Abstract
This cross-sectional study examines suicide mortality rates among Asian American youths and young adults overall and by ethnic subgroup from 2018 to 2021.
Disparities in suicide rates among youths exist across races and ethnicities. Alaska Native, American Indian, and White youths have the highest rates of suicide, while Asian and Black youths have lower yet increasing rates. A lack of disaggregation of Asian American health data has inhibited identification of health needs of specific subgroups. We calculated suicide rates for youths (aged 15-19 years) and young adults (aged 20-24 years) from 2018 to 2021 for the 5 largest Asian American subgroups (Chinese, Filipino, Indian, Korean, and Vietnamese) and all other Asian American individuals.
Methods
This cross-sectional study followed the STROBE reporting guideline and used publicly available data, meeting exemption for review by the Seattle Children’s institutional review board and waiver of informed consent per the Common Rule. We extracted our numerator, suicide death counts by Asian American subgroup, from the CDC WONDER database from January 2018 to December 2021. Dates of analysis were from February 4, 2024, to February 21, 2024. Any subgroup-age-years group with less than 10 deaths was suppressed and assumed to be 0 in the main analysis. We obtained our denominator, population size by Asian American subgroup and age group, for 2018, 2019, and 2021 from the American Community Survey. Because population data for 2020 were unavailable, we averaged the 2019 and 2021 denominator data for each subgroup-age group. We pooled all 4 years to calculate annualized age-specific suicide death rates (per 100 000 individuals) with 95% CIs for each Asian American subgroup, all other Asian American individuals, all Asian American individuals, and all non–Asian American individuals. We calculated mortality rate ratios and 95% CIs to assess differences for each group compared with Chinese individuals, the largest Asian American group for young adults.
Because of suppressed data, we conducted a sensitivity analysis assuming each instance had 9 deaths (eMethods in Supplement 1). Analysis was performed using Microsoft Excel, version 16.81.
Results
Of the 1097 Asian American individuals who died by suicide, 305 (27.8%) were female and 792 (72.2%) were male (mean [SD] age, 20.3 [2.7] years). Asian American youths had lower rates of suicide (9.17 [95% CI, 8.28-10.06] per 100 000 individuals) than non–Asian American youths (10.77 [95% CI, 10.54-10.99] per 100 000 individuals) (Table). Chinese, Filipino, and Indian youths had lower rates of suicide than Korean, Vietnamese, and other Asian American youths. Rate ratios showed that compared with Chinese youths, Indian youths had significantly lower suicide rates and Vietnamese and other Asian American youths had significantly higher suicide rates.
Table. Suicide Rates and Rate Ratios for Youths and Young Adults Across Asian American Subgroups, 2018 to 2021a.
| Asian American group | Youths | Young adults | ||||
|---|---|---|---|---|---|---|
| Individuals, No.b | Annualized suicide death rate, per 100 000 (95% CI) | Rate ratio (95% CI) | Individuals, No.b | Annualized suicide death rate, per 100 000 (95% CI) | Rate ratio (95% CI) | |
| All | 1 110 184 | 9.17 (8.28-10.06) | 1.21 (1.09-1.40) | 1 167 103 | 14.18 (13.13-15.24) | 1.53 (1.40-1.73) |
| Chinese | 243 379 | 7.59 (5.92-9.27) | 1 [Reference] | 281 662 | 9.24 (7.57-10.91) | 1 [Reference] |
| Filipino | 160 976 | 7.64 (5.50-9.79) | 1.01 (0.93-1.06) | 178 424 | 16.03 (13.16-18.90) | 1.73 (1.73-1.74) |
| Indian | 248 009 | 6.91 (5.20-8.62) | 0.91 (0.88-0.93) | 225 346 | 13.93 (11.48-16.38) | 1.51 (1.50-1.52) |
| Korean | 71 612 | 8.44 (5.20-11.69) | 1.11 (0.88-1.26) | 78 679 | 15.66 (11.56-19.77) | 1.69 (1.53-1.81) |
| Non-Asian American | 20 643 127 | 10.77 (10.54-10.99) | 1.42 (1.19-1.78) | 20 235 918 | 18.32 (18.03-18.61) | 1.98 (1.71-2.38) |
| Vietnamese | 129 100 | 10.57 (7.83-13.32) | 1.39 (1.32-1.44) | 129 596 | 17.66 (14.05-21.26) | 1.91 (1.85-1.95) |
| All otherc | 257 108 | 13.37 (11.09-15.65) | 1.76 (1.69-1.87) | 273 396 | 16.79 (14.35-19.24) | 1.82 (1.76-1.89) |
Youths included individuals aged 15 to 19 years and young adults, 20 to 24 years.
Population in 2021.
Included all other Asian American ethnic groups not otherwise listed due to lack of data disaggregation or data suppression within the CDC WONDER database. These ethnic groups, as categorized by the American Community Survey, include Bangladeshi, Bhutanese, Burmese, Cambodian, Hmong, Indonesian, Japanese, Laotian, Malaysian, Mongolian, Nepalese, Pakistani, Sri Lankan, Taiwanese, and Thai.
Asian American young adults had lower rates of suicide (14.18 [95% CI, 13.13-15.24] per 100 000 individuals) than non–Asian American young adults (18.32 [95% CI, 18.03-18.61] per 100 000 individuals). Filipino, Indian, Korean, Vietnamese, and other Asian American young adults had higher suicide rates compared with Chinese young adults. Sensitivity analyses did not change the direction of findings for Filipino and Korean youths and young adults.
Discussion
This study found that disparities in suicide mortality in youths and young adults existed among Asian American subgroups. When suicide data were aggregated into a single Asian American category, the lower rates of suicide among Chinese individuals masked the higher rates in other subgroups. These findings align with research showing that suicide was a leading cause of death for Korean and Vietnamese individuals. The other Asian American subgroup included southeast Asians, such as Cambodian individuals, who may have high rates of suicidal ideation.
This study was limited by our lack of ability to further disaggregate Asian subgroups, assess differences by gender, and quantify morbidity from depression and other suicide risk factors by subgroup. It is unknown whether misclassification of suicide death varies by ethnicity. Suppressed data may underestimate suicide rates for Filipino and Korean youths and young adults. Future research should disaggregate by Asian American subgroups and explore why Asian American disparities in youth suicide exist to inform the development of culturally responsive mental health interventions for specific subgroups.
eMethods. Methodological Details
eReferences
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
eMethods. Methodological Details
eReferences
Data Sharing Statement