Perspectives in Disease Prevention and Health Promotion Suicide -- United States, 1970-1980

During the 11-year period 1970-1980, 287,322 suicides occurred in the United States--approximately one every 20 minutes.* The unadjusted suicide rate for this period rose from a low of 11.6 suicides per 100,000 population in 1970 to a high of 13.1/100,000 in 1977, then declined to 11.9/100,000 in 1980. Males had a markedly higher risk of suicide than females, and the differential between rates for males and females continued to widen. Between 1970 and 1980, almost three-fourths (72.8%) of suicides occurred among males, and the suicide rate increased for males while it decreased for females. In 1980, the age-adjusted suicide rate for males (18.0) was more than three times that for females (5.4) (Table 1).

The age-adjusted suicide rate for whites (12.1) was almost twice that for blacks and other races (6.7). White males consistently had the highest suicide rates, with black and other males the second highest, followed by white females and black and other females. In terms of absolute numbers of suicides committed in the United States in 1980, 70% were among white males; 22%, among white females; 6%, among black and other males; and 2%, among black and other females.

While the overall suicide rate changed little, rates for older persons decreased, and rates for younger persons increased. In 1970, the median age of persons who committed suicide was 47.2 years of age; by 1980, the median age had decreased sharply to 39.9 years. In 1970, fewer than one-fourth (22.8%) of males who committed suicide were under age 30 years; by 1980, more than one-third (34.3%) of males who committed suicide were under age 30 years.

The most striking aspect of the change in suicide rates from 1970 to 1980 was the large percentage increase in rates for males in both the 15- to 24-year and 25- to 34-year age groups and the consistent percentage decrease in rates for females in all age groups except the youngest (15-24 years) (Figure 1). Between 1970 and 1980, suicide rates for males 15-24 years of age increased 50%, while those for females in this age group increased only slightly, the only increase for females in any age group. Again, in the 25- to 34-year age group, suicide among males increased almost 30%, while suicide among females in that age group decreased almost 20%.

Within the 15- to 24-year age group, most of the increase in the suicide rate is due to the increase in the suicide rate for white males. Suicide rates increased by 60% for white males 15-19 years of age, and for white males 20-24 years of age, by 44% between 1970 and 1980. As a result of these changes, even though white males had their highest suicide rates in the oldest age group, in absolute numbers, most suicides occurred among young persons. White males ages 15-39 years in 1980 represented one-half of suicides among white males and more than one-third (35.0%) of all suicide deaths in the United States. On the other hand, in both 1970 and 1980, approximately one-fifth of all suicides among white males were among those over 65 years of age.

For males, this pattern of suicide rates by age group has been changing consistently over the past 30 years (Figure 2). In 1950, suicide rates for males were lowest at the youngest ages and increased with each successive age group, attaining the highest rates at the oldest age groups. The 1980 pattern of suicide for males by age had changed so that the curve was relatively flat for all age groups before age 65 years. This change occurred, because, from 1950 to 1980, age-specific suicide rates for males increased for the youngest three age groups but decreased for the oldest four age groups. For females, the curve between 1950 and 1980 by age was unchanged, namely an inverted U-shaped curve with the lowest suicide rates in the youngest and oldest age groups and the highest rates in mid-life. However, as with the males from 1950 to 1980, rates for younger women increased, and rates for older women decreased.

The most commonly used method of suicide in the United States is firearms.** In 1970, 50.1% of the 23,480 suicides were caused by firearms; in 1980, 57.3% of the 26,869 suicides were caused by firearms. The pattern of suicide by method varies little by race. While the male pattern of suicide by method has changed little between 1970 and 1980, the female pattern of suicide by method has significantly changed. In 1970, as in 1980, firearms were the leading method of suicide for males (58.4% and 63.1%, respectively), followed by hanging, strangulation, and suffocation (14.6% and 14.6%, respectively). There was a shift, however, between 1970 and 1980, in the most frequent method of suicide for females. In 1970, poisoning by solids or liquids was the method most frequently used by females (36.7%), followed by firearms (30.2%); in 1980 firearms were the methods most frequently used by females (38.6%), followed by poisoning by solids and liquids (26.9%).

By geographic area, suicide rates in 1980 ranged from a low of 7.4 suicides/100,000 population in New Jersey to 22.9/100,000 in Nevada. By region of the country, suicide rates were lowest in the Northeast and highest in the West in both 1970 and 1980, but this difference diminished over this period. Rates for the Northeast, North Central, and South all increased between 1970 and 1980, while rates decreased for the West.

For the aggregate of all suicides for 1970-1980, there was a seasonal trend in the occurrence of suicide.*** Suicides were more likely to occur during March, April, and May than other months of the year. Reported by Violence Epidemiology Br, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Suicide is a serious public health problem in the United States. According to national vital statistics information, almost 27,000 persons took their own lives in 1980, making suicide the tenth leading cause of death for that year (Figure 3). Suicide is a special concern for adolescents and young adults for whom it is the third leading cause of death. In 1980 alone, suicide accounted for a loss of some 619,533 years of potential life lost for individuals between the ages of 1 and 65 years.**** Suicide ranked as the second leading cause of death for white persons 15-34 years of age. A problem of this magnitude requires priority attention on the part of public health agencies at the national, state, and local levels.

The marked increase in the percentage of suicides by firearms is also of considerable public health concern. The trend toward firearms and away from poisoning as a preferred method of suicide for females indicates a move toward more immediately lethal methods, i.e., methods with less chance of intervention or "rescue."

The number of suicides specified in the national vital statistics reflects the judgments and professional opinions of the physicians, coroners, or medical examiners who certify the medical/legal cause of death on the death certificate. Suicide statistics based on death certificates probably understate the true number of suicides for several reasons: (1) inadequate information on which to make a determination of suicide as the cause of death; (2) certifier error or bias; and (3) lack of awareness of a suicide because a body was never recovered, e.g., drowning after jumping from a bridge.

The Violence Epidemiology Branch of the Center for Health Promotion and Education, CDC, is responsible for assessing the magnitude of mortality and morbidity related to suicide and suicide attempts, identifying population groups at highest risk of suicide, and suggesting intervention and prevention strategies to be implemented by public health, social service, and education agencies (1).

Because of the increase in the suicide rate among young persons over the decade, the U.S. Department of Health and Human Services has established a specific health objective focusing on the problem of suicide among young persons. The federal objective states, "By 1990, the rate of suicide among people 15 to 24 should be below 11 per 100,000. (In 1978, the suicide rate for this age group was 12.4 per 100,000.)" (2). In an attempt to improve the statistical understanding of this phenomenon, CDC has begun working with appropriate professional organizations and individuals to explore the feasibility of developing and implementing a uniform set of criteria for the classification of suicide.

References

1. CDC. Suicide surveillance. Atlanta, Georgia: Centers for Disease Control, 1985.

2. U.S. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, D.C.: U.S. Public Health Service, 1980:85. *Suicide deaths for these years were compiled from death certificate information by the National Center for Health Statistics, U.S. Department of Health and Human Services. Suicide deaths of nonresident aliens and U.S. citizens living abroad are excluded from this report. Because suicide varies by age, age-adjusted suicide rates are used in some parts of this report to allow for comparison of rates between populations without concern for age. The age-adjusted rates were computed by the direct method of standardization using the 1940 U.S. population as the standard.

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