Spatiotemporal clustering of suicides in the US from 1999 to 2016: a spatial epidemiological approach
This study aims to describe and characterize the spatial and temporal clustering patterns of suicide in the ten states with the greatest suicide burden in the United States from 1999 to 2016.
All suicide deaths from January 1, 1999 to December 31, 2016 in the United States were identified using data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset. The ten states with the highest age-adjusted suicide rates were Montana, Alaska, Wyoming, New Mexico, Nevada, Utah, Idaho, Colorado, Arizona, and Oklahoma. A spatiotemporal scan statistic using a discrete Poisson model was employed to retrospectively detect spatiotemporal suicide clusters.
From 1999 to 2016, a total of 649,843 suicides were recorded in the United States. Nineteen statistically significant spatiotemporal suicide mortality clusters were identified in the states with the greatest suicide rates, and 13.53% of the suicide cases within these states clustered spatiotemporally. The risk ratio of the clusters ranged from 1.45 to 3.64 (p < 0.001). All states had at least one cluster, with three clusters spanning multiple states, and four clusters were found in Arizona. While there was no clear secular trend in the average size of suicide clusters, the number of clusters increased from 1999 to 2016.
Hot spots for suicidal behavior in the United States warrant public health intervention and continued surveillance. As suicide rates in the US continue to increase annually, public health efforts could be maximized by focusing on regions with substantial clustering.
KeywordsSuicide Suicide clusters Epidemiology Spatial statistics Cluster analysis
Support for this work was provided by the National Institute of Alcohol Abuse and Alcoholism (K01AA021511, Keyes), the Center for Injury Epidemiology and Prevention at Columbia University, and the National Institute of General Medical Science (R01GM110748, Shaman).
Compliance with ethical standards
Conflict of interest
JS and Columbia University disclose partial ownership of SK Analytics. SK has consulted for SK Analytics. The other authors report no conflicts of interest and have no financial relationships with commercial interests.
- 1.Centers for Disease Control and Prevention (2018) Suicide rates rising across the US. Vital signs morbidity and mortality weekly report, June 2018. https://www.cdc.gov/vitalsigns/pdf/vs-0618-suicide-H.pdf. Accessed 19 May 2018
- 2.National Center for Health S (2017) Health, United States. In: Health, United States, 2016: With Chartbook on Long-term Trends in Health. National Center for Health Statistics (US), Hyattsville (MD)Google Scholar
- 6.Gould MS, Kleinman MH, Lake AM, Forman J, Midle JB (2014) Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988–96: a retrospective, population-based, case–control study. Lancet Psychiatry 1(1):34–43. https://doi.org/10.1016/S2215-0366(14)70225-1 CrossRefPubMedGoogle Scholar
- 10.Pirkis J, Nordentoft M (2011) International handbook of suicide prevention: research, policy and practice. In: O’Connor R, Platt S, Gordon J (eds) Media influences on suicide and attempted suicide. Wiley, Chichester, pp 531–544Google Scholar
- 16.Fontanella CA, Saman DM, Campo JV, Hiance-Steelesmith DL, Bridge JA, Sweeney HA, Root ED (2018) Mapping suicide mortality in Ohio: a spatial epidemiological analysis of suicide clusters and area level correlates. Prev Med 106:177–184. https://doi.org/10.1016/j.ypmed.2017.10.033 CrossRefPubMedGoogle Scholar
- 24.Centers for Disease Control and Prevention, National Center for Health Statistics (2017) Underlying Cause of Death 1999-2016 on CDC WONDER Online Database. http://wonder.cdc.gov/ucd-icd10.html. Accessed 17 Jan 2018
- 25.US Census Bureau (2010) Profile of General Population and Housing Characteristics: 2010 (DP-1) using American FactFinder. http://factfinder.census.gov. Accessed 25 March 2019
- 26.Kulldorff M (2006) Satscan: software for the spatial and space-time scan statistics. http://www.satscan.org. Accessed 2 Dec 2017
- 28.Perez-Costillas L, Blasco-Fontecilla H, Benitez N, Comino R, Anton JM, Ramos-Medina V, Lopez A, Palomo JL, Madrigal L, Alcalde J, Perea-Milla E, Artieda-Urrutia P, de Leon-Martinez V, de Diego Otero Y (2015) Space-time suicide clustering in the community of Antequera (Spain). Rev Psiquiatr Salud Ment 8(1):26–34. https://doi.org/10.1016/j.rpsm.2014.01.007 CrossRefPubMedGoogle Scholar
- 31.Dantas AP, Azevedo UN, Nunes AD, Amador AE, Marques MV, Barbosa IR (2018) Analysis of suicide mortality in Brazil: spatial distribution and socioeconomic context. Revista brasileira de psiquiatria (Sao Paulo, Brazil: 1999) 40(1):12–18. https://doi.org/10.1590/1516-4446-2017-2241 CrossRefGoogle Scholar
- 33.R Development Core Team (2008) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org. Accessed 18 Oct 2017
- 35.Leavitt RA, Ertl A, Sheats K, Petrosky E, Ivey-Stephenson A, Fowler KA (2018) Suicides among American Indian/Alaska natives—National Violent Death Reporting System, 18 States, 2003–2014. MMWR Morb Mortal Wkly Rep 67:237–242. https://doi.org/10.15585/mmwr.mm6708a1 CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Hanzlick R (2006) Medical examiners, coroners, and public health: a review and update. Arch Pathol Lab Med 130(9):1274–1282. https://doi.org/10.1043/1543-2165(2006)130%5b1274:MECAPH%5d2.0.CO;2 CrossRefPubMedGoogle Scholar
- 40.Center for Disease Control and Prevention Public Health Law Program (2015) Coroner/medical examiner laws, by state. https://www.cdc.gov/phlp/publications/topic/coroner.html. Accessed 5 Apr 2019