Suicide Rates Were Lowest in Counties With More Insurance, Broadband and Income, 2022

About 49,000 people died by suicide in the United States in 2022 — 49,476, an age-adjusted rate of 14.2 per 100,000 — and provisional data show about as many in 2023. That is roughly one death every 11 minutes. Suicide was the second leading cause of death for people aged 10–34, and rates have risen over the past 20 years. Yet suicide is preventable.

Image from CDC's report

Who is most affected

Three community factors

Prevention works both downstream — treatment, crisis care, support after a loss — and upstream, improving the conditions in which people are born, grow, live, work and age before a crisis begins. CDC sorted U.S. counties into thirds by three such conditions and compared suicide rates:

Suicide deaths per 100,000.

The more a county had of each, the lower its suicide rate. Possible reasons:

• Insurance opens doors to mental health care, primary care and crisis help.
• Broadband — called a "superdeterminant" of health — connects people to jobs, social support and telehealth.
• Higher income helps people meet basic needs such as food and stable housing.

Suicide rates by county factor, 2022. Image from CDC's report

Strongest for the hardest-hit groups

For American Indian and Alaska Native people, White people, males and adults 25–44, rates were significantly lower in counties in the middle and top thirds for all three factors. For AI/AN people, rates in the top-third counties were about half those in the bottom third (rate ratios 0.44–0.49) — which matters all the more because AI/AN people are more likely to live where these factors are scarce.

For some groups the link was weaker. Among females, rates in the highest- and lowest-income counties were about the same (rate ratio 0.98), and among Black people the same held for insurance (1.03). Other factors — such as structural racism or norms about seeking help — may matter more for them.

How strongly each factor was associated with suicide rates, by group. Image from CDC's report

What communities can do

The 2024 National Strategy for Suicide Prevention stresses upstream prevention, and CDC's Suicide Prevention Resource for Action lays out the best-evidenced options:

• strengthen economic supports — household financial security, such as the Supplemental Nutrition Assistance Program, and stable housing;
• improve access to and delivery of suicide care, such as Zero Suicide;
• promote healthy connections, such as community engagement;
• teach coping and problem-solving skills;
• create protective environments, such as healthy workplace policies and culture.

CDC's Comprehensive Suicide Prevention Program puts these into practice. Vermont runs a stigma campaign, trains hospital and ED staff, and reaches rural residents and farmers through peer support and tele-mental health; Colorado builds connectedness, trains gatekeepers to spot people at risk, and partners on food security, affordable housing and transportation.

Limits: the study compares counties, so it can't show cause and effect; it couldn't look at veterans, people with disabilities or sexual and gender minorities; counties are large units; AI/AN and Hispanic deaths may be undercounted; and other county factors weren't examined.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

Based on Alison L. Cammack, Mark R. Stevens, Rebecca B. Naumann, Jing Wang, Wojciech Kaczkowski, Jorge Valderrama, Deborah M. Stone and Robin Lee, "Vital Signs: Suicide Rates and Selected County-Level Factors — United States, 2022," MMWR, volume 73, Centers for Disease Control and Prevention; a work of the United States government in the public domain.