Perspectives in Disease Prevention and Health Promotion Premature Mortality Due to Suicide and Homicide -- United States, 1983

In 1984, suicide and homicide together ranked as the fourth leading cause of years of potential life lost before age 65 (YPLL). They accounted for 1,247,000 YPLL or 10.6% of all YPLL (Table V, page 365). In this report, YPLL was calculated using data from the National Center for Health Statistics' detailed mortality computer tapes for 1983, the latest year for which tapes are available. Data were analyzed on YPLL attributable to suicide and homicide individually, by sex, race (white, black, other races), weapon or method of injury, and year. To compare differences in YPLL across time and among different race, sex, and age groups independent of changes and differences in population size, crude YPLL rates per 100,000 persons were calculated. SUICIDE

Considered alone, suicide is the fifth leading cause of YPLL in the United States, accounting for 631,990 YPLL in 1983. Suicides among white males accounted for 70.6% of the total suicide-attributable YPLL (Table 2). White females accounted for another 19.7%. White males had the highest crude YPLL rate due to suicide in 1983 (458/100,000), followed by males of other races (369/100,000), black males (283/100,000), and white females (122/100,000).

Suicides committed with firearms accounted for 363,828 YPLL in 1983, comprising 57.6% of the total YPLL attributable to suicide. This proportion was higher for males (60.9%) than for females (45.4%). Among males, hanging accounted for the next highest proportion of total YPLL (17.2%), followed by poisoning by gas (8.7%) and poisoning by solids or liquids (6.7%). Among females, poisoning by solids or liquids comprised the next highest proportion of YPLL due to suicide (25.9%), followed by poisoning by gas (10.5%) and hanging (9.8%).

The crude YPLL rate attributable to suicide increased for both black and white males from 1968 to 1983 (Figure 2). For white males, the YPLL rate increased 52.7% from 300/100,000 in 1968 to 458/100,000 in 1983. For black males, the YPLL rate increased 65.5% from 171/100,000 to 283/100,000. The YPLL rates for white and black females did not change appreciably during this period. HOMICIDE

Homicide accounted for 609,244 YPLL in 1983, making homicide alone the sixth leading cause of YPLL in the United States. Homicides among males accounted for more than three-quarters of the total YPLL due to homicide (Table 2); 40.2% of homicide-attributable YPLL was due to white males, and 35.0%, to black males. In 1983, the crude YPLL rate due to homicide was highest for black males (1,604/100,000), followed by black females (373/100,000), males of other races (334/100,000), and white males (252/100,000).

Firearm homicides accounted for 375,369 YPLL in 1983, or 61.6% of the total homicide-attributable YPLL. This proportion was higher for males (66.2%) than females (46.4%). Homicides committed with cutting and piercing instruments accounted for 21.6% of the total YPLL for males and 18.6% of the total YPLL for females.

From 1968 to 1983, the crude YPLL rate due to homicide increased by 24.4%, from 209/100,000 to 260/100,000. During this period, the crude YPLL rate was 6-11 times higher for black males than for white males and 5-7 times higher for black females than white females (Figure 3). From 1968 to 1983, the crude YPLL rate increased for white males and females by 60.5% and 43.6%, respectively, and decreased for black males and females by 8.7% and 4.6%, respectively. Reported by Div of Injury Epidemiology and Control, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: The number of YPLL is a measure of public health impact and is dependent on population size. For this reason, YPLL alone is inadequate to compare premature mortality across different years or across subpopulations, such as blacks and whites. This consideration is important, for example, when comparing homicide-attributable YPLL among blacks with that among whites. While whites accounted for a greater proportion than blacks of the total homicide-attributable YPLL in 1983 (53.6%, compared with 44.0%), the crude YPLL rate was 5.9 times higher for blacks than whites in that year. Moreover, although the crude suicide-attributable YPLL rate increased only 0.8% for white females from 1968 to 1983, the total number of suicide-attributable YPLL for white females increased 15.1% (from 108,099 to 124,475), mainly due to population increases.

Relative to other important causes of premature death, intentional injuries take their heaviest toll among the young. Over two-thirds of YPLL due to both suicide and homicide is attributable to deaths among persons under 35 years of age. In contrast, almost two-thirds of YPLL due to heart disease is attributable to deaths among persons 45 years of age or older. This observation is underscored by the fact that the average YPLL per death for heart disease is 2.1 years, compared with 22.3 years for suicide and 30.6 years for homicide. Injury prevention is, therefore, an appropriate focus for programs designed to target young populations, such as maternal- and child-health programs.

Firearms have been previously noted to be the weapon used in the largest proportion of deaths due to suicide and homicide (1,2). These data clearly indicate that their role in intentional injury should be examined more closely.

For both homicide and suicide, persons of nonblack minority races were noted to be at intermediate risk between blacks and whites. However, this finding is difficult to interpret. Nonblack minority races comprise a relatively small, heterogeneous population with varying risks of homicide and suicide. It has been reported that Native Americans are at higher risk of both homicide and suicide than whites, but that, in general, Asian/Pacific Islanders are not (3). Further research is needed to identify specific Native American populations at highest risk of death from intentional injuries and develop interventions appropriate for these high-risk groups.

Black males comprised only 7.0% of the total population in 1983 (4), but homicides among black males accounted for 35.0% of the total YPLL attributable to homicide in that year. Future research should clarify the role that various factors play in homicide deaths so that preventive interventions might be devised.

Although the overall suicide rate has not changed much since 1968, the crude suicide-attributable YPLL rate has increased considerably because of the changing age distribution of suicide victims. In the past, suicide rates were relatively low among the young and increased with increasing age. However, beginning in the early 1950s, suicide rates have gradually increased among young persons, particularly among young white males, while decreasing among older persons (5,6). In the past, many ideas about the causes of suicide and ways to prevent it were derived from concepts of suicide as a phenomenon primarily affecting older people. This marked increase in the rate of suicide among young people suggests a need to reexamine past assumptions.

YPLL due to suicide is probably substantially underestimated because suicides are thought to be underreported on death certificates (4,5). Reasons for underreporting include difficulties in establishing suicidal intent, certifier error or bias, and the lack of awareness of a suicide because a body was never recovered (e.g., drowning after jumping off a bridge).

References

1. CDC. Homicide among young black males--United States, 1970-1982. MMWR 1985;34:629-33.

2. Rosenberg ML, Stark E, Zahn MA. Interpersonal violence: homicide and spouse abuse. In: Public Health and Preventive Medicine, 12th edition, JM Last, ed. Norwalk, Connecticut: Appleton-Century-Crofts, 1986:1399-426.

3. U.S. Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Washington, D.C.: Department of Health and Human Services, 1985.

4. U.S. Bureau of the Census, Current population reports, series P-25, no. 965. Estimates of the population of the United States by age, sex, and race: 1980 to 1984, Washington, D.C., 1985.

5. CDC. Suicide--United States, 1970-1980. MMWR 1985;34:353-7.

6. CDC. Suicide surveillance. Atlanta, Georgia: Centers for Disease Control, 1985.

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