Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 1;174(3):287-294.
doi: 10.1001/jamapediatrics.2019.5678.

Association of Pediatric Suicide With County-Level Poverty in the United States, 2007-2016

Jennifer A Hoffmann  1 , Caitlin A Farrell  2 , Michael C Monuteaux  2 , Eric W Fleegler  2 , Lois K Lee  2
Affiliations

Association of Pediatric Suicide With County-Level Poverty in the United States, 2007-2016

Jennifer A Hoffmann et al. JAMA Pediatr. .

Abstract

Importance: Suicide is the second leading cause of death among youths aged 10 to 19 years in the United States, with rates nearly doubling during the past decade. Youths in impoverished communities are at increased risk for negative health outcomes; however, the association between pediatric suicide and poverty is not well understood.

Objective: To assess the association between pediatric suicide rates and county-level poverty concentration.

Design, setting, and participants: This retrospective, cross-sectional study examined suicides among US youths aged 5 to 19 years from January 1, 2007, to December 31, 2016. Suicides were identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes from the Centers for Disease Control and Prevention's Compressed Mortality File. Data analysis was performed from February 1, 2019, to September 10, 2019.

Exposures: County poverty concentration and the percentage of the population living below the federal poverty level. Counties were divided into 5 poverty concentration categories: 0% to 4.9%, 5.0% to 9.9%, 10.0% to 14.9%, 15.0% to 19.9%, and 20.0% or more of the population living below the federal poverty level.

Main outcomes and measures: The study used a multivariable negative binomial regression model to analyze the association between pediatric suicide rates and county poverty concentration, reporting adjusted incidence rate ratios (aIRRs) with 95% CIs. The study controlled for year, demographic characteristics of the children who died (age, sex, and race/ethnicity), county urbanicity, and county demographic features (age, sex, and racial composition). Subgroup analyses were stratified by method.

Results: From 2007 to 2016, a total of 20 982 youths aged 5 to 19 years died by suicide (17 760 [84.6%] were aged 15-19 years, 15 982 [76.2%] male, and 14 387 [68.6%] white non-Hispanic). The annual suicide rate was 3.35 per 100 000 youths aged 5 to 19 years. In the multivariable model, compared with counties with the lowest poverty concentration (0%-4.9%), counties with poverty concentrations of 10% or greater had higher suicide rates in a stepwise manner (10.0%-14.9%: aIRR, 1.25 [95% CI, 1.06-1.47]; 15.0%-19.9%: aIRR, 1.30 [95% CI, 1.10-1.54]; and 20.0% or more: aIRR, 1.37 [95% CI, 1.15-1.64]). When stratified by method, firearm suicides had the strongest association with county poverty concentration (aIRR, 1.87; 95% CI, 1.41-2.49) in counties with 20% or higher poverty concentration compared with counties with 0% to 4.9% poverty concentration.

Conclusions and relevance: The findings suggest that higher county-level poverty concentration is associated with increased suicide rates among youths aged 5 to 19 years. These findings may guide research into upstream risk factors associated with pediatric suicide to inform suicide prevention efforts.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Fleegler reported receiving honoraria for grand round presentations related to firearm injuries, social determinants of health, and sedation and serving as a consultant to Veta Health. Drs Fleegler and Lois Lee received royalties for authoring chapters for UpToDate (publisher, Wolters Kluwer). No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted Incidence Rate Ratio of Suicides Among Youths Aged 5 to 19 Years by County Poverty Concentration and Method
Models control for year, individual demographics, county urbanicity, and county youth demographic composition. Data are reported compared with the lowest poverty concentration (0%-4.9% of the county population living below the federal poverty level). Error bars indicate 95% CIs.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control Web-based Injury Statistics Query and Reporting System (WISQARS). https://www.cdc.gov/violenceprevention/suicide/statistics/index.html. Published 2005. Accessed June 11, 2018.
    1. Calear AL, Christensen H, Freeman A, et al. A systematic review of psychosocial suicide prevention interventions for youth. Eur Child Adolesc Psychiatry. 2016;25(5):467-482. doi: 10.1007/s00787-015-0783-4 - DOI - PubMed
    1. Council on Community Pediatrics Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339. doi: 10.1542/peds.2016-0339 - DOI - PubMed
    1. Farrell CA, Fleegler EW, Monuteaux MC, Wilson CR, Christian CW, Lee LK. Community poverty and child abuse fatalities in the United States. Pediatrics. 2017;139(5):e20161616. doi: 10.1542/peds.2016-1616 - DOI - PubMed
    1. Roos LL, Wall-Wieler E, Lee JB. Poverty and early childhood outcomes. Pediatrics. 2019;143(6):e20183426. doi: 10.1542/peds.2018-3426 - DOI - PubMed