Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study
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Visual Abstract. Suicide Case-Fatality Rates in the United States, 2007 to 2014
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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Information & Authors
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Published In
Annals of Internal Medicine
Volume 171 • Number 12 • 17 December 2019
Pages: 885 - 895
History
Published online: 3 December 2019
Published in issue: 17 December 2019
Keywords
Copyright
© 2019 American College of Physicians.
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Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study. Ann Intern Med.2019;171:885-895. [Epub 3 December 2019]. doi:10.7326/M19-1324
Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study. Ann Intern Med.2019;171:885-895. [Epub 3 December 2019]. doi:10.7326/M19-1324
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