Widening Rural-Urban Disparities in Youth Suicides, United States, 1996-2010 | Adolescent Medicine | JAMA Pediatrics | JAMA Network
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Original Investigation
May 2015

Widening Rural-Urban Disparities in Youth Suicides, United States, 1996-2010

Author Affiliations
  • 1Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
  • 2College of Social Work, The Ohio State University, Columbus
  • 3Center for Biostatistics, The Ohio State University, Columbus
  • 4Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Nationwide Children’s Hospital, Columbus, Ohio
  • 5Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus
  • 6Bureau of Research and Evaluation, Ohio Department of Mental Health and Addiction Services, Columbus
JAMA Pediatr. 2015;169(5):466-473. doi:10.1001/jamapediatrics.2014.3561

Importance  Little is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities.

Objective  To examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum.

Design, Setting, and Participants  Longitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States into distinct groups based on population size and adjacency to metropolitan areas. The population included all suicide decedents aged 10 to 24 years.

Main Outcomes and Measures  Rates of suicide per 100 000 persons.

Results  Across the study period, 66 595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100 000, respectively) and females (4.40 and 2.39 per 100 000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males, suggesting widening rural-urban disparities (1996-1998: adjusted incidence rate ratio [IRR], 0.98; 2008-2010: adjusted IRR, 1.19; difference in IRR, P = .02). Firearm suicide rates declined, and the rates of hanging/suffocation for both males and females increased. However, the rates of suicide by firearm (males: 1996-1998, 2.05; and 2008-2010: 2.69 times higher) and hanging/suffocation (males: 1996-1998, 1.24; and 2008-2010: 1.63 times higher) were disproportionately higher in rural areas, and rural-urban differences increased over time (P = .002 for males; P = .06 for females).

Conclusions and Relevance  Suicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time. Further research should carefully explore the mechanisms whereby rural residence might increase suicide risk in youth and consider suicide-prevention efforts specific to rural settings.