Health Disparities
Racial disparities in suicide mortality in the United States: examining the mediating role of neighborhood socioeconomic conditions in a nationwide study, 2011-2021 Alua Yeskendir* Alua Yeskendir Yeskendir Yeskendir Yeskendir Yeskendir Yeskendir University College London
Suicide is a major public health problem in the United States, exacerbated by substantial racial disparities, with rates increasing 37% between 2000 and 2022. Neighborhood socioeconomic conditions are a plausible pathway through which these disparities may arise, yet their mediating role remains unclear at the national level. We used data from the National Violent Death Reporting System covering 49 states and the District of Columbia (2011–2021; 267,349 suicide deaths) to examine racial differences in suicide mortality and to quantify mediation by neighborhood socioeconomic conditions.
We calculated age-adjusted suicide rates, estimated race-specific associations between neighborhood socioeconomic deprivation and suicide using negative binomial regression, and applied exploratory causal mediation analysis using the g-formula to decompose racial disparities into direct and indirect effects through neighborhood-level poverty, unemployment, and low education.
American Indian/Alaska Native populations had the highest suicide rates (22.1 per 100,000, 95% CI 21.4–22.8), followed by White populations (18.6 per 100,000, 95% CI 18.5–18.7), who accounted for 88% of all deaths, while Asian, Black/African American, and Multiracial populations had lower rates (6.4–7.9 per 100,000). Suicide rates were 1.17–1.34 times higher (95% CI 1.14–1.37) in the most versus least deprived neighborhoods for education and poverty, with dose-response relationships present among American Indian/Alaska Native and White populations but not other groups. Despite these gradients, neighborhood socioeconomic factors mediated less than 9% of racial disparities in suicide.
These findings suggest that racial disparities in suicide mortality largely operate through pathways beyond neighborhood socioeconomic conditions, underscoring the need to investigate alternative social and structural mechanisms shaping suicide risk.
