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Epidemiology of Self-Directed Violence

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Epidemiology of Self-Directed Violence

  1. 1. The epidemiology of self-directed violence Alex E. Crosby Division of Violence Prevention Centers for Disease Control and Prevention Feb 2015 National Center for Injury Prevention and Control Division of Violence Prevention/Etiology and Surveillance Branch "The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.”
  2. 2. Why is suicidal behavior a public health issue? • Morbidity and mortality • 10th leading cause of death in 2013 accounted for over 41,000 deaths • Estimated 483,586 emergency dept visits for self-inflicted injury in 2012 (NEISS) • Health consequences in many areas • Physical, mental, behavioral, reproductive, sexual transmitted diseases • Potential for impact by public health • Focus on prevention • Science base • Stresses multi-disciplinary approach • Mission of public health includes this issue “ … to reduce the amount of disease, premature death, and disease-producing discomfort and disability in the population.” J. Last, Dictionary of Epidemiology 1988
  3. 3. Leading causes of death – United States, 2013 Rank Cause Number of deaths 1 Heart Disease 611,105 2 Malignant Neoplasms 584,881 3 Chronic Lower Respiratory Ds 149,205 4 Unintentional Injuries 130,557 5 Cerebrovascular Ds 128,978 6 Alzheimer’s Disease 84,767 7 Diabetes mellitus 75,578 8 Influenza and pneumonia 56,979 9 Nephritis 47,112 10 Suicide 41,149 11 Septicemia 38,156 Source: CDC vital statistics
  4. 4. Leading causes of death for selected age groups – United States, 2013 Rank 10-14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years 1 Unintentional Injuries Unintentional Injuries Unintentional Injuries Unintentional Injuries Malignant Neoplasms Malignant Neoplasms 2 Malignant Neoplasms Suicide Suicide Suicide Heart Disease Heart Disease 3 Suicide Homicide Homicide Malignant Neoplasms Unintentional Injuries Unintentional Injuries 4 Congenital Malformations Malignant Neoplasms Malignant Neoplasms Heart Disease Suicide Liver Disease 5 Homicide Heart Disease Heart Disease Homicide Liver Disease Chronic Lower Respiratory Ds 6 Heart Disease Congenital Malformations Diabetes Mellitus Liver Disease Diabetes Mellitus Diabetes Mellitus 7 Chronic Lower Respiratory Ds Influenza and Pneumonia Congenital Malformations Diabetes Mellitus Cerebro- Vascular Suicide 8 Influenza and Pneumonia Chronic Lower Respiratory Ds HIV Cerebro- Vascular Homicide Cerebro- Vascular Source: CDC vital statistics
  5. 5. Leading causes of death by ethnicity – United States, 2013 Source: CDC Vital Statistics Rank White Black American Indian/AN Asian Latino 1 Heart Disease Heart Disease Heart Disease Malignant Neoplasms Malignant Neoplasms 2 Malignant Neoplasms Malignant Neoplasms Malignant Neoplasms Heart Disease Heart Disease 3 Chronic Low Respiratory Cerebro Vascular Unintentional Injuries Cerebro vascular Unintentional Injuries 4 Unintentional Injuries Diabetes Mellitus Diabetes Mellitus Unintentional Injuries Cerebro vascular 5 Cerebro vascular Unintentional Injuries Liver Disease Diabetes Mellitus Diabetes Mellitus 6 Alzheimer’s Disease Chronic Low Respiratory Chronic Low Respiratory Influenza and pneumonia Liver Disease 7 Diabetes Mellitus Nephritis Cerebro Vascular Chronic Low Respiratory Chronic Low Respiratory 8 Influenza and pneumonia Homicide Suicide Alzheimer’s Disease Alzheimer’s Disease 9 Suicide Septicemia Influenza and pneumonia Nephritis Influenza and pneumonia
  6. 6. 0 5 10 15 20 25 30 1933 1938 1943 1948 1953 1958 1963 1968 1973 1978 1983 1988 1993 1998 2003 2008 2013 Year Rateper100,000population Male Female Total Source: CDC vital statistics Suicide among all persons by sex -- United States, 1933-2013
  7. 7. Suicide rates among persons aged 15-19 years -- United States, 1956-2013 0 2 4 6 8 10 12 14 16 18 20 1956 1959 1962 1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013 Year Rateper100,000 population Male Total Female Source: CDC vital statistics
  8. 8. 0 500 1000 1500 2000 2500 3000 3500 4000 4500 0-4 ^5-9^10-14^15-19^20-24^25-29^30-34^35-39^40-44^45-49^50-54^55-59^60-64^65-69^70-74^75-79^80-84 ^85+ Age Group Numberofdeaths 0 3 6 9 12 15 18 21 Rateper100,000population Rate Number Source: CDC vital statistics Suicides and suicide rates among all persons -- United States, 2013
  9. 9. 0 10 20 30 40 50 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age Group in years Rateper100,000population Males Females Suicide rates among all persons by age and sex--United States, 2013 Source: CDC vital statistics
  10. 10. Suicide by method – United States, 2013 Firearms 51.4% Suffocation 24.5% Poisoning 16.1% Fall 2.4% Other 5.7% Source: CDC vital statistics
  11. 11. Age-adjusted suicide rates among all persons by state -- United States, 2013 (U.S. avg 12.6) Rates per 100,000 population 5.8 to 11.6 11.7 to 12.5 12.6 to 15.6 15.7 to 23.7 Source: Centers for Disease Control and Prevention (CDC) vital statistics Wash., D.C.
  12. 12. 0 5 10 15 20 25 30 35 40 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Age Group in years Rateper100,000population Eur-Amer NonLatino Afr-Amer NonLatino Native American Non-Latino Asian-PI Non-Latino Latino Suicide rates by ethnicity and age group -- United States, 2009-2013 Source: CDC Vital Statistics
  13. 13. Burden of injury Hospitalizations Emergency Dept visits Events reported on surveys Unreported events Deaths
  14. 14. Public Health Burden of suicidal behavior -- United States, 2012 *Source: CDC’s National Vital Statistics System ¶Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) § Source: CDC’s National Electronic Injury Surveillance System – All Injury Program
  15. 15. Number and ratio of persons affected by suicidal thoughts and behavior among adults aged ≥18 years — United States, 2012 *Source: CDC’s National Vital Statistics System, † Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) § Source: Source: CDC’s National Electronic Injury Surveillance System-All Injury Program ¶ Source: SAMHSA’s National Survey on Drug Use and Health ** Source: SAMHSA’s National Survey on Drug Use and Health Number in parentheses represent the ratio of deaths to other categories Deaths* Hospitalizations † Emergency Department visits§ Suicide attempts ¶ Seriously considered suicide** 39,426 (1) 129,205 (3.3) 405,000 (10.3) 1,129,000 (32.7) 9,031,000 (229.1)
  16. 16. 0 50 100 150 200 250 300 350 400 450 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Age Group in years Rateper100,000population Males Females Self-inflicted injury among all persons by age and sex--United States, 2013 Source: CDC WISQARS NEISS
  17. 17. Suicidal ideation and behavior among high school students by category and sex* -- United States, 2013 0 5 10 15 20 25 Seriously consider suicide Suicide plan Attempted suicide^ Suicide attempt with medical Category Percentageofallstudents Female Male Total Source: CDC Youth Risk Behavior Survey * During the 12 months preceding the survey ^One or more times
  18. 18. Percentage of high school students who report suicidal behavior* by sex – U.S., 1990- 2013 0 2 4 6 8 10 12 14 1990 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 Year Percentageofallstudents Source: Youth Risk Behavior Surveillance System *At least one attempt during the 12 months preceding the survey Female Male Total
  19. 19. Resources and internet-based Statistics • National Center for Injury Prevention and Control • Division of Violence Prevention • www.cdc.gov/ncipc • www.cdc.gov/ncipc/wisqars/default.htm • Injury mortality and leading cause of death statistics available by: • Intent, Method • Year • State • Demographics • Age, Sex, Race • Injury morbidity • Hospital emergency dept events • Natl Violent Death reporting System
  20. 20. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you National Center for Injury Prevention and Control Division of Violence Prevention www.cdc.gov/injury; 770-488-4410

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