• Andrew Conner, Deborah Azrael, and Matthew Miller.
• Quinnipiac University, North Haven, Connecticut (A.C.).
• Ann. Intern. Med. 2019 Dec 17; 171 (12): 885-895.

BackgroundThe suicide case-fatality rate (CFR)-the proportion of suicidal acts that are fatal-depends on the distribution of methods used in suicidal acts and the probability of death given a particular method (method-specific CFR).ObjectiveTo estimate overall and method-specific suicide CFRs and the distribution of methods used in suicidal acts by demographic characteristics.DesignCross-sectional study.SettingUnited States, 2007 to 2014.ParticipantsSuicide deaths (n = 309 377 records from the National Vital Statistics System) and nonfatal suicide attempts requiring treatment in an emergency department (ED) (n = 1 791 638 records from the Nationwide Emergency Department Sample) or hospitalization (n = 1 556 871 records from the National [Nationwide] Inpatient Sample) among persons aged 5 years or older.MeasurementsRates of suicide deaths and nonfatal suicide attempts, overall and method-specific CFRs, and distribution of methods used, by sex, age group, region, and urbanization.ResultsOverall, 8.5% of suicidal acts were fatal (14.7% for males vs. 3.3% for females; 3.4% for persons aged 15 to 24 years vs. 35.4% for those aged ≥65 years). Drug poisoning accounted for 59.4% of acts but only 13.5% of deaths; firearms and hanging accounted for only 8.8% of acts but 75.3% of deaths. Firearms were the most lethal method (89.6% of suicidal acts with a firearm resulted in death), followed by drowning (56.4%) and hanging (52.7%). Method-specific CFRs were higher for males and older persons. The distribution of methods varied across demographic groups.LimitationsResults are based on suicidal acts resulting in an ED visit, a hospitalization, or death. Consequently, the reported CFRs are larger than they would have been had the data included nonfatal attempts that did not result in an ED visit.ConclusionVariation in overall suicide CFR between sexes and across age groups, regions, and urbanization is largely explained by the distribution of methods used in suicidal acts.Primary Funding SourceJoyce Foundation.

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