Firearm suicides are a significant public health concern in the USA. In 2021, firearms were the most common mechanism for suicide with over 26 000 suicide deaths resulting from a firearm injury.¹ Age-adjusted rates of firearm suicide increased by 27% from 2001 to 2021.² However, disparities exist in these rates, with individuals 65 years and older, non-Hispanic white persons, and males having higher rates.³ These disparities in rates indicate that select demographic groups may disproportionately experience risk factors associated with firearm suicide. There are multiple interrelated factors at the individual, relationship, community and societal levels that may increase firearm suicide risk.^{4 5} Many communities are disproportionately impacted by these risk factors, underscoring how policy-driven solutions addressing social and economic risk factors might be leveraged to reduce suicide risk.

Research suggests that economic stressors may serve as community-level and individual-level drivers of suicide.^{3 6–10} Suicide rates historically increase during economic recessions and decrease during economic expansions, most notably among working individuals aged 25–64 years.⁸ A prior study found that counties with the highest community poverty levels had firearm suicide rates 1.3 times as high as counties with the lowest community poverty levels.³ Together, these findings suggest that policies that enhance economic security and decrease community-level poverty by providing support to individuals and families with low incomes may be an effective strategy for reducing risk of firearm suicide. One example of income support policies is minimum wage (MW) laws.

MW laws determine the lowest hourly wage most companies must pay their employees. These laws are set at the federal, state or local level. If there is no state MW law or a state’s MW is lower than the federal rate (currently at US$7.25 an hour since 2009), then employees receive the federal MW. At the end of 2021, 30 states had MWs that were higher than the federal minimum, with Washington having the highest rate of US$15.74 an hour.¹¹ Raising the MW may increase low-wage workers’ incomes and reduce the number of families living in poverty.¹²

As poverty has been identified as a structural determinant of firearm suicide risk, higher MW may serve as an important strategy for reducing firearm suicides.³ Additionally, increasing MW may help alleviate financial stress¹³ and improve life satisfaction,¹⁴ which in turn may decrease suicide risk.⁹ MW laws may also impact individuals who do not work MW jobs. For example, higher MW is associated with improved child health.¹⁵ Higher MW may improve child well-being by reducing parental stress, increasing family income and increasing time available for parenting.¹⁶

Previous research indicates that a higher MW was associated with a decrease in state-level suicide rates. One study estimated that a US$1.00 increase in a state’s real MW was associated with a 1.9% decrease in the annual state suicide rate.¹⁷ Another study found that a US$1.00 increase in the MW was associated with a 5.9% decrease in suicide rates among individuals with a high school education or less.¹⁸ However, to our knowledge, no study to date has examined if this relationship applies to firearm suicides, accounted for the differing cost of living between states, or if the association is consistent across different populations.

As firearm injuries account for most of suicide deaths,¹ this study examined the association between state MW and firearm suicides specifically between 2000 and 2020. Analyses were stratified by decedent characteristics to examine whether associations differed by demographics and by state estimates of firearm ownership. Findings may improve our understanding of how MW may relate to suicide risk and inform potential strategies to reduce firearm suicides.

The mean number of firearm suicides between 2000 and 2020 was 19 823.4±627.1 annually. The trend in the number of firearm suicides has been increasing since approximately 2006 (figure 1). The mean modified KI percent was 28.2±0.4 annually, signifying on average, a full-time MW worker would earn over a quarter of the state’s median income.

A 1 percentage point increase in a state’s modified KI was associated with a 0.3% (95% CI −0.6% to −0.0%) decrease in firearm suicides (table 1). The association between the modified KI and the number of firearm suicides was robust across models which excluded data from 2020 and controlled for both the state Gini coefficient and state poverty rate. When MW was dichotomised, there was no association between having a state MW higher than the federal rate and firearm suicides. For the centred MW conceptualisation, a US$1.00 increase in a state’s MW above the federal MW was associated with a 1.4% (95% CI −2.1% to −0.6%) decrease in firearm suicides.

When stratified by decedent characteristics, the modified KI was associated with decreases in the number of firearm suicides among men (−0.3%, 95% CI −0.6% to −0.1%), non-Hispanic black decedents (−0.8%, 95% CI −1.5% to −0.1%), non-Hispanic white decedents (−0.3%, 95% CI −0.6% to −0.0%) and decedents who resided in an MSA (−0.5%, 95% CI −0.8% to −0.2%) (table 2). When stratified by decedent age group, there were reductions in firearm suicides among decedents 10–24 years (−0.9%, 95% CI −1.5% to −0.3%) and 45–64 years (−0.4%, 95% CI −0.8% to −0.1%).

A US$1.00 increase in state MW above the federal MW was associated with reductions in firearm suicides in all groups except for among Hispanic decedents (−1.5%, 95% CI −4.0% to +1.1%), residents in a non-MSA (−0.6%, 95% CI −1.8% to +0.6%) and among decedents 25–44 years (−0.6%, 95% CI −1.8% to +0.6%).

Results from the firearm ownership interaction models suggest that an increase in the modified KI was associated with decreases in firearm suicides among states in the lowest quartile of firearm ownership (−0.6%, 95% CI −1.0% to −0.1%) and in the second lowest quartile of ownership (−0.3%, 95% CI −0.7% to −0.0%). Furthermore, these two quartiles of firearm ownership were most consistently associated with decreases in firearm suicide attributed to changes in the modified KI across model stratifications (table 3).

A higher state MW relative to the state’s median income was associated with a small 0.3% decrease in firearm suicides. This association was statistically significant even when including both a state’s Gini coefficient in the model and the percent of the state population living below the federal poverty line. The small effect size could be the result of the size of change in the modified KI. A one percentage point increase in the modified KI translates to about a US$0.25 increase in MW. This result implies a US$1.00 increase in MW would have been associated with 300 fewer firearm suicides in 2020.

These findings are consistent with previous research that found higher state MW was associated with reductions in suicide. A prior study found a 1.9% decrease in the annual state suicide rate, including firearm and non-firearm suicides, was associated with a US$1.00 increase in state MW using similar suicide data sources as this study.¹⁷ Another study found effects ranging from a 3.4% to 5.9% decrease in suicide rates among different demographic groups associated with a US$1.00 increase in state MW above the federal MW.¹⁸ Our findings may be lower than the estimates from that study as it used a more targeted population of adults with high school education or less, a different time period and examined all age-adjusted suicides as opposed to just firearm suicides. It is possible that MW is particularly impactful in some populations relative to others or the effect size of MW varies by mechanism. Future research could continue to explore the associations between different conceptualisations of MW and suicide in select populations and by additional mechanisms.

When dichotomised, state MW was not associated with firearm suicides. The dichotomous conceptualisation of MW represents the population average of all states with a MW higher than the federal, regardless of the size of the MW rate, and thus does not capture the purchasing power of MW in a state or the magnitude of MW changes over time. This null finding demonstrates the importance of conceptualising MW to capture these factors so as not to overlook underlying associations between MW and health outcomes.

When stratified by decedent characteristics, a few patterns emerged. Higher MW was consistently associated with decreases in firearm suicides among decedents who were men, non-Hispanic white, non-Hispanic black and residents of an MSA. All of these groups experience a higher rate of firearm suicide except for residents of MSAs and non-Hispanic black populations. The association between higher MW and individuals who are non-Hispanic black is consistent with prior research that found MW may reduce inequities in pay between non-Hispanic white and non-Hispanic black workers.²⁵ Rural areas have higher rates of suicide,²⁶ yet MW was associated with decreases only among decedents in an MSA. Multiple factors might explain the lack of significance among decedents in a non-MSA. For example, some types of farm work are ineligible for MW and the majority of MW workers are employed in service occupations in the leisure and hospitality industry, which may be more concentrated in denser areas.²⁷ Future research could explore the mechanisms driving these geographic and gender differences in associations and how protections for agricultural workers may be associated with firearm suicides.

Increased MW was more consistently associated with a decrease in firearm suicide among decedents between 10 and 24 years and 45 and 64 years relative to most other age groups. These associations could align with key life events, such as finishing school, achieving financial independence, or preparing to retire. Future research could explore whether age impacts this association, particularly as individuals transition across life events. Reducing suicide among middle-aged adults may reduce age-related disparities in suicide, as middle-aged adults experience higher rates of suicide.¹

While the extent to which higher MW may reduce disparities can be assessed in some populations, these data did not allow for other important stratifications for understanding the equity implications of higher MW. Although suicide impacts all communities, some populations may be disproportionately burdened by suicide but there are challenges to examining these disparities at the state level over time. For example, due to the population size being too small for meaningful analysis, this study could not assess the association between MW and suicides among non-Hispanic American Indian or Alaskan Native populations, which experience among the highest rates of suicides.²⁶ This study also could not assess the association between higher MW and suicides among individuals who are sexual or gender minorities, another group who experiences an inequitable risk of suicide as the result of adverse experiences such as discrimination.^{28 29} This is an important limitation of these data, as individuals who are sexual minorities,^{30 31} gender minorities³¹ and Indigenous peoples³² are more likely to experience economic stressors which may be impacted by higher MW. Future studies using more comprehensive data-sets can examine if policies, including MW, help protect sexual and gender minorities and Indigenous peoples who experience historic and ongoing legacies of social and structural inequities, including racism, transphobia and heterosexism from firearm suicide.

Higher MW may be more protective in states with the two lowest quartiles of firearm ownership. MW was not associated with decreases in firearm suicide among states in the top two quartiles of firearm ownership in the main model. This finding is in contrast to prior research that found that higher MW was associated with decreases in firearm homicides more consistently in states with higher rates of firearm ownership.²⁰ Future studies could continue to examine how rates of firearm ownership moderate the relationship between state MW laws and firearm suicides.

Higher MW was associated with a small decrease in firearm suicides. Policy-makers seeking options to reduce suicide rates may want to consider MW. This small association observed between MW and firearm suicide suggests a need for comprehensive strategies because suicide risk is driven by a variety of factors. Suicide is preventable and CDC’s Suicide Prevention Resource for Action describes a range of strategies based on the best available evidence.