Urban-rural differences in suicide in the state of Maryland: The role of firearms

Paul S. Nestadt, Patrick Triplett, David R. Fowler, Ramin Mojtabai

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objectives. To assess whether the use of firearms explains rural-urban differences in suicide rates. Methods. We performed a retrospective analysis on all 6196 well-characterized adult suicides in Maryland from 2003 through 2015. We computed rate ratios by using census data and then stratified by sex, with adjustment for age and race. Results. Suicide rates were higher in rural compared with urban counties. However, the higher rural suicide rates were limited to firearm suicides (incident rate ratio [IRR] = 1.66; 95% confidence interval [CI] = 1.20, 2.31). Nonfirearm suicide rates were not significantly higher in rural settings. Furthermore, 89% of firearm suicides occurred in men and the higher rural firearm suicide rate was limited to men (IRR = 1.36; 95% CI = 1.09, 1.69). Women were significantly less likely to complete suicide in rural areas (IRR = 0.63; 95% CI = 0.43, 0.94), regardless of method. Conclusions. Malefirearmuse drives the increased rate of suicide in rural areas.The opposite associations between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide.

Original languageEnglish (US)
Pages (from-to)1548-1553
Number of pages6
JournalAmerican journal of public health
Issue number10
StatePublished - Oct 2017

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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