The suicide case-fatality rate (CFR)—the proportion of suicidal acts that are fatal—depends on the distribution of methods used in the act and the probability of death given a particular method. In this cross-sectional study, the authors use data from 3 large databases for 2007 to 2014 to evaluate rates of suicide deaths and nonfatal suicide attempts, overall and method-specific CFRs, and distributions of methods used among persons aged 5 years or older.
Abstract
Background:
The suicide case-fatality rate (CFR)—the proportion of suicidal acts that are fatal—depends on the distribution of methods used in suicidal acts and the probability of death given a particular method (method-specific CFR).
Objective:
To estimate overall and method-specific suicide CFRs and the distribution of methods used in suicidal acts by demographic characteristics.
Design:
Cross-sectional study.
Setting:
United States, 2007 to 2014.
Participants:
Suicide deaths (n = 309 377 records from the National Vital Statistics System) and nonfatal suicide attempts requiring treatment in an emergency department (ED) (n = 1 791 638 records from the Nationwide Emergency Department Sample) or hospitalization (n = 1 556 871 records from the National [Nationwide] Inpatient Sample) among persons aged 5 years or older.
Measurements:
Rates of suicide deaths and nonfatal suicide attempts, overall and method-specific CFRs, and distribution of methods used, by sex, age group, region, and urbanization.
Results:
Overall, 8.5% of suicidal acts were fatal (14.7% for males vs. 3.3% for females; 3.4% for persons aged 15 to 24 years vs. 35.4% for those aged ≥65 years). Drug poisoning accounted for 59.4% of acts but only 13.5% of deaths; firearms and hanging accounted for only 8.8% of acts but 75.3% of deaths. Firearms were the most lethal method (89.6% of suicidal acts with a firearm resulted in death), followed by drowning (56.4%) and hanging (52.7%). Method-specific CFRs were higher for males and older persons. The distribution of methods varied across demographic groups.
Limitations:
Results are based on suicidal acts resulting in an ED visit, a hospitalization, or death. Consequently, the reported CFRs are larger than they would have been had the data included nonfatal attempts that did not result in an ED visit.
Conclusion:
Variation in overall suicide CFR between sexes and across age groups, regions, and urbanization is largely explained by the distribution of methods used in suicidal acts.
Primary Funding Source:
Joyce Foundation.
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Author, Article, and Disclosure Information
Andrew Conner,
Quinnipiac University, North Haven, Connecticut (A.C.)
Harvard T.H. Chan School of Public Health, Boston, Massachusetts (D.A.)
Harvard T.H. Chan School of Public Health and Northeastern University, Boston, Massachusetts (M.M.)
Financial Support: By the Joyce Foundation.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1324.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Mr. Conner (e-mail, andrew.
Corresponding Author: Matthew Miller, MD, MPH, ScD, Professor of Health Sciences and Epidemiology, Northeastern University, Bouvé College of Health Sciences, Department of Health Sciences, Room 316 Robinson Hall, 360 Huntington Avenue, Boston, MA 02115; e-mail, ma.
Current Author Addresses: Mr. Conner: Frank H. Netter MD School of Medicine, Quinnipiac University, 370 Bassett Road, North Haven, CT 06473.
Dr. Azrael: Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115.
Dr. Miller: Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115.
Author Contributions: Conception and design: A. Conner, D. Azrael, M. Miller.
Analysis and interpretation of the data: A. Conner, D. Azrael, M. Miller.
Drafting of the article: A. Conner, D. Azrael, M. Miller.
Critical revision of the article for important intellectual content: A. Conner, D. Azrael, M. Miller.
Final approval of the article: A. Conner, D. Azrael, M. Miller.
Provision of study materials or patients: A. Conner.
Statistical expertise: D. Azrael.
Obtaining of funding: M. Miller.
Administrative, technical, or logistic support: M. Miller.
Collection and assembly of data: A. Conner.
This article was published at Annals.org on 3 December 2019.
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