- Age-adjusted mortality increased 64% from 0.45 to 0.74 between 2001 and 2023; AAPC 1.70%.
- Higher mortality in men, but steeper proportional increases in women; highest burden among ages 45-54, non-Hispanic White, Midwest, nonmetropolitan areas.
- Forecasts diverged: ARIMA projected stable rates while ETS predicted modest rise to 2035, indicating uncertainty and need for targeted prevention.
Front Public Health. 2026 Jun 18;14:1830159. doi: 10.3389/fpubh.2026.1830159. eCollection 2026.
ABSTRACT
BACKGROUND: Suicide remains a leading cause of mortality in the United States, and substance use disorders (SUD) are strong predictors of suicide risk. Long-term trends and disparities in SUD-related suicide mortality remain insufficiently characterized.
METHODS: We analyzed 2001-2023 mortality data from the CDC WONDER Multiple Cause of Death database, using the most recent complete 23-year national time series. SUD-related suicide deaths were defined as deaths with suicide as the underlying cause (ICD-10 U03, X60-X84, Y87.0) and SUD listed among multiple-cause or contributing conditions (ICD-10 F10-F19). Each death was counted once. AAMRs were calculated by sex, race/ethnicity, census region, and urban-rural status, while age-specific rates were calculated by age group. Joinpoint regression estimated APC and AAPC. ARIMA and ETS models forecasted AAMRs through 2035.
RESULTS: The overall AAMR increased from 0.45 in 2001 to 0.74 in 2023, representing a 64% rise (AAPC, 1.70, 95% CI, 1.16-2.24). Men consistently had higher mortality than women, whereas women showed steeper proportional increases. Mortality was highest among adults aged 45-54 years and lowest among those aged 15-24 years. Non-Hispanic White individuals, the Midwest, and nonmetropolitan areas had the highest burdens. ARIMA projected largely stable rates with widening prediction intervals, whereas ETS suggested a modest increase through 2035, mainly driven by the male series.
CONCLUSIONS: SUD-related suicide mortality increased substantially and remained unevenly distributed across demographic and geographic groups. Divergent forecasts highlight uncertainty and the need for targeted prevention.
PMID:42395281 | PMC:PMC13323130 | DOI:10.3389/fpubh.2026.1830159
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