Injuries/Violence
Demographic Differences in Suicide Mortality, Attempts, and Ideation Among Publicly Insured, Privately Insured, and Health System Patients in North Carolina, 2006-2020 Grace Yeboah-Kodie* Grace Yeboah-Kodie Yeboah-Kodie Yeboah-Kodie Yeboah-Kodie Yeboah-Kodie Yeboah-Kodie Yeboah-Kodie Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
Background: Assessing differences in suicide-related outcomes based on demographics and healthcare access can inform suicide prevention strategies. We analyzed suicide mortality, attempts, and ideation in North Carolina (NC) by age, sex, and race and ethnicity in three subpopulations based on insurance coverage and patient status in a healthcare delivery system.
Methods: We examined suicide-related outcome rates in three NC subpopulations: individuals enrolled in Medicaid, individuals enrolled in a statewide private health insurance plan, and patients of a large integrated healthcare delivery system. We estimated standardized mortality ratios (SMRs) stratified separately by sex, age, and race and ethnicity, comparing suicide mortality in each subpopulation with the NC population. We additionally estimated similarly stratified rates of suicide mortality, attempts, and ideation in each subpopulation.
Results: Private insurance enrollees consistently had less suicide mortality, and Medicaid enrollees and health system patients had excess suicide mortality, compared to the NC population across demographic strata. However, Medicaid enrollees aged 12-24 years had an SMR of 0.78 (95% CI: 0.76, 0.81). The most elevated suicide mortality was observed among Medicaid enrollees aged 25-34 years (SMR: 1.69 (95% CI: 1.63, 1.74)), 35-44 years (SMR: 1.83 (95% CI: 1.77, 1.89)), and 45-54 years (SMR: 1.85 (95% CI: 1.79, 1.91)). For all subpopulations, males had age-adjusted suicide mortality rates more than three times those of females, while White non-Hispanic individuals had the highest SMRs relative to other race and ethnicity groups.
Conclusions: These findings highlight differences in suicide-related outcomes across demographic strata in NC, emphasizing the need for suicide prevention strategies that serve publicly insured populations. There is a clear need for interventions accounting for the intersecting influences of insurance coverage, access to healthcare, and demographics.