The epidemiology of case fatality rates for suicide in the northeast

We examine how method-specific case fatality rates for suicide differ by age and sex.

Seven northeastern states provided mortality and hospital discharge data (1996 to 2000). Suicide acts were divided into 8 categories according to the method used. For each method, the fraction of acts resulting in death (the method-specific case fatality rate) was calculated. Only suicide acts that resulted in hospitalization or death were included.

Overall, 13% of all suicide acts proved lethal (23% for males compared with 5% for females; 7% for people aged 15 to 24 years compared with 34% for individuals aged > or =65 years). Poisoning with drugs accounted for 74% of acts but only 14% of fatalities; firearms and hanging accounted for only 10% of acts but 67% of fatalities. Firearms were the most lethal means (91% resulted in death), followed by drowning (84%) and hanging (82%). For every means, method-specific case fatality rates were higher for male victims and older individuals. Age and sex were associated with overall case fatality rates primarily because of their association with the distribution of methods chosen.

Our findings are based on suicide acts that result in hospitalization or death and therefore underestimate the actual incidence of suicide acts and overestimate case fatality rates. Nevertheless, we find that age and sex influence overall case fatality rates primarily through their association with methods used, rather than because of variation in method-specific case fatality rates.