Table 2. Unadjusted Youth Suicide Rates by US County Characteristics.
| County characteristica | Youth suicides (2015-2016) | Mean national population, 5-19 y (2015-2016) | Annual suicide rate per 100 000 youth | IRR (95% CI) |
|---|---|---|---|---|
| Mental health HPSA designation | ||||
| Partial/no county | 3414 | 47 165 279 | 3.62 | 1 [Reference] |
| Whole county | 1620 | 15 899 231 | 5.09 | 1.41 (1.33-1.49) |
| Mental health HPSA score, quartileb | ||||
| Lowest (<13) | 268 | 3 171 683 | 4.22 | 1 [Reference] |
| Second (13-15) | 406 | 4 306 050 | 4.71 | 1.12 (0.95-1.31) |
| Third (16-17) | 582 | 5 285 928 | 5.51 | 1.30 (1.13-1.51) |
| Highest (≥18) | 339 | 3 085 947 | 5.49 | 1.30 (1.10-1.53) |
| Child psychiatrists | ||||
| 0 | 1303 | 12 996 907 | 5.01 | 1 [Reference] |
| 1-5 | 1319 | 13 588 425 | 4.85 | 0.97 (0.90-1.05) |
| 6-60 | 1813 | 24 637 056 | 3.68 | 0.73 (0.68-0.79) |
| >60 | 599 | 11 842 122 | 2.53 | 0.50 (0.46-0.56) |
| Children’s mental health hospital | ||||
| Absent | 4830 | 59 844 749 | 4.04 | 1 [Reference] |
| Present | 204 | 3 219 761 | 3.17 | 0.79 (0.68-0.90) |
| Uninsured children, quartilec | ||||
| Lowest (<3.9%) | 1950 | 27 545 205 | 3.54 | 1 [Reference] |
| Second (3.9%-5.2%) | 1107 | 14 695 637 | 3.77 | 1.06 (0.99-1.15) |
| Third (5.3%-7.6%) | 1041 | 10 515 070 | 4.95 | 1.40 (1.30-1.51) |
| Highest (≥7.7%) | 936 | 10 308 598 | 4.54 | 1.28 (1.19-1.39) |
| Low education county typed | ||||
| No | 4521 | 54 000 848 | 4.19 | 1 [Reference] |
| Yes | 513 | 9 063 662 | 2.83 | 0.68 (0.62-0.74) |
| Low employment county typed | ||||
| No | 4452 | 56 407 411 | 3.95 | 1 [Reference] |
| Yes | 582 | 6 657 099 | 4.37 | 1.11 (1.01-1.21) |
| Persistent poverty county typed | ||||
| No | 4786 | 59 381 679 | 4.03 | 1 [Reference] |
| Yes | 248 | 3 682 831 | 3.37 | 0.84 (0.73-0.95) |
| Persistent childhood poverty county typed | ||||
| No | 4411 | 54 298 128 | 4.06 | 1 [Reference] |
| Yes | 623 | 8 766 382 | 3.55 | 0.87 (0.80-0.95) |
| Rural-urban status | ||||
| Metropolitan | 4077 | 53 880 704 | 3.78 | 1 [Reference] |
| Rural adjacent to a metropolitan county | 563 | 6 064 085 | 4.64 | 1.23 (1.12-1.34) |
| Rural remote | 394 | 3 119 721 | 6.31 | 1.67 (1.50-1.85) |
Abbreviations: IRR, incidence rate ratio; HPSA, Health Professional Shortage Area.
a
For county characteristics that varied between 2015 and 2016, categorization of the county was based on 2015 characteristics.
b
Among 2106 US counties with an HPSA score assigned. Quartiles were defined using mean HPSA scores from 2015 and 2016.
c
Quartiles were defined using mean uninsured rates from 2015 and 2016.
d
Definitions of Economic Research Service county typology codes are listed in eTable 2 in the Supplement.