Areas of high poverty also have high child suicide rates

Although I was routinely warned against them in graduate school (beware ecological fallacy!) I am increasingly interested in ecological studies that examine the relationship between social factors (poverty, minimum wage, firearm availability) and adverse health outcomes, particularly suicide. I agree that we should not commit the fatal flaw and infer from this data that income, low wages, or the presence of firearms cause suicide, but they provide a unique lens to think about why such associations exist: what is it about areas of high concentrations of poverty that might result in increased suicide rates? This is the question I asked myself after reading Jennifer Hoffmann’s recent study that found higher childhood suicide rates in counties with higher concentrations of poverty. Importantly, she and her colleagues found a ‘dose-response’ relationship: that as poverty rates increased, so too did child suicide rates. They then examined the trend for three different types of suicide: by suffocation, poisoning, and firearms. The relationship was only present for firearm suicide. To me, this leads to a very important research question that they authors put forth: “Because areas of high poverty concentration also experience higher rates of unintentional firearm deaths, further study is needed to determine whether children living in these areas have increased access to firearms or less safe firearm storage.” Unfortunately, there are data limitations that prevent us from assessing this (read more here), but I’m always impressed by the creativity of researchers to tackle seemingly insurmountable challenges.

Hoffmann J et al. 2020. Association of Pediatric Suicide With County-Level Poverty in the United States, 2007-2016. JAMA Pediatrics, doi: 10.1001/jamapediatrics.2019.5678. [Epub ahead of print].

Abstract available here: https://www.ncbi.nlm.nih.gov/pubmed/31985759