217604 Relationship of suicide and unintentional poisoning mortality trends in the United States, 1987-2006

Monday, November 8, 2010 : 3:30 PM - 3:50 PM

Ian R.H. Rockett, PhD, MPH , Department of Community Medicine, West Virginia University, Morgantown, WV
Gerald Hobbs, PhD , Department of Statistics, West Virginia University, Morgantown, WV
Diego De Leo, MD, PhD, DSc , Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
Steven Stack, PhD , Department of Criminal Justice, Wayne State University, Detroit, MI
James Frost, MD , Department of Pathology, West Virginia University, Morgantown, WV
Alan Ducatman, MD, MSc , Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV
Nestor Kapusta, MD , Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria
Rheeda Walker, PhD , Department of Psychology, University of Georgia, Athens, GA
  
Background: Suicide undercounting is an ever-present problem in the US according to an Institute of Medicine report. Not previously linked, counter trends in suicide and unintentional poisoning rates have been separately reported. Objectives: To compare trends in suicide and poisoning mortality rates, and assess whether these trends were independent. Methods: A trend analysis using cross-sectional mortality data from WISQARS, the Web-based Injury Statistics Query and Reporting System, for the period 1987-2006, employing analysis of variance with repeated measures. The outcome measure was the gender/age-specific rate of death adjusted for suicide period [rate decline(1987-2000)/rate reversal(2001-2006)], year nested in suicide period, cause of death [suicide/ unintentional poisoning/poisoning mortality of undetermined intent], and interaction between suicide period and cause. A description of selected rate and ratio trends informed the statistical analysis. Results: Following a 19% decline between 1987 and 2000, the crude suicide rate then rose 5% by 2006. The crude unintentional poisoning mortality rate increased over four-fold between 1987 and 2006. Only males and females aged 65+ years showed suicide rate declines throughout the entire observation period. Consistently highest by gender and age, the male rate declined approximately 40%. There were statistically significant associations between suicide and unintentional poisoning mortality rates across the two suicide periods for decedents aged 15-64 years of both genders (p < 0.05). Conclusions: There is rising potential for suicide misclassification within unintentional poisoning, the elderly aside. We recommend assessing the association between psychopharmacology and the persistent decline in elderly male and female suicide rates.

Learning Objectives:
1.Delineate an approach for using descriptive data to refine a statistical model. 2.Assess a statistical approach for evaluating rate independence. 3.Develop a case for broadening cause-of-death data to address suicide surveillance and prevention.

Keywords: Suicide, Toxicants

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an injury epidemiologist and professor of epidemiology who has been working on suicide-related research for over 25 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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