PODCAST: Suicide Trends in the U.S. and Weekly NCHS Updates

February 26, 2021



HOST:  Last week NCHS released the latest trend report on suicide rates in the nation.  Joining us today is Holly Hedegaard, the lead author of this new report.

Holly, so what do the latest final numbers tell us?

HOLLY HEDEGAARD:  Well the report that was just released from the National Center for Health Statistics looked at suicide rates over the last 20 years and what we saw was that from 1999 through 2018 there’s been a steady increase in the suicide rate – it increased about 35% over that time period. But what’s interesting is that in 2019 the rate is lower than it was in 2018 and that’s the first significant drop in suicide rates we’ve seen in the past 20 years.  While that’s an encouraging sign, I think it’s important to remember that a single year drop doesn’t necessarily say that’s a meaningful change in the overall trend is just that within a single year we saw a decrease in the suicide rates in 2019 compared to 2018

HOST:  Youth suicide in particular is a major concern.  What do the trends show among young people?

HOLLY HEDEGAARD:  So for young people suicide rates are actually lower than for other age groups – so that’s a good thing that the rates are lower – but what’s concerning is that these are the age groups where we’ve seen quite a bit of an increase in the suicide rates in recent years.  And so for example for girls who are age 10 to 14, their rates have increased about four-fold in the past 20 years, but their rates are still among the lowest of all the age and sex groups.  Rates have also increased for boys and for young men but not to the same extent as for girls.  And so again, for both boys and girls and for age 10 to 14 and ages 15 to 24, the rates are low but they are increasing – and I think that’s the reason of concern about suicide rates in young people.

HOST:  What groups have the highest suicide rates in the country?

HOLLY HEDEGAARD:  This report focuses on rates by sex and by age group, so the report looks at those particular characteristics, and the suicide rates are highest for men age 75 and older and that’s been true for a long period of time so the highest rates among men aged 75 and older.  For females the highest rates are for women ages 45 to 64 so it’s more of the middle-aged female when you look for high suicide rates among females.

HOST:  There aren’t full-year data available yet for 2020, but mental health professionals worry that the stress and isolation from the pandemic will result in a spike in suicide rates.  Do you have any insight at all about 2020 at this point?

HOLLY HEDEGAARD:  As you mentioned, we don’t have any of the final data for 2020 yet so we can’t give a definitive answer but NCHS has been generating from provisional estimates to try to get a sense of what has been happening during 2020.  And NCHS has posted some provisional estimates for the first quarter of 2020 – which it goes through March of 2020 – and as of the beginning of last year the rate, the suicide rate, was slightly higher than the rate during the comparable time period in 2019.  So a slight increase in the first quarter.  NCHS has been developing some additional modeling techniques to look at the trends in a variety of different types of deaths including drug overdose, suicide, and transportation related deaths during the early months of 2020, and based on that modeling technique the predicted weekly numbers of suicide deaths early 2020 were similar to historic levels, and then declined a little bit between March and June, and then again was pretty much no different than historic levels from July through October.  So based on these model estimates, that suggested there hasn’t really been a spike in suicide mortality, at least in the first half of 2020.  But it’s important to recognize that these are modeled estimates – these are not final numbers, they aren’t the final rates – and we’ll continue to be refining and confirming these estimates as NCHS receives more data for the deaths that occurred in 2020.  So as of now, we don’t have anything that looks like there’s been a huge increase in suicide during 2020 but that’s again based on modeled estimates.

HOST:  Your report looks at the different mechanisms used in suicides in the U.S.  What do those numbers tell us?

HOLLY HEDEGAARD:  The means of suicide varies by males compared to females, and for males about little over half of the suicides involve use of a firearm and about 28% involve hanging or suffocation… A much smaller proportion involved poisoning or other means. We’ve seen a slight increase in the rates for firearm-related suicides among men over the past 20 years but where there’s been a rather large increase has been in the rate for suicide by hanging or suffocation.  That rate among men has doubled over the last 20 years.  The picture for women is a little bit different.  From about 2001 through 2015, poisoning was the leading means of suicide among women.  But Interestingly in the last few years, since about 2016, we’ve actually seen a decline in the rate of suicide by poisoning among women and an increase in the rate of suicides that involve firearms or suffocation.  And so in the most recent years, the rates of suicide by firearm and by suffocation are slightly higher than the rate of suicide by poisoning.  The rate of suicide by suffocation among females has actually tripled in the past 20 years.

HOST:  Now by poisoning are you referring to drug overdoses?

HOLLY HEDEGAARD:  No, poisoning is actually a broader terminology that includes drug poisoning, but it also includes other types of poisons like carbon monoxide or chemicals or a variety of other things that sometimes people ingest or take. But they aren’t drugs there are used for other purposes.

HOST:  So your data then show that drug overdoses are really not a significant method used in suicides?

HOLLY HEDEGAARD:  It’s different – again, as I mentioned – for men or for women.  For men, only about 5% of suicide actually involve a drug overdose.  For women, it’s about 27% of their suicides involve a drug overdose.  So they’re not the, drug overdoses are not the leading means of suicide for either men or women.  For both men and women, rates of firearm-related suicide or suicide by hanging and suffocation are higher than the rates of suicide by drug overdose.

HOST:  This report doesn’t look at geographical differences but what areas of the country are having a tougher time with this problem?

HOLLY HEDEGAARD:  So the higher suicide rates are found in the Rocky Mountain states such as Wyoming, Montana, New Mexico, Colorado, Utah, as well as Alaska.  So these are states that have historically been high and they continue to remain high.  In the most current years or recent years, we’ve seen increase in the rates in some of the other states in the Midwest and in the New England states, up in Maine and Vermont and New Hampshire.  They aren’t the highest rates but they are increasing, so it’s important to sort of recognize that there are states in addition to the Rocky Mountain stage that also are seeing higher suicide rates.

HOST:   The National Health Interview Survey issued two new reports, on Tuesday and Wednesday of this week.  On Tuesday, NCHS teamed with the VA on a report that examined multiple chronic conditions among veterans and non-veterans.  Based on data from the 2015-2018 NHIS, the study authors found that about one-half of male veterans and over one-third of female veterans had two or more chronic conditions, compared with less than one-fourth of male nonveterans and less than one-fifth of female nonveterans.  Hypertension and arthritis were the most prevalent chronic conditions among all veterans age 25 and over.  Diabetes was also prevalent among male veterans ages 25 to 64 and asthma was also prevalent among female veterans in this age group.  Cancer was also prevalent among all veterans age 65 and older.

On Wednesday, NCHS released another study looking at health care utilization among those afflicted with inflammatory bowel disease, or IBD.  The study used NHIS data and found that adults with IBD were more likely than those without IBD to have visited any doctor or mental health provider in the past year, and were also more likely to have been prescribed medication or to have received acute care services such as ER visits, overnight hospital stays, or surgeries.

On Thursday, NCHS released a third study – on dietary supplement use among American adults age 20 and over.  The report used data from the 2017-2018 National Health and Nutrition Examination Survey, and found that over half of adults used a dietary supplement in the past month – nearly two-thirds /3 of women and just over half of men.  Eight out of ten women age 60 and over used dietary supplements, and older Americans are more likely to use more than one dietary supplement.   The most common dietary supplement used was multivitamin-mineral supplements.  Vitamin D and omega-3 fatty acid supplements were also commonly used.

Finally, today NCHS is releasing the latest quarterly provisional data on birth rates in the United States, through the third quarter of 2020, showing that fertility rates in the country continued to drop compared to the same point in 2019.  Teen birth rates and pre-term rates also declined in Quarter 3 of 2020 compared with Quarter 3 of 2019, while cesarean delivery rates increased over this period.


QuickStats: Death Rates for Motor-Vehicle–Traffic Injuries, Suicide, and Homicide Among Adolescents and Young Adults Aged 15–24 Years — United States, 1999–2019

February 5, 2021

Mortality rates for adolescents and young adults aged 15–24 years for deaths from motor-vehicle–traffic injury, suicide, and homicide remained relatively stable during 1999–2006 and then exhibited different patterns through 2019.

In 1999, the rate for motor-vehicle–traffic deaths was 25.6 per 100,000 population and declined to 13.7 in 2019. The suicide rate was 10.1 in 1999 and increased to 14.5 in 2018 before declining to 13.9 in 2019.

The homicide rate was 12.9 in 1999 and declined to 9.5 in 2014 before increasing to 11.2 in 2019.

In 2019, the death rates for motor-vehicle–traffic injury and suicide were similar; both rates were higher than the homicide rate.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data, 2009–2019. https://www.cdc.gov/nchs/nvss/deaths.htm


Fact or Fiction: Suicide rates among young people in the Northeastern United States have not increased much over the last decade

September 11, 2020

Source: National Vital Statistics System


QuickStats: Age-Adjusted Suicide Rates by State — National Vital Statistics System, United States, 2018

May 1, 2020

In 2018, the U.S. suicide rate was 14.2 per 100,000 standard population, with rates varying by state.

The five states with the highest age-adjusted suicide rates were Wyoming (25.2), New Mexico (25.0), Montana (24.9), Alaska (24.6), and Idaho (23.9).

The five jurisdictions with the lowest suicide rates were the District of Columbia (7.5), New Jersey (8.3), New York (8.3), Rhode Island (9.5), and Massachusetts (9.9).

Source: National Vital Statistics System. Underlying cause of death data, 1999–2018. https://wonder.cdc.gov/ucd-icd10.html.


Increase in Suicide Mortality in the United States, 1999–2018

April 8, 2020

Questions for Holly Hedegaard, Health Statistician and Lead Author of “Increase in Suicide Mortality in the United States, 1999–2018.”

Q: Are there any major changes in the suicide rates rate from 2017 to 2018?

HH: The suicide rate in 2018 (14.2 per 100,000) is slightly higher than the rate in 2017 (14.0).

Q: Can you summarize how the rates data varied by sex, age groups and urbanicity?

HH: The report looks at suicide rates from 1999 through 2018. Suicide rates in 2018 were higher than in 1999 for males and females in all age groups under age 75. Among females, suicide rates from 1999 through 2018 were highest for those aged 45–64 and lowest for those aged 10–14. Among males, suicide rates were highest for those aged 75 and over and lowest for those aged 10–14. After years of increase, the suicide rates for several demographic groups have stabilized in recent years. These include females aged 45 and over, and males aged 45–64. Females aged 10–44, males aged 10–44, and males 65 and over continue to experience increasing trends in suicide rates. In 2018, the suicide rate for females in the most rural counties was 1.6 times the rate for females in the most urban counties. A similar pattern was seen for males where the suicide rate in the most rural counties was 1.7 times the rate for males in the most urban counties.

Q: Are you able to break down the data by race?

HH: The National Center for Health Statistics (NCHS) has data on suicide rates by race and ethnicity, however those results are not presented in this report. Data can be accessed via an on-line query system CDC WONDER at: https://wonder.cdc.gov/

Q: Was there a specific finding in the data that surprised you from this report?

HH: It was promising to see that after years of increase, the suicide rates for several demographic groups, including females aged 45 and over and males aged 45–64, have stabilized in recent years.

Q: Do you have any predictions for the 2019 suicide data?

HH: The National Center for Health Statistics (NCHS) prepares quarterly provisional estimates for many of the leading causes of death. See  https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm. The quarterly provisional estimates suggest that the age-adjusted suicide death rate for the 12-month period ending in June 2019 was 14.2, which is the same as the age-adjusted death rate of 14.2 for the 12-month period ending in June 2018. This would suggest that by midyear of 2019, the suicide rate was similar to the rate in midyear 2018 (no increase or decrease).

QuickStats: Age-Adjusted Suicide Rates by Sex and Three Most Common Methods — United States, 2000–2018

March 6, 2020

The three most common methods of suicide among males and females during 2000–2018 were by firearm, suffocation, and poisoning.

After remaining steady from 2000 to 2006, age-adjusted firearm suicide rates increased during 2006–2018 among males (from 10.3 to 12.6 per 100,000) and females (from 1.4 to 1.9).

Suffocation suicide rates among males and females increased steadily during 2000–2018 (from 3.4 to 6.7 for males and from 0.7 to 1.9 for females).

In contrast to the other suicide methods, poisoning suicide rates during 2000–2018 initially increased and then declined, from 2.3 in 2010 to 1.9 in 2018 among males and from 2.0 in 2015 to 1.7 in 2018 among females.

Throughout the period 2000–2018, suicide rates by all methods were higher among males than among females, with the greatest difference in the rates for suicide by firearm.

Source: National Center for Health Statistics, National Vital Statistics System, mortality data. https://www.cdc.gov/nchs/nvss/deaths.htm.


Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017

October 17, 2019

Questions for Lead Author Sally Curtin, Health Statistician, of “Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017.”

Q: Why did you decide to focus on ages 10 through 24 for suicides and homicides?

SC: Suicide and homicide are among the leading causes of death for this age range.  As there are almost no suicides below the age of 10, we began with age 10 and decided to go through the young adults age range, through age 24.

Q: How did the data vary by age groups?

SC: For the 10-24 age range, rates of both suicide and homicide are lowest for 10-14, intermediate for 15-19 and highest for 20-24.  The patterns differed between age groups.  For children and adolescents aged 10-14, suicide rates nearly tripled from 2007 to 2017 whereas homicide rates gradually declined over the period.  For 15-19 and 20-24, both suicide and homicide rates increased, with the increase beginning earlier for the suicide rates.

Q: Is this the first time you have published a report on this topic?

SC: We have published some similar reports recently, but this is the first one which focuses on these two causes of death for this age range.  Suicide and homicide are often referred to as the two major components of violent death.

Q:  Was there a specific finding in your report that surprised you?

SC: That both suicide and homicide have increased recently for 15-19 and 20-24 year olds.  Homicide has only been increasing since 2014, but this is after years of decline whereas suicide began to increase sooner.

Q: Why do you think suicide and homicide death rates have risen?

SC: That is for others in the prevention and research community to answer.  However, other studies have shown that some of the risk factors for suicide and homicide have increased.  In particular, depression and other mental health disorders have been shown to be increasing in youth.

QuickStats: Age-Adjusted Rates of Suicide, by State — National Vital Statistics System, United States, 2017

September 13, 2019

In 2017, the U.S. age-adjusted suicide rate was 14.0 per 100,000 population, but rates varied by state.

The five states with the highest rates were Montana (28.9 deaths per 100,000 population), Alaska (27.0), Wyoming (26.9), New Mexico (23.3), and Idaho (23.2).

The five with the lowest rates were the District of Columbia (6.6), New York (8.1), New Jersey (8.3), Massachusetts (9.5), and Maryland (9.8).

Source: National Center for Health Statistics, National Vital Statistics System. Mortality Data, 2017. https://www.cdc.gov/nchs/deaths.htm.


2017 Final Deaths, Leading Causes of Death and Life Tables Reports Released

June 24, 2019

NCHS released a report that presents the final 2017 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends, by selected characteristics such as age, sex, Hispanic origin and race, state of residence, and cause of death.

Key Findings:

  • In 2017, a total of 2,813,503 deaths were reported in the United States.
  • The age-adjusted death rate was 731.9 deaths per 100,000 U.S. standard population, an increase of 0.4% from the 2016 rate.
  • Life expectancy at birth was 78.6 years, a decrease of 0.1 year from the 2016 rate.
  • Life expectancy decreased from 2016 to 2017 for non-Hispanic white males (0.1 year) and non-Hispanic black males (0.1), and increased for non-Hispanic black females (0.1).
  • Age-specific death rates increased in 2017 from 2016 for age groups 25–34, 35–44, and 85 and over, and decreased for age groups under 1 and 45–54.
  • The 15 leading causes of death in 2017 remained the same as in 2016 although, two causes exchanged ranks.
  • Chronic liver disease and cirrhosis, the 12th leading cause of death in 2016, became the 11th leading cause of death in 2017, while Septicemia, the 11th leading cause of death in 2016, became the 12th leading cause of death in 2017.
  • The infant mortality rate, 5.79 infant deaths per 1,000 live births in 2017, did not change significantly from the rate of 5.87 in 2016.

NCHS also released the 2017 U.S. Life Tables and Leading Causes of Death Reports.

Mortality in the United States, 2017

November 29, 2018

Questions and Answers from the authors of the recently released 2017 mortality data.  The data can be found in the following reports, “Mortality in the United States, 2017, ” “Drug Overdose Deaths in the United States, 1999–2017, ” and “Suicide Mortality in the United States, 1999–2017.”

Q: Why did life expectancy decline in 2017?

A: Mortality rates increased for 7 out of the 10 leading causes of death in the U.S., including a 5.9% increase in the flu/pneumonia death rate, a 4.2% increase in the accidental/unintentional injury death rate, and 3.7% in the suicide rate. Many of the accidental/unintentional deaths were from drug overdoses, which continued to increase in 2017.

Q: Isn’t this the third straight year that life expectancy declined?

A: Estimated life expectancy at birth in 2017 was 0.3 years lower than in 2014 and 0.1 years lower than in 2016. The 2016 life expectancy estimate was revised to 78.7 years, up from an estimated 78.6 years, which was reported a year ago. This means that the 2016 life expectancy estimate is the same as the 2015 estimate, which also was revised to 78.7 years, down from an estimated 78.8 years, originally reported two years ago. As a routine matter, for the highest degree of accuracy, NCHS blends Medicare data for people ages 66 and over with our vital statistics data to estimate life expectancy. However, the two data sets are released on different schedules. When Medicare data for a year aren’t available at the time we release our final mortality statistics, we use the most recent Medicare data available at the time. We later revise life expectancy estimates when updated Medicare data become available.

Q: How many deaths in 2017 were attributed to opioids?

A: In 2017, 47,600 drug overdose deaths mentioned involvement of any type of opioid, including heroin and illicit opioids, representing over two-thirds of all overdose deaths (68%).

Q: Why is the 70,237 number of overdose deaths smaller than what CDC has previously reported for 2017?

A: The 70,237 number is a final, official number of overdose deaths among U.S. residents for 2017 whereas the previously reported (and slightly higher) numbers were provisional estimates. In August of 2017, CDC began calculating monthly provisional data on counts of drug overdose deaths as a rapid response to this public health crisis, in order to provide a more accurate, closer to “real-time” look at what is happening both nationally and at the state level. These monthly totals are provisional counts, and they include all deaths occurring in the U.S. – which include deaths among non-residents (i.e., visitors here on business or leisure, students from abroad, etc). These counts also do not include deaths that are still under investigation. As a result, the monthly numbers are provisional or very preliminary, and the final 2017 number of 70,237 deaths is an official number that only include deaths among U.S. residents and account for any previously unresolved deaths that were under investigation.

Q: Does this mean that the 70,237 total does not include deaths to undocumented immigrants here in the U.S.?

A: We don’t get immigration status off the death certificates, so we wouldn’t know how many of the deaths were to undocumented immigrants.

Q: In comparing the 2017 numbers with 2016 and past years, is the crisis of drug overdose deaths growing or about the same?

A: From 2016 to 2017, the number of drug overdose deaths increased from 63,632 deaths to 70,237, a 10% increase, which is a smaller increase compared to the 21% increase from 2015 to 2016, when the number of drug overdose deaths increased from 52,404 deaths to 63,632 deaths. Over a longer period of time, from 1999 through 2017, the age-adjusted rate of drug overdose deaths increased on average by 10% per year from 1999 to 2006, by 3% per year from 2006 to 2014, and by 16% per year from 2014 to 2017. So the trend is continuing, although the increase in 2017 was not as large as in previous years.

Q: Are there any other trends of significance when looking at the types of drugs attributed to overdose deaths?

A: The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased 45% in one year, from 6.2 per 100,000 in 2016 to 9.0 per 100,000 in 2017. In 2017, 40%(?) of all drug overdose deaths mentioned involvement of a synthetic opioid other than methadone.

Q: Has fentanyl overtaken heroin as the major cause of overdose death?

A: The data brief on drug overdose deaths does not specifically address fentanyl. However the rate of drug overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, increased 45% 2016 and 2017 whereas the overdose death rate from heroin did not change (4.9 deaths per 100,000).

Q: There is a lot of stark news in these three reports. Are there any positives to report?

A: The cancer mortality rate declined between 2016 and 2017, and although estimated life expectancy declined in 2017, life expectancy for people at age 65 actually increased. Also, regarding drug overdose deaths, the rate of increase in drug overdose deaths slowed between 2016 and 2017, although the increases that occurred were still very significant.