Rural–Urban Comparisons in the Rates of Self-Harm, U.S., 2018

Abstract

This study compares rural and urban differences in the rates of nonfatal self-harm in the U.S. in 2018. Nationwide Emergency Department Sample and Census data were analyzed to calculate the RR of emergency department visits for self-harm between rural and urban residents. The analyses were conducted in 2021. Among a weighted total of 488,000 emergency department visits for self-harm in the U.S., 80.5% were urban residents, and 18.3% were rural residents. In both settings, poisoning was the most common mechanism for self-harm, followed by cutting. Firearm-related self-harm and suffocation each accounted for <2% of total self-harm cases. Overall, the age-adjusted emergency department visit rate for self-harm was 252.3 per 100,000 for rural residents, which was 1.5 (95% CI=1.4, 1.6) times greater than the rate for urban residents (170.8 per 100,000 residents). The rates of self-harm among rural residents were higher than those of urban residents for both male and female residents, for all age groups except people aged ≥65 years, and by all mechanisms. Comprehensive suicide prevention strategies tailored to rural communities may mitigate the rural-urban disparity in morbidity from suicidal behavior.