NCHS Data Brief ■ No. 330 ■ November 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Suicide Mortality in the United States, 1999–2017

Holly Hedegaard, M.D., Sally C. Curtin, M.A., and Margaret Warner, Ph.D.

Key findings

Data from the National 

Vital Statistics System, 

Mortality

● From 1999 through 2017,

the age-adjusted suicide rate

increased 33% from 10.5 to

14.0 per 100,000.

● Suicide rates were

significantly higher in 2017

compared with 1999 among

females aged 10–14 (1.7 and

0.5, respectively), 15–24 (5.8

and 3.0), 25–44 (7.8 and 5.5),

45–64 (9.7 and 6.0), and 65–74

(6.2 and 4.1).

● Suicide rates were

significantly higher in 2017 

compared with 1999 among 

males aged 10–14 (3.3 and 1.9, 

respectively), 15–24 (22.7 and 

16.8), 25–44 (27.5 and 21.6), 

45–64 (30.1 and 20.8) and 

65–74 (26.2 and 24.7).

● In 2017, the age-adjusted

suicide rate for the most rural

(noncore) counties was 1.8 times

the rate for the most urban (large

central metro) counties (20.0 and

11.1 per 100,000, respectively).

Since 2008, suicide has ranked as the 10th leading cause of death for all ages 

in the United States (1). In 2016, suicide became the second leading cause 

of death for ages 10–34 and the fourth leading cause for ages 35–54 (1). 

Although the Healthy People 2020 target is to reduce suicide rates to 10.2 

per 100,000 by 2020 (2), suicide rates have steadily increased in recent years 

(3,4). This data brief uses final mortality data from the National Vital Statistics 

System (NVSS) to update trends in suicide mortality from 1999 through 2017 

and to describe differences by sex, age group, and urbanization level of the 

decedent’s county of residence.

From 1999 through 2017, suicide rates increased for 

both males and females, with greater annual percentage 

increases occurring after 2006.

● From 1999 through 2017, the age-adjusted suicide rate increased 33%

from 10.5 per 100,000 standard population to 14.0 (Figure 1). The rate

0

5

10

15

20

25

Female2

Male1

Total2

1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

Figure 1. Age-adjusted suicide rates, by sex: United States, 1999–2017

1Stable trend from 1999 through 2006; significant increasing trend from 2006 through 2017, p < 0.001.

2Significant increasing trend from 1999 through 2017 with different rates of change over time, p < 0.001.

NOTES: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of-death codes 

U03, X60–X84, and Y87.0. Age-adjusted death rates were calculated using the direct method and the 2000 U.S. standard 

population. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db330_tables-508.pdf#1. 

SOURCE: NCHS, National Vital Statistics System, Mortality. Deaths per 100,000 standard population
NCHS Data Brief ■ No. 330 ■ November 2018

■ 2  ■

increased on average by about 1% per year from 1999 through 2006 and by 2% per year 

from 2006 through 2017. 

● For males, the rate increased 26% from 17.8 in 1999 to 22.4 in 2017. The rate did not

significantly change from 1999 to 2006, then increased on average by about 2% per year

from 2006 through 2017.

● For females, the rate increased 53% from 4.0 in 1999 to 6.1 in 2017. The rate increased

on average by 2% per year from 1999 through 2007 and by 3% per year from 2007

through 2017.

Suicide rates for females aged 10–74 were higher in 2017 than in 1999. 

● Suicide rates for females were highest for those aged 45–64 in both 1999 (6.0 per 100,000)

and 2017 (9.7) (Figure 2).

● Suicide rates were significantly higher in 2017 compared with 1999 among females aged

10–14 (1.7 and 0.5, respectively), 15–24 (5.8 and 3.0), 25–44 (7.8 and 5.5), 45–64 (9.7 and

6.0), and 65–74 (6.2 and 4.1).

● The suicide rate in 2017 for females aged 75 and over (4.0) was significantly lower than the

rate in 1999 (4.5).

10–14 15–24 25–44 45–64 65–74 75 and over

1999 2017

Age group (years)

Figure 2. Suicide rates for females, by age group: United States, 1999 and 2017

1Significantly different from 1999 rate, p < 0.05. 

2Significantly higher than rates for all other age groups in 1999, p < 0.05.

3Significantly higher than rates for all other age groups in 2017, p < 0.05.

NOTES: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. 

Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db330_tables-508.pdf#2. 

SOURCE: NCHS, National Vital Statistics System, Mortality.

0

2

4

6

8

10

0.5

1

1.7

3.0

5.5

2 6.0

4.1

15.8

17.8

1,3 9.7

16.2

4.5 1

4.0

Deaths per 100,000 in specified group
NCHS Data Brief ■ No. 330 ■ November 2018

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Suicide rates for males aged 10–74 were higher in 2017 than in 1999. 

● Suicide rates for males were highest for those aged 75 and over in both 1999 (42.4 per

100,000) and 2017 (39.7) (Figure 3).

● Suicide rates were significantly higher in 2017 compared with 1999 among males aged

10–14 (3.3 and 1.9, respectively), 15–24 (22.7 and 16.8), 25–44 (27.5 and 21.6), 45–64

(30.1 and 20.8), and 65–74 (26.2 and 24.7).

● The suicide rate in 2017 for males aged 75 and over (39.7) was significantly lower than the

rate in 1999 (42.4).

0

10

20

30

40

50

10–14 15–24 25–44 45–64 65–74 75 and over

1.9

1

3.3

16.8

21.6 20.8

24.7 1

22.7

1

27.5

1

30.1

1

26.2

2

42.4

1,339.7

Figure 3. Suicide rates for males, by age group: United States, 1999 and 2017

1Significantly different from 1999 rate, p < 0.05.

2Significantly higher than rates for all other age groups in 1999, p < 0.05.

3Significantly higher than rates for all other age groups in 2017, p < 0.05.

NOTES: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of-death codes U03, X60–X84, and Y87.0. 

Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db330_tables-508.pdf#3. 

SOURCE: NCHS, National Vital Statistics System, Mortality. Deaths per 100,000 in specified group

1999 2017

Age group (years)
NCHS Data Brief ■ No. 330 ■ November 2018

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The difference in age-adjusted suicide rates between the most rural and 

most urban counties was greater in 2017 than in 1999. 

● In both 1999 and 2017, the age-adjusted suicide rate increased with decreasing urbanization

(Figure 4). In 1999, the age-adjusted suicide rate for the most rural (noncore) counties (13.1

per 100,000) was 1.4 times the rate for the most urban (large central metro) counties (9.6).

This difference increased in 2017, with the suicide rate for the most rural counties (20.0 per

100,000) increasing to 1.8 times the rate for the most urban counties (11.1).

● The age-adjusted suicide rate for the most urban counties in 2017 (11.1 per 100,000) was

16% higher than the rate in 1999 (9.6).

● The age-adjusted suicide rate for the most rural counties in 2017 (20.0 per 100,000) was

53% higher than the rate in 1999 (13.1).

0

5

10

15

20

25

20171,2 19991

Figure 4. Age-adjusted suicide rates, by county urbanization level: United States, 1999 and 2017

1Significantly increasing suicide rates by decreasing urbanization, p < 0.05. 

2Significantly higher than 1999 rate for each level of urbanization, p < 0.05.

NOTES: Suicides are identified using International Classification of Diseases, Tenth Revision underlying cause-of death codes U03, X60–X84, and Y87.0. 

Age-adjusted death rates are calculated using the direct method and the 2000 U.S. standard population. Classification of the decedent’s county of residence is 

based on the 2006 NCHS Urban–Rural Classification Scheme for Counties, available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02_154.pdf. Categories 

are presented from most urban (large central metro) to least urban (small metro), and from rural (micropolitan) to most rural (noncore). Access data table for 

Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db330_tables-508.pdf#4. 

SOURCE: NCHS, National Vital Statistics System, Mortality. Deaths per 100,000 in specified group

Large central metro Large fringe metro Medium metro Small metro

Micropolitan Noncore

10.7

12.0 12.2

13.1

11.1

12.5

15.4

18.4

20.0

17.2

9.6 9.3
NCHS Data Brief ■ No. 330 ■ November 2018

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Summary

This report highlights trends in suicide rates from 1999 through 2017. During this period, the 

age-adjusted suicide rate increased 33% from 10.5 per 100,000 in 1999 to 14.0 in 2017. The 

average annual percentage increase in rates accelerated from approximately 1% per year from 

1999 through 2006 to 2% per year from 2006 through 2017. The age-adjusted rate of suicide 

among females increased from 4.0 per 100,000 in 1999 to 6.1 in 2017, while the rate for males 

increased from 17.8 to 22.4. Compared with rates in 1999, suicide rates in 2017 were higher for 

males and females in all age groups from 10 to 74 years. The differences in age-adjusted suicide 

rates between the most rural (noncore) and most urban (large central metro) counties was greater 

in 2017 than in 1999. In 1999, the age-adjusted suicide rate for the most rural counties (13.1 per 

100,000) was 1.4 times the rate for the most urban counties (9.6), while in 2017, the age-adjusted 

suicide rate for the most rural counties (20.0) was 1.8 times the rate for the most urban counties 

(11.1). The age-adjusted suicide rate for the most urban counties in 2017 (11.1 per 100,000) was 

16% higher than the rate in 1999 (9.6), while the rate for the most rural counties in 2017 (20.0) 

was 53% higher than the rate in 1999 (13.1). 
NCHS Data Brief ■ No. 330 ■ November 2018

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Data sources and methods

Data were analyzed using the NVSS multiple cause-of-death mortality files for 1999 through 

2017 (5). Suicide deaths were identified using International Classification of Diseases, Tenth 

Revision (ICD–10) underlying cause-of-death codes U03, X60–X84, and Y87.0 (6). Age-adjusted 

death rates were calculated using the direct method and the 2000 U.S. standard population (7). 

Suicides for persons aged 5–9 years were included in the total numbers and age-adjusted rates but 

not shown as part of the age-specific numbers or rates, due to the small number of suicide deaths 

among this age group. 

Urbanization level of the decedent’s county of residence was categorized using the 2006 

NCHS Urban–Rural Classification Scheme for Counties (8). Counties were classified into six 

urbanization levels based on metropolitan–nonmetropolitan status, population distribution, and 

other factors. The six urbanization levels ranged from the most urban (large central metro) to the 

most rural (noncore). Metropolitan counties include large central counties, the fringes of large 

counties (suburbs), medium counties, and small counties. Nonmetropolitan counties (i.e., rural 

counties) include micropolitan statistical areas and noncore areas, including open countryside, 

rural towns (populations of less than 2,500), and areas with populations of 2,500–49,999 that are 

not part of larger labor market areas (metropolitan areas).

Trends in age-adjusted death rates were evaluated using the Joinpoint Regression Program (9). 

The Joinpoint software was used to fit weighted least-squares regression models to the estimated 

proportions on the linear scale. The default settings allowed for as few as four observed time 

points in the beginning, ending, and middle line segments, including the joinpoints. Using these 

settings, a maximum of three joinpoints were searched for using the grid search algorithm and 

permutation test, and an overall alpha level of 0.05 (10). Pairwise comparisons of rates in Figures 

2–4 were conducted using the z test statistic with an alpha level of 0.05 (7). 

About the authors

Holly Hedegaard is with the National Center for Health Statistics, Office of Analysis and 

Epidemiology, and Sally C. Curtin and Margaret Warner are with the National Center for Health 

Statistics, Division of Vital Statistics. 
NCHS Data Brief ■ No. 330 ■ November 2018

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References

1. Centers for Disease Control and Prevention. CDC WISQARS: Leading causes of death

reports, 1981–2016. Available from: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html.

2. U.S. Department of Health and Human Services. Healthy People 2020: Mental health status

improvement. 2010. Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/

mental-health-and-mental-disorders/objectives.

3. Hedegaard H, Curtin SC, Warner M. Suicide rates in the United States continue to increase.

NCHS Data Brief, no 309. Hyattsville, MD: National Center for Health Statistics. 2018. Available

from: https://www.cdc.gov/nchs/data/databriefs/db309.pdf.

4. Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999–2014.

NCHS Data Brief, no 241. Hyattsville, MD: National Center for Health Statistics. 2016. Available

from: https://www.cdc.gov/nchs/data/databriefs/db241.pdf.

5. National Center for Health Statistics. Public-use data files: Mortality multiple cause files.

2017. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm#Mortality_

Multiple.

6. World Health Organization. International statistical classification of diseases and related

health problems, tenth revision (ICD–10). 2008 ed. Geneva, Switzerland. 2009.

7. Xu JQ, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: Final data for 2016. National

Vital Statistics Reports; vol 67 no 5. Hyattsville, MD: National Center for Health Statistics. 2018.

Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf.

8. Ingram DD, Franco SJ. NCHS urban–rural classification scheme for counties. National Center 

for Health Statistics. Vital Health Stat 2(154). 2012. Available from: https://www.cdc.gov/nchs/

data/series/sr_02/sr02_154.pdf.

9. National Cancer Institute. Joinpoint Regression Program (Version 4.4.0.0) [computer

software]. 2016.

10. Ingram DD, Malec DJ, Makuc DM, Kruszon-Moran D, Gindi RM, Albert M, et al. National

Center for Health Statistics Guidelines for Analysis of Trends. National Center for Health

Statistics. Vital Health Stat 2(179). 2018. Available from: https://www.cdc.gov/nchs/data/series/

sr_02/sr02_179.pdf. 
NCHS Data Brief ■ No. 330 ■ November 2018

Keywords: death certificates • intentional self-harm • urban-rural • National 

Vital Statistics System

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Suggested citation

Hedegaard H, Curtin SC, Warner M. Suicide 

mortality in the United States, 1999–2017. 

NCHS Data Brief, no 330. Hyattsville, MD: 

National Center for Health Statistics. 2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics 

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology 

Irma E. Arispe, Ph.D., Director

Irma E. Arispe, Ph.D., Acting Associate 

Director for Science

Division of Vital Statistics

Steven Schwartz, Ph.D., Director

Hanyu Ni, Ph.D., M.P.H., Associate Director 

for Science