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Suicide Among Adults Aged 35?64 Years ? United States, 1999?2010
May 3, 2013 / 62(17);321-325
Suicide is an increasing public health concern. In 2009, the number of deaths from suicide surpassed the number of deaths from motor vehicle crashes in the United States (1). Traditionally, suicide prevention efforts have been focused mostly on youths and older adults, but recent evidence suggests that there have been substantial increases in suicide rates among middle-aged adults in the United States (2). To investigate trends in suicide rates among adults aged 35?64 years over the last decade, CDC analyzed National Vital Statistics System (NVSS) mortality data from 1999?2010. Trends in suicide rates were examined by sex, age group, race/ethnicity, state and region of residence, and mechanism of suicide. The results of this analysis indicated that the annual, age-adjusted suicide rate among persons aged 35?64 years increased 28.4%, from 13.7 per 100,000 population in 1999 to 17.6 in 2010. Among racial/ethnic populations, the greatest increases were observed among American Indian/Alaska Natives (AI/ANs) (65.2%, from 11.2 to 18.5) and whites (40.4%, from 15.9 to 22.3). By mechanism, the greatest increase was observed for use of suffocation (81.3%, from 2.3 to 4.1), followed by poisoning (24.4%, from 3.0 to 3.8) and firearms (14.4%, from 7.2 to 8.3). The findings underscore the need for suicide preventive measures directed toward middle-aged populations.
CDC used the Web-based Injury Statistics Query and Reporting System (3) to compile NVSS data on suicides reported during 1999?2010 among U.S. residents aged >10 years. Age group?specific annual suicide rates, as well as age-adjusted annual suicide rates calculated using the U.S. standard 2000 population, were based on bridged race population estimates from the U.S. Census Bureau. Trends in age-adjusted suicide rates from 1999, when signs of an increase began (4), through 2010, the latest data available, were analyzed for adults aged 35?64 years by sex and mechanism of suicide. The three most common suicide mechanisms were firearms (i.e., penetrating injury or gunshot wound from a weapon using a powder charge to fire a projectile), poisoning (predominantly drug overdose), and suffocation (predominantly hanging). These three mechanisms and an “all other” mechanism category were used for comparisons. Data also were analyzed by age group, race/ethnicity,* and U.S. Census region.
Percentage changes in observed suicide rates from 1999 to 2010 were calculated along with corresponding 95% confidence intervals, assuming a Poisson distribution. Tests of significance of trends in annual age-adjusted suicide rates for adults aged 35?64 years across the 12-year period were conducted using joinpoint regression (5), assuming a log-linear model. This report focuses on adults aged 35?64 years because percentage changes from 1999 to 2010 in the annual age-adjusted suicide rates for persons aged 10?34 years and ?65 years were comparatively small and not statistically significant (a 7.0% increase from 9.2 in 1999 to 9.9 in 2010 [p = 0.06] and a 5.9% decrease from 15.8 in 1999 to 14.9 in 2010 [p = 0.09], respectively). Finally, data were analyzed by state, and percentage changes in age-adjusted suicide rates from 1999 to 2010 were calculated for all 50 states.
From 1999 to 2010, the age-adjusted suicide rate for adults aged 35?64 years in the United States increased significantly by 28.4%, from 13.7 per 100,000 population to 17.6 (p<0.001) (Table 1). The suicide rate for men aged 35?64 years increased 27.3%, from 21.5 to 27.3, and the rate for women increased 31.5%, from 6.2 to 8.1 (Table 2). Among men, the greatest increases were among those aged 50?54 years and 55?59 years, (49.4%, from 20.6 to 30.7, and 47.8%, from 20.3 to 30.0, respectively). Among women, suicide rates increased with age, and the largest percentage increase in suicide rate was observed among women aged 60?64 years (59.7%, from 4.4 to 7.0).
By racial/ethnic population, the greatest increases from 1999 to 2010 among men and women overall were observed among AI/ANs (65.2%, from 11.2 to 18.5) and whites (40.4%, from 15.9 to 22.3). Among AI/ANs, the suicide rate for women increased 81.4%, from 5.7 to 10.3; the rate for men increased 59.5%, from 17.0 to 27.2. Among whites, the rate for women increased 41.9%, from 7.4 to 10.5; the rate for men increased 39.6%, from 24.5 to 34.2.
Suicide rates from 1999 to 2010 increased significantly across all four geographic regions and in 39 states.? In 2010, rates for adults aged 35?64 years were highest (19.5 per 100,000 population) in the West U.S. Census Region (Table 1). By suicide mechanism, age-adjusted rates increased for the three primary mechanisms for both men and women (Figure). Firearms and suffocation were the most common mechanisms for men (14.3 and 6.8 in 2010, respectively), whereas poisoning and firearms were the most common mechanisms for women (3.4 and 2.5 in 2010, respectively). By mechanism, the greatest increase was observed for use of suffocation (81.3%, from 2.3 to 4.1), followed by poisoning (24.4%, from 3.0 to 3.8) and firearms (14.4%, from 7.2 to 8.3) (Table 1). By sex, the increase for suffocation was 75.0% for men (from 3.9 to 6.8) and 115.0% for women (from 0.7 to 1.5) (Table 2). From 1999 to 2010, suicides by suffocation increased from 18% to 24% of all suicides for men and from 12% to 18% of all suicides for women.