Suicide Mortality in the United States, 1999–2019

● From 1999 through 2019, rates for male suicide were highest for those by firearm, while rates for suicide by suffocation saw the greatest percent increase, doubling from 3.3 in 1999 to 6.6 in 2019. In 2019, suicide was the 10th leading cause of death for all ages in the United States (1). As the second leading cause of death for ages 10–34 and the fourth leading cause for ages 35–54, suicide is a major contributor to premature mortality (2). Recent reports have documented a steady increase in suicide rates over the past two decades (3–6). This Data Brief uses final mortality data from the National Vital Statistics System to update trends in suicide rates from 1999 through 2019 and to describe differences by sex, age group, and means of suicide.

• For females, rates in 2019 were similar to those in 2018 for all age groups except 25-44, where the rate in 2019 was significantly lower than the rate in 2018.
• Similar to 2018, the 2019 rates for female suicide by suffocation (1.8) and by firearm (1.8) were higher than the rate for suicide by poisoning (1.7).
• From 1999 through 2019, rates for male suicide were highest for those by firearm, while rates for suicide by suffocation saw the greatest percent increase, doubling from 3.3 in 1999 to 6.6 in 2019.
In 2019, suicide was the 10th leading cause of death for all ages in the United States (1). As the second leading cause of death for ages 10-34 and the fourth leading cause for ages 35-54, suicide is a major contributor to premature mortality (2). Recent reports have documented a steady increase in suicide rates over the past two decades (3)(4)(5)(6). This Data Brief uses final mortality data from the National Vital Statistics System to update trends in suicide rates from 1999 through 2019 and to describe differences by sex, age group, and means of suicide.
For both males and females, the suicide rate in 2019 was significantly lower than the rate in 2018. • The total age-adjusted suicide rate increased 35.2% from 10.5 per 100,000 standard population in 1999 to 14.2 in 2018, before declining by 2.1% to 13.9 in 2019 ( Figure 1). Female suicide rates in 2019 were similar to rates in 2018 for most age groups.
• Generally, suicide rates among females increased between 1999 and 2019 for all age groups except women aged 75 and over. Patterns of increase varied by age group, with different rates of change over time ( Figure 2).
• From 1999 through 2019, female suicide rates were highest among those aged 45-64. The rate increased from 6.0 in 1999 to 10.2 in 2015, then decreased slightly to 9.6 in 2019; however, this decline in the trend was not significant. • Female suicide rates in 2019 were similar to rates in 2018 for each age group except 25-44. For this group, the rate in 2019 (7.4) was significantly lower than the rate in 2018 (7.9).
Male suicide rates in 2019 were significantly lower than the rates in 2018 for age groups 10-14, 45-64, and 65-74.
• Generally, suicide rates among males increased between 1999 and 2019 for all age groups except men aged 75 and over. Patterns of increase varied by age group, with different rates of change over time ( Figure 3). • Rates for suicide by suffocation (includes hanging, asphyxiation, strangulation, and other means of suffocation) tripled from 0.6 in 1999 to 1.8 in 2019.
• Similar to 2018, the 2019 rates for female suicide by firearm and suffocation were significantly higher than the rate for suicide by poisoning. This continues a recent pattern of a shift away from poisoning as the leading means of suicide for females.

For males, rates of suicide by firearm and suffocation have increased in recent years.
• Age-adjusted rates for male suicides by firearm decreased from 11.1 per 100,000 in 1999 to 10.3 in 2006, then increased to 12.3 in 2019. Throughout the period, the rates for suicide by firearm were higher than for other means ( Figure 5).
• Rates for male suicides by suffocation doubled from 3.3 in 1999 to 6.6 in 2019.
• Rates for male suicides by poisoning increased from 2.1 in 1999 to 2.3 in 2010, then decreased to 1.8 in 2019.

Summary
This report highlights trends in suicide rates from 1999 through 2019. During this period, the ageadjusted suicide rate increased 35% from 10.5 per 100,000 standard population in 1999 to 14.2 in 2018. The suicide rate in 2019 (13.9) was significantly lower (2%) than the rate in 2018. Suicide rates were consistently higher for males compared with females throughout the study period. For both males and females, the age-adjusted suicide rates in 2019 were significantly lower than the rates in 2018.
Suicide rates by sex and age group remained stable or declined from 2018 through 2019. For females, the 2019 suicide rates were similar to the 2018 rates for all age groups except 25-44. For this group, the rate in 2019 was significantly lower than the rate in 2018. Male suicide rates in 2019 were significantly lower than the rates in 2018 for age groups 10-14, 45-64, and 65-74, and similar to the rates in 2018 for age groups 15-24, 25-44, and 75 and over.
For females, suicides involving firearms and suffocation have replaced poisoning as the leading means of suicide in recent years due to a decline in suicides by poisoning beginning in 2016, and an increase in the rates of suicide by firearm and by suffocation. From 1999 through 2019, rates for males were highest for suicide by firearms, however during this period, the rates for suicide by suffocation saw the largest percent increase, doubling from 3.3 in 1999 to 6.6 in 2019.

Data source and methods
Data were analyzed using the National Vital Statistics System multiple cause-of-death mortality files for 1999 through 2019 (7). Suicide deaths were identified using International Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death codes U03, X60-X84, and Y87.0 (8). Means of suicide were identified using ICD-10 codes X72-X74 for firearm, X60-X69 for poisoning, and X70 for suffocation. "Other" includes: Cut or pierce; Drowning; Falls; Fire and flame; Other land transport; Struck by or against; Other specified, classifiable injury; Other specified, not elsewhere classified injury; and Unspecified injury, as classified by ICD-10.
Age-adjusted death rates were calculated using the direct method and the 2000 U.S. standard population (9). Suicides for persons aged 5-9 years were included in the total numbers and ageadjusted rates, but not shown as part of age-specific numbers or rates due to the small number of suicides per year among this age group.
Trends in death rates were evaluated using the Joinpoint Regression Program (4.8.0.1) (10). The Joinpoint software was used to fit weighted least-squares regression models to the estimated proportions on the logarithmic scale. Using the default settings, which allowed for as few as two observed time points in the beginning, ending, and middle line segments (excluding the joinpoints), a maximum of three joinpoints were searched for using the grid search algorithm and the permutation test and an overall alpha level of 0.05 (11). Pairwise comparisons of rates were conducted using the z test with an alpha level of 0.05 (9).

Keywords: intentional self-harm • means of suicide • firearm • suffocation • poisoning • National Vital Statistics System
For e-mail updates on NCHS publication releases, subscribe online at: https://www.cdc.gov/nchs/email-updates.htm.
For questions or general information about NCHS: