An Assessment of Maternal Mortality in the United States

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 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).

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 1979-98 E950-E959
• ICD-8 1968-78 E950-E959
• ICD-7 1958-67 E963, E970-E979
• ICD-6 1949-57 E963, 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 CRs
  of 1.00.

6
Highlights Age and Mechanism

• 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.

7

Highlights 1995-2002

• 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.

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 death1950-2000
Age at death (years)
65
45-64
35-44
25-34
Deaths per 100,000 population
15-24
Year of death
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
Firearm
Poisoning
Suffocation
Other
Year
12
Average annual percent change in rates by
mechanism, sex and age 1995-2002
Male
Female
change
10-14 15-19 20-64 65
10-14 15-19 20-64 65
ns
ns
ns
ns
ns
ns
ns Average annual percent change is not
significantly different from 0.
Poisoning not shown, unstable rates for all
years.
13
Suicide rates, ages10-14 years 1995-2002
Females
Males
Deaths per 100,000 pop
Unstable rate based on 20 or fewer deaths
14
Suicide rates, ages 15-19 years 1995-2002
Females
Males
Deaths per 100,000 pop
15
Suicide rates,15 years of age and over by
urbanization level 1995-2001
County Population
Decedents County of Residence
Least
Non-micropolitan
Non- metropolitan
Micropolitan
Deaths per 100,000 population (age-adjusted)
Small
Metropolitan
Medium
Large
Most
Year of Death
16
Mechanism of suicide, 15 years of age and over by
urbanization level 2001
Poisoning
Suffocation
Firearm
Non-Micropolitan
Large
Medium
Small
Micropolitan
Metropolitan
Non-metropolitan
Decedents County of Residence
17

• For additional questions e-mail
• Margaret Warner at MWarner_at_cdc.gov
• Manon Boudreault at MBoudreault _at_cdc.gov
• Lois Fingerhut at LFingerhut_at_cdc.gov