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

Publisher: American Public Health Association Country of Publication: United States NLM ID: 1254074 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1541-0048 (Electronic) Linking ISSN: 00900036 NLM ISO Abbreviation: Am J Public Health Subsets: MEDLINE

Publication: Washington, DC : American Public Health Association
Original Publication: New York [etc.]

Firearms/*statistics & numerical data ; Rural Population/*statistics & numerical data ; Suicide/*statistics & numerical data ; Urban Population/*statistics & numerical data; Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Maryland/epidemiology ; Middle Aged ; Racial Groups ; Retrospective Studies ; Sex Distribution ; Young Adult

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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T32 MH014592 United States MH NIMH NIH HHS

Date Created: 20170818 Date Completed: 20171002 Latest Revision: 20211204

20240105

PMC5607660

10.2105/AJPH.2017.303865

28817331