Pediatric Suicide Rates Increase in High Poverty Counties

Jennifer Hoffmann, MD

Higher county-level poverty concentrations were associated with increased suicide rates among children and adolescents.

Jennifer Hoffmann, MD, and a team of investigators examined suicides among US youths 5—19 years old from January 2007–December 2016. The team found that the annual suicide rate was higher in white non-Hispanic males who lived in counties with greater concentrations of poverty.

The findings may lead to improved suicide prevention efforts and guide more research into risks associated with pediatric suicide.

Hoffmann, from the emergency medicine division at Ann & Robert H. Lurie Children’s Hospital of Chicago, and her colleagues from Boston Children’s Hospital, sought to learn the association between pediatric suicide and county-level poverty in the US. Their primary outcome was suicide deaths among youths 5—19 years old. Death codes included intentional self-harm.

The investigators used mortality data from the Centers for Disease Control and Prevention’s (CDC’s) Compressed Mortality File, which contained death certificate data. The causes of death were classified according to the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and county-level death counts were reported annually.

The team divided the annual country poverty concentration into 5 groups: 0—4.9%; 5–9.9%; 10–14.9%; 15–19.9%; and > 20%. The federal poverty level was $21,027 in 2007 and $24,339 in 2016 for a family of 4.

Over the nine-year period, there were 20,982 suicides among youths 5—19 years old and 84.6% were 15–19 years old. A majority of the youths (76.2%) were male and 68.5% were white non-Hispanic.

The annual national suicide rate during the study was 3.35 per 100,000 youths 5—19 years old. The rate was three-times greater for males than females (IRR, 3.05; 95% CI, 2.76–3.38). Black non-Hispanic youths (IRR, .56; 95% CI, .48–.64) and Hispanic youths (IRR, .51; 95% CI, .45–.58) had lower suicide rates than white non-Hispanic youths.

There was a lower percentage of white non-Hispanic youths living in counties with higher poverty concentrations. The counties with the lowest poverty concentration (0—4.9%) had a suicide rate of 3.18 per 100,000 youths. Counties with the highest poverty concentration (> 20%) had a suicide rate of 3.35 per 100,000.

In a multivariable model, counties with the highest poverty concentration had a higher suicide rate (> 20%; aIRR, 1.37; 95% CI, 1.15—1.64) compared with the lowest poverty counties. Suicide rates increased as poverty concentration increased.

In that model, males had a higher suicide rate than females (aIRR, 3.03; 95% CI, 2.92—3.15). Suicide rates were higher among those 10–14 years old (aIRR, 56.03; 95% CI, 41.89–74.96) and 15–19 years old (aIRR, 300.05; 95% CI, 224.71–400.64), compared to youths 5–9 years old.

Rates of suicide were higher in 2016 than 2007 (aIRR, 2.53; 95% CI, 1.43—1.64) and in the most rural counties compared with the most urban (aIRR, 1.66; 95% CI, 1.45–1.91).

Overall, there was a 57% increase in suicide rates from 2007—2016 among youths 5–19 years old. Data from 2017 suggest that rates are continuing to rise, the investigators reported.

County poverty concentration was also associated with higher pediatric suicide rates by firearms, rather than suffocation or poisoning.

Youths in poverty-concentrated counties could be exposed to more family turmoil, violence, and social isolation. Living in a poor neighborhood could also lead to increased hopelessness, more internalized problems, and increased externalized mental conditions.

Additional research could determine which factors contributes most to the increased risk of pediatric suicide in higher poverty-concentrated counties.

The study, “Association of Pediatric Suicide With County-Level Poverty in the United States, 2007-2016,” was published online in JAMA Pediatrics.