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. 2017 Oct;107(10):1548-1553.
doi: 10.2105/AJPH.2017.303865. Epub 2017 Aug 17.

Urban-Rural Differences in Suicide in the State of Maryland: The Role of Firearms

Paul S Nestadt  1 , Patrick Triplett  1 , David R Fowler  1 , Ramin Mojtabai  1
Affiliations

Urban-Rural Differences in Suicide in the State of Maryland: The Role of Firearms

Paul S Nestadt et al. Am J Public Health. 2017 Oct.

Abstract

Objectives: To assess whether the use of firearms explains rural-urban differences in suicide rates.

Methods: We performed a retrospective analysis on all 6196 well-characterized adult suicides in Maryland from 2003 through 2015. We computed rate ratios by using census data and then stratified by sex, with adjustment for age and race.

Results: Suicide rates were higher in rural compared with urban counties. However, the higher rural suicide rates were limited to firearm suicides (incident rate ratio [IRR] = 1.66; 95% confidence interval [CI] = 1.20, 2.31). Nonfirearm suicide rates were not significantly higher in rural settings. Furthermore, 89% of firearm suicides occurred in men and the higher rural firearm suicide rate was limited to men (IRR = 1.36; 95% CI = 1.09, 1.69). Women were significantly less likely to complete suicide in rural areas (IRR = 0.63; 95% CI = 0.43, 0.94), regardless of method.

Conclusions: Male firearm use drives the increased rate of suicide in rural areas. The opposite associations between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide.

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Figures

FIGURE 1—
FIGURE 1—
Incidence Rate Ratios (IRR) for Suicide in Rural Counties (Rural–Urban Continuum Code 6) Compared With the Most Urban Counties (Rural–Urban Continuum Code 1): Maryland, 2003–2015 Note. The results are presented separately for men and women, adjusted for age and race/ethnicity. *The IRR was significantly different from 1 at P < .05.
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References

    1. Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999–2014. NCHS Data Brief. 2016;(241):1–8. - PubMed
    1. Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System (WISQARS). Fatal injury reports. 2017. Available at: http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html. Accessed March 30, 2017.
    1. Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban–rural differences in psychiatric disorders. Acta Psychiatr Scand. 2010;121(2):84–93. - PubMed
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication [erratum: Arch Gen Psychiatry. 2005;62(7):709] Arch Gen Psychiatry. 2005;62(6):617–627. - PMC - PubMed
    1. Spicer RS, Miller TR. Suicide acts in 8 states: incidence and case fatality rates by demographics and method. Am J Public Health. 2000;90(12):1885–1891. - PMC - PubMed

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