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Comparative Study
. 2002 Jul;92(7):1161-7.
doi: 10.2105/ajph.92.7.1161.

Increasing rural-urban gradients in US suicide mortality, 1970-1997

Gopal K Singh  1 , Mohammad Siahpush
Affiliations
Comparative Study

Increasing rural-urban gradients in US suicide mortality, 1970-1997

Gopal K Singh et al. Am J Public Health. 2002 Jul.

Abstract

Objectives: This study examined rural-urban gradients in US suicide mortality and the extent to which such gradients varied across time, sex, and age.

Methods: Using a 10-category rural-urban continuum measure and 1970-1997 county mortality data, we estimated rural-urban differentials in suicide mortality over time by multiple regression and Poisson regression models.

Results: Significant rural-urban gradients in age-adjusted male suicide mortality were found in each time period, indicating rising suicide rates with increasing levels of rurality. The gradient increased consistently, suggesting widening rural-urban differentials in male suicides over time. When controlled for geographic variation in divorce rate and ethnic composition, rural men, in each age cohort, had about twice the suicide rate of their most urban counterparts. Observed rural-urban differentials for women diminished over time. In 1995 to 1997, the adjusted suicide rates for young and working-age women were 85% and 22% higher, respectively, in rural than in the most urban areas.

Conclusions: The slope of the relationship between rural-urban continuum and suicide mortality varied substantially by time, sex, and age. Widening rural-urban disparities in suicide may reflect differential changes over time in key social integration indicators.

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Figures

FIGURE 1
FIGURE 1
—Age-adjusted US suicide mortality rates for the most urban counties (metropolitan, 1 million people or more) and the most rural counties (fewer than 2500 people): 1970 to 1997.
See this image and copyright information in PMC

Comment in

  • Rurality and suicide.
    Gessert CE. Gessert CE. Am J Public Health. 2003 May;93(5):698; author reply 698-9. doi: 10.2105/ajph.93.5.698. Am J Public Health. 2003. PMID: 12721117 Free PMC article. No abstract available.

References

    1. Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Natl Vital Stat Rep. 1999;47(19):1–108. - PubMed
    1. National Center for Health Statistics. Vital Statistics of the United States, 1970–1997, Volume II: Mortality, Parts A and B. Washington, DC: Public Health Service; 1999.
    1. Siahpush S, Singh GK. Social integration and mortality in Australia. Aust N Z J Public Health. 1999;23:571–577. - PubMed
    1. Singh GK, Wilkinson AV, Song FF, et al. Health and Social Factors in Kansas: A Data and Chartbook, 1997–98. Lawrence, Kan: Allen Press; 1998.
    1. Kposowa AJ, Breault KD, Singh GK. White male suicide in the United States: a multivariate individual-level analysis. Soc Forces. 1995;74:315–323.

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