image: Relative risk of suicide among children 5-19 years old by county poverty concentration and by mechanism, 2007-2016 view more
Credit: Jennifer A. Hoffmann, MD, FAAP
NEW ORLEANS, La. –Research being presented at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition shows that U.S. children living in counties with the highest poverty level are more than one-third more likely to die by suicide than those living in the least impoverished counties. The association is most pronounced for suicide by firearms.
An abstract of the study, “Pediatric Suicide Rates and Community-Level Poverty in the United States, 2007-2016,” will be presented on Sunday, Oct. 27, at the Hilton New Orleans Riverside.
Youth suicide has nearly doubled in the last 10 years, making it the second leading cause of death for children and adolescents between ages 10 and 19 years old in the United States.
“Understanding risk factors for youth suicide is critically needed to inform prevention efforts,” said abstract author Jennifer A. Hoffmann, MD, FAAP, a pediatric emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and an Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.
For the study, researchers conducted a retrospective, cross-sectional analysis of suicides among U.S. children ages 5-19 years old from 2007 to 2016 using Centers for Disease Control and Prevention and U.S. Census data.
Overall, the annual suicide rate was 3.4/100,000 children 5 to 19 years old. Of the 20,982 children between 5-19 years old who died by suicide during that time period, 85% were 15 to 19 years old, 76% were male, and 69% were Caucasian.
The researchers then divided counties into five poverty concentration categories, ranging from 0% to 20% or more of the population living below the federal poverty level. Controlling for variables including the year, demographics of the children who died (age, sex, and race), county rural-urban classification, and community demographics (county age, sex, and racial composition), the researchers found that counties with greater than 10% poverty concentration had a higher incidence of suicide compared to the lowest poverty concentration counties (0-4.9%). Suicide rates continued to rise with increased poverty concentration, with children living in counties with the highest poverty concentration (greater than 20% of the population living below the federal poverty level) being 37% more likely to die by suicide than youth living in the least impoverished counties.
The researchers also performed subgroup analyses for the three most common suicide mechanisms: suffocation (including hanging), firearms, and poisoning. Suicide rates from hanging and overdoses were not different between the different county poverty levels. Among firearm suicides, the suicide rate increased with increasing poverty concentration, relative to the lowest poverty concentration counties.
Dr. Hoffmann calls for additional research into the association between youth suicide and poverty.
"We need to figure out why children living in higher poverty communities are at increased risk for suicide,” she said. “It could be related to unsafe gun storage, limited access to mental health care, or the build up of chronic stressors that children in poverty experience throughout the lifespan."
More immediately, Dr. Hoffmann said the findings suggest a need to target pediatric suicide prevention strategies in high poverty areas, including firearm suicide prevention.
“The majority of teen suicides by firearm occur in the home with a firearm owned by an adult in the home. Safe firearm storage (keeping the gun unloaded and locked separately from the ammunition) has been shown to decrease youth firearm suicide,” Dr. Hoffmann said. Safely storing dangerous medications is another proven way to help decrease suicide risk among children.
Dr. Hoffmann also recommends parents keep an open line of communication with their children.
"Parents should not be afraid to have a conversation with their child about mental health and suicide. Talking about mental health openly decreases stigma and may allow a child to access help before it's too late," she said.
Dr. Hoffmann will present an abstract of the study on Sunday, Oct. 27, between 3:10 pm and 3:18 p.m. in Jefferson Ballroom at the Hilton New Orleans Riverside.
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To request an interview with Dr. Hoffmann, journalists may contact AAP media relations or Kathleen Keenan, communications officer at Lurie Children’s, at 312-227-4262 or kkeenan@luriechildrens.org.
In addition, Dr. Hoffmann will be among highlighted abstract authors will give brief presentations and be available for interviews during a press conference and luncheon starting at 12:30 p.m. Saturday in rooms 208-209 (Press Office). During the meeting, you may reach AAP media relations staff in the National Conference Press Room at 504-670-5406.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
Abstract Title: Pediatric Suicide Rates and Community-Level Poverty in the United States, 2007-2016
Jennifer A. Hoffmann, MD, FAAP, presenting author
Purpose: Suicide is the second leading cause of death among children 10-19 years old in the United States (U.S.), with rates increasing over time. Children in impoverished communities are at risk for negative health outcomes; however, the relationship between pediatric suicide rates and community-level poverty is unknown. Our objective was to analyze the association between pediatric suicide rates and county poverty concentration. Methods: We conducted a retrospective, cross-sectional analysis of suicides among U.S. children 5-19 years old from 2007-2016. Suicides were identified from the Centers for Disease Control and Prevention Compressed Mortality File. County poverty concentration, the percentage of the population living below the federal poverty level (FPL), was obtained from U.S. Census data. Counties were divided into 5 poverty concentration categories: 0-4.9%, 5-9.9%, 10-14.9%, 15-19.9%, and ≥20% of the population living below the FPL. We developed a multivariate negative binomial regression model to analyze the relationship between pediatric suicide rates and county poverty concentration, reporting adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CI). We controlled for year, demographics of the children who died (age, sex, and race), and community demographics (county age, sex, and racial composition). We performed subgroup analyses for the 3 most common suicide mechanisms: suffocation (including hanging), firearms, and poisoning. Results: From 2007 to 2016, 20,982 children 5-19 years old died by suicide: 85% were 15-19 years old, 76% were male, and 82% were white. The annual suicide rate was 3.4/100,000 children 5-19 years old. In the multivariate model, counties with >10% poverty concentration had a higher incidence of suicide compared to the lowest poverty concentration counties (0-4.9%) (Figure 1). Suicide rates increased with increasing poverty concentration: 10-14.9% poverty concentration, aIRR 1.31 (95% CI 1.11, 1.54); 15-19.9% poverty concentration, aIRR 1.38 (95% CI 1.17, 1.62); and ≥20% poverty concentration, aIRR 1.60 (95% CI 1.34, 1.91). Among suicides by suffocation, there was a higher suicide rate in the highest poverty concentration counties (≥20%) (aIRR 1.33, 95% CI 1.04, 1.69) compared to the lowest poverty concentration counties (0-4.9%). Among firearm suicides, the suicide rate increased with increasing poverty concentration, relative to the lowest poverty concentration counties (0-4.9%): 5-9.9% poverty concentration, aIRR 1.45 (95% CI 1.11, 1.90); 10-14.9% poverty concentration, aIRR 1.89 (95% CI 1.44, 2.47); 15-19.9% poverty concentration, aIRR 2.15 (95% CI 1.64, 2.82); and ≥20% poverty concentration, aIRR 2.44 (95% CI 1.84, 3.23). No association was found between suicides by poisoning and county poverty concentration. Conclusions: Higher community-level poverty is associated with increased suicide rates among children 5-19 years old. This association is most pronounced for suicide by firearms. Pediatric suicide prevention strategies should target high poverty areas, including firearm suicide prevention.