Suicide Case-Fatality Rates in the United States, 2007 to 2014: A Nationwide Population-Based Study

Ann Intern Med. 2019 Dec 17;171(12):885-895. doi: 10.7326/M19-1324. Epub 2019 Dec 3.


Background: The suicide case-fatality rate (CFR)-the proportion of suicidal acts that are fatal-depends on the distribution of methods used in suicidal acts and the probability of death given a particular method (method-specific CFR).

Objective: To estimate overall and method-specific suicide CFRs and the distribution of methods used in suicidal acts by demographic characteristics.

Design: Cross-sectional study.

Setting: United States, 2007 to 2014.

Participants: Suicide deaths (n = 309 377 records from the National Vital Statistics System) and nonfatal suicide attempts requiring treatment in an emergency department (ED) (n = 1 791 638 records from the Nationwide Emergency Department Sample) or hospitalization (n = 1 556 871 records from the National [Nationwide] Inpatient Sample) among persons aged 5 years or older.

Measurements: Rates of suicide deaths and nonfatal suicide attempts, overall and method-specific CFRs, and distribution of methods used, by sex, age group, region, and urbanization.

Results: Overall, 8.5% of suicidal acts were fatal (14.7% for males vs. 3.3% for females; 3.4% for persons aged 15 to 24 years vs. 35.4% for those aged ≥65 years). Drug poisoning accounted for 59.4% of acts but only 13.5% of deaths; firearms and hanging accounted for only 8.8% of acts but 75.3% of deaths. Firearms were the most lethal method (89.6% of suicidal acts with a firearm resulted in death), followed by drowning (56.4%) and hanging (52.7%). Method-specific CFRs were higher for males and older persons. The distribution of methods varied across demographic groups.

Limitations: Results are based on suicidal acts resulting in an ED visit, a hospitalization, or death. Consequently, the reported CFRs are larger than they would have been had the data included nonfatal attempts that did not result in an ED visit.

Conclusion: Variation in overall suicide CFR between sexes and across age groups, regions, and urbanization is largely explained by the distribution of methods used in suicidal acts.

Primary funding source: Joyce Foundation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cause of Death
  • Child
  • Child, Preschool
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Middle Aged
  • Suicide, Attempted / statistics & numerical data
  • Suicide, Completed / statistics & numerical data*
  • United States
  • Young Adult