Vital Signs: Suicide Rates and Selected County-Level Factors - United States, 2022.
Level 4 - case-series / case-control
Ecological cross-sectional surveillance study using national vital statistics and county-level data.
PubMed 39298366 · doi:10.15585/mmwr.mm7337e1
What was done
Suicide deaths in the United States during 2022 (~49,000 deaths) were identified using the National Vital Statistics System. Researchers linked these deaths to county-level social determinants from federal data sources, specifically health insurance coverage, household broadband internet access, and household income greater than 100% of the federal poverty level. Rates were calculated across tertiles of these county-level factors and stratified by race and ethnicity, sex, age, and urbanicity.
What was found
The overall US suicide rate in 2022 was 14.2 per 100,000 population. Rates were highest among non-Hispanic American Indian or Alaska Native (AI/AN) individuals (27.1), males (23.0), and rural residents (20.0). County-level suicide rates were lowest in counties in the highest tertile for health insurance coverage (13.0 per 100,000), broadband internet access (13.3), and household income above the poverty level (13.5). These protective associations were strongest in disproportionately affected populations; among AI/AN individuals, suicide rates in the highest-tertile counties were approximately half those of the lowest-tertile counties.
Why it matters
This analysis highlights specific upstream community infrastructure and socioeconomic factors—such as broadband connectivity, health coverage, and income stability—that correlate with lower suicide rates and may guide targeted public health investments.
Limits
The study is ecological and cross-sectional, meaning associations at the county level cannot establish individual-level causation (risk of ecological fallacy). The analysis evaluated only three specific county-level variables, does not adjust for individual-level mental health or life-stress variables, and relies on single-year cross-sectional vital statistics.
Cited by
- supports Approximately 40,000 men per year die by suicide in the United States.