns

**Notes:**
The average annual percent change summarizes the changes between 1995-2002.  For all ages and sex groups rates of firearm suicide have declined and rates of suicide by suffocation among young persons are increasing.

## Suicide rates, ages10-14 years: 1995-2002

**Males**

**Females**

- Deaths per 100,000 pop

- Unstable rate based on 20 or fewer deaths

## Suicide rates, ages 15-19 years: 1995-2002

**Males**

**Females**

- Deaths per 100,000 pop

## Suicide rates,15 years of age and over by urbanization level: 1995-2001

**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**

**Notes:**
Suicide rates appear to be associated with urbanization level. Higher suicide rates were observed in counties that were the least populated and lowest rates were in counties that are the most populated.  This trend is seen for the males and drives the national rates, however, females do not show the same pattern.

## Mechanism of suicide, 15 years of age and over by urbanization level: 2001

**Firearm**

**Suffocation**

**Poisoning**

- Non-Micropolitan

- Micropolitan

-  Large

-  Medium

- Small

** ****Metropolitan**

** ****Non-metropolitan **

- Decedent’s County of Residence

**Notes:**
In 2001, the percent of firearms used in suicides increases as the level of urbanization decreases.  This was similar to the gradient seen in 1995.

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