Perspectives in Disease Prevention and Health Promotion Violent Deaths Among Persons 15-24 Years of Age -- United States, 1970-1978

In the past 25 years, the U.S. suicide rate among people 15-24 years of age has increased dramatically; the rate began to increase markedly in the mid-1950s and had more than tripled by 1978, moving suicide from the fifth leading cause of death in this age group in 1960 to the third leading cause in 1978. Homicide is the second leading cause of death for people in the 15- to 24-year age group; for black males 15-24 years of age, it is the primary cause of death. Because of these statistics, the U.S. Department of Health and Human Services has established two priority objectives focusing on the problems of violent deaths in the groups at very high risk:

Suicide: By 1990, the rate of suicide among people 15-24 years of age should be below 11 per 100,000 (compared with 12.4/100,000 in 1978) (1). Homicide: By 1990, the death rate from homicide among black males 15-24 years of age should be reduced to below 60/100,000 (compared with 72.5/100,000 in 1978) (1). To monitor and promote progress toward these objectives, CDC and the National Institute of Mental Health investigated trends and characteristics of suicide and homicide within these high-risk groups.* SUICIDE AMONG PERSONS 15-24 YEARS OF AGE

Between 1970 and 1978, 39,011 U.S. residents 15-24 years of age committed suicide. The suicide rate for this age group increased 41% (from 8.8 deaths/100,000 population in 1970 to 12.4/100,000 in 1978), while the rate for the remainder of the population remained stable.

In this age group, the increase is due primarily to an increasing number and rate of suicides among males; rates for males increased by 47.4% (from 13.5 to 19.9/100,000), compared with an 11.9% increase for females (4.2 to 4.7/100,000), so that by 1978, the ratio of suicides committed by males to those by females was greater than 4 to 1. Most (88.8%) male suicide victims were white. Moreover, the white-male group was the only race-sex category to show a clear upward trend in suicide rates from 1970-1978 (Figure 1). Except for 1972, rates for males of black and other races rose gradually but remained lower than rates for white males. Rates for white females and for females of black and other races were approximately equal and relatively stable (88.8%) male suicide victims were white. Moreover, the white-male group was the only race-sex category to show a clear upward trend in suicide rates from 1970-1978 (Figure 1). Except for 1972, rates for males of black and other races rose gradually but remained lower than rates for white males. Rates for white females and for females of black and other races were approximately equal and relatively stable over time.

Young adults (20-24 years old) had approximately twice the number and rate of suicides as adolescents 15-19 years old.

For 15- to 24-year-olds, the western United States had consistently higher suicide rates from 1970 to 1978 than the other three regions (north-central, northeastern, and southern). However, this difference in rates narrowed substantially by 1978, because rates for each of the other regions increased over this period.

The method of suicide changed dramatically from 1970 to 1978. The proportion of suicides committed by firearms or explosives increased for both males and females, and the proportion of both males and females committing suicide by poisoning declined (Figure 2). These changes were more marked among females, who have traditionally committed suicide by poisoning. HOMICIDE AMONG BLACK MALES 15-24 YEARS OF AGE

Homicide is the leading cause of death for U.S. black males 15-24 years of age. In 1978, the homicide rate for this group was 72.5 deaths/100,000 population, compared with a rate of 13.2/100,000 for all persons 15-24 years of age. However, this high 1978 rate still represented a decrease of more than 25% in the rate of homicide deaths among black males 15-24 years of age over the 9-year period 1970-1978. Rates were greater than 100/100,000 for 1970-1972 but decreased to rates of less than 80/100,000 for 1976-1978 (Figure 3). Rates for black males in the 20- to 24-year age group are more than twice those in the 15- to 19-year age group for each of the 9 years 1970-1978. In 1978, 38.6% percent of all deaths among black males 20-24 years old were due to homicide.

Homicide rates for males of black and other races** 15-24 years of age are consistently highest in the north-central states, followed by the northeastern and southern states, with the lowest rate in the western states. The difference between the rates in the northeast, south, and west have narrowed, so that in 1978, they were 64.1/100,000, 56.1/100,000, and 53.9/100,000, respectively, while the rate for the north-central states remained highest at 105.4/100,000. Also, for each of the 9 years from 1970 to 1978, the homicide rate in metropolitan counties has been approximately twice as high as in non-metropolitan counties. In 1978, the rates were 77.2/100,000 and 37.5/100,000 for metropolitan and non-metropolitan counties, respectively.

Most homicide deaths occurring among black males 15-24 years of age are due to firearms (more than 75% in each year 1970-1978). Cutting or piercing instruments are consistently the second most frequent method (approximately 15%). Approximately three-fourths of the homicide deaths from firearms involve handguns.

Most black male homicide victims 15-24 years of age are not killed in connection with documented criminal events, such as robberies or drug trafficking. In 1979, 66.4% of such deaths were not related to felonies; 15.6% were considered related to felonies. For 18.0% of such deaths, the circumstances were undetermined.

Most black male homicide victims 15-24 years of age were killed by persons known to them, usually acquaintances but not family members. In 1979, 54.4% of these homicide victims were killed by people known to them (87% of whom were non-family), and 12.9% were killed by strangers. For 32.7% of the deaths, it was unknown whether strangers or persons known to the victims committed the homicides. Reported by Violence Epidemiology Br, Office of the Director, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Suicide may be underreported (2,3) because of difficulty in establishing suicidal intent, practical considerations (such as loss of insurance benefits), the social stigmata associated with suicide, and the addition of the category "undetermined whether death is accidental or purposely inflicted" to the International Classification of Diseases' coding scheme (4-8). Nevertheless, there is no evidence to suggest that the impact of these biases has changed substantially from 1970 to 1978, so the trends revealed in these data should be accurate.

Data presented in this report suggest that, among persons 15-24 years of age, young white male adults (20-24 years old) have the highest suicide risk. Further research is needed to explain the marked increase in suicide among young, white males and to characterize their deaths more precisely. For public health agencies to have an effective role in suicide prevention, it will be necessary to understand the importance of contributing factors, such as mental illness and alcohol and drug abuse, as well as specific social and cultural factors, and to relate these epidemiologic data to clinical psychiatric data and theory.

Young black men are at exceedingly high risk of homicide--of all black males 20-24 who died in 1978, over one-third were victims of homicide. Researchers must determine more precise risk factors for this group, as well as the factors contributing to the substantial decline in homicide rates between 1970 and 1978.

For all forms of interpersonal violence--including homicide, suicide, family violence, child abuse, and sexual abuse--the goal of public health research is to decrease the premature morbidity and mortality associated with violence. It is important to determine the nature and timing of critical precedents that place individuals at high risk of committing violent acts and at high risk of death at their own hands or at the hands of others. It is also important to identify the persons or groups in contact with high-risk individuals who could save lives through critical interventions, e.g., family members, friends, teachers, and personal physicians.

References

1. U.S. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, D.C.: U.S. Public Health Service, 1980.

2. Dublin L. Suicide: a sociological and statistical study. New York: Ronald Press, 1963.

3. Maris R. Social forces in urban suicide. Homewood, Illinois: Dorsey Press, 1969.

4. Hopper K, Guttmacher S. Rethinking suicide: notes toward a critical epidemiology. Int J Health Serv 1979;9:417-38.

5. Bakwin H. Suicide in children and adolescents. J Pediat 1957;50:749-69.

6. Schrut A. Suicidal adolescents and children. JAMA 1964;188: 1103-7.

7. Shaffer D, Fisher P. The epidemiology of suicide in children and young adolescents. J Am Academy of Child Psychiatry 1981;20(3):545-65.

8. Warshauer ME, Monk M. Problems in suicide statistics for whites

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