- Suicide rates elevated in non metropolitan areas and linked to higher area deprivation index and marginally to older age; inverse association with minority population proportion.
- Undetermined manner deaths significantly associated with greater area deprivation and cluster as many small urban areas, suggesting social burden and access to care issues.
- Geospatial methods identified distinct regions for surveillance; negative binomial models and SaTScan reveal differing spatial patterns informing targeted public health interventions.
Res Sq [Preprint]. 2026 Sep 20:rs.3.rs-10832081. doi: 10.21203/rs.3.rs-10832081/v1.
ABSTRACT
BACKGROUND: The rate of suicide death is known to be unequally distributed by geography and associated with multiple sociocultural and clinical risk factors. It is less clear whether the same patterns exist for deaths where the manner is undetermined, acknowledging that it is not always possible for a medical examiner to know whether death is intentional.
METHODS: Cumulative counts of suicide and undetermined death were aggregated to the Census tract level of the State of Maryland, between 2012-2020 and used as primary outcomes of interest. We evaluated death rate using two statistical approaches: 1) negative binomial models and 2) SaTScan geospatial clustering of pooled cases.
RESULTS: Model effects for suicide reveal a marginal association with older age, and greater area deprivation index (ADI), but an inverse association with proportion of minority race population. Undetermined death was found to be significantly associated with ADI. SaTScan clusters for suicide revealed a small number of large clusters covering rural areas of Maryland, but many small clusters around metropolitan areas for undetermined manner of death.
CONCLUSIONS: The two techniques identified distinct regions of interest for public health surveillance and intervention planning, and with respect to each manner of death. Suicide deaths were found to be elevated in non-metropolitan areas. Limited access to care and increased social burden are found to be associated with undetermined death. There is more uncertainty around intent for these cases, often due to a lack of diagnoses, treatment or other clinical context.
PMID:42780271 | PMC:PMC13596640 | DOI:10.21203/rs.3.rs-10832081/v1
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
