# Rural–Urban Suicide Mortality Disparities in High-Burden U.S. States: An Intersectional Analysis

## TL;DR

Rural areas in the U.S. have higher suicide rates than urban areas, especially among young adults and American Indian/Alaska Native populations, highlighting the need for targeted mental health interventions.

## Contribution

This study provides an intersectional analysis of rural–urban suicide disparities in high-burden U.S. states, identifying key demographic subgroups at highest risk.

## Key findings

- Rural suicide rates were significantly higher than urban rates (28.69 vs. 20.20 per 100,000; p < 0.001).
- American Indian/Alaska Native populations had the highest suicide rates in both rural and urban areas.
- The largest rural–urban suicide gap occurred among young adults (20–39 years).

## Abstract

Background: Suicide remains a leading cause of death in the United States, with more than 49,000 fatalities in 2023. Rural counties consistently face higher suicide mortality rates than urban areas, reflecting deep-seated mental health inequities. Methods: This study analyzes 39 U.S. states with suicide mortality rates exceeding the national average, as defined by the Centers for Disease Control and Prevention (CDC) (>14.1 per 100,000), to examine rural–urban disparities and their intersectional demographic factors. Age-adjusted mortality data (2019–2023) from HDPulse were analyzed using IBM SPSS Statistics, version 31.0. Counties were classified by USDA Rural–Urban Continuum Codes and stratified by region, sex, age, and race. Subgroup differences were tested using a two-way ANOVA (p < 0.01). Results: Rural suicide rates were significantly higher than urban rates (28.69 vs. 20.20 per 100,000; p < 0.001). The West reported the highest mortality and widest rural–urban gap (38.23 vs. 24.83), while the Northeast had the lowest. Men had higher rates than women, particularly in rural settings (37.12 vs. 11.77). The largest rural–urban gap occurred among young adults (20–39 years). American Indian/Alaska Native populations experienced the highest rates (rural: 58.73; urban: 35.15). The literature review highlighted limited healthcare access, social stigma, substance use, and economic hardship as variables commonly associated with rural–urban differences in suicide mortality. Conclusions: Suicide mortality is markedly elevated in rural America across all subgroups, with the greatest risks among young adults, men, and American Indian/Alaska Native populations. Tailored prevention strategies and expanded mental health infrastructure are critical for high-burden states.