Sunday, June 13, 2010

Rural areas in Iowa have higher risk of suicide

While suicide affects all parts of the state, features unique to rural Iowa put those living there at a higher risk.
Should I be concerned?

I don't mean to minimize the seriousness and tragedy of suicide. It leaves a wake of devastation for years for loved ones they left behind. I'm looking at how number-skewing affects reporting.

The quote above comes from the article: Suicide numbers up in rural Iowa, the newspaper of the University of Iowa, The Daily Iowan, reports that suicide rates are rising in the state, especially in our less populated counties.

I posted earlier that one "study" wrote off the whole state as urban based on the idea that any county with a population over 2500 people was high: Every county in Iowa is urban, while in the Daily Iowan article, it's reported that 89 of Iowa counties are rural. Adding more to the mix, Iowa's Wiki page reports that 61% of Iowa's population is urban by citing Census Bureau figures:
Urban counties in Iowa grew 8.5% from 2000 to 2008, while rural counties declined by 4.2%
All of this is a backdrop to the reported suicide rates:
• From 2000 to 2008, 1,568 people committed suicide in rural counties of Iowa, versus 1,382 in the state’s urban parts.

• The suicide rate of from 2000 to 2008 in rural counties was 11.36 per 100,000 population; it was 10.82 in urban counties.

• In 2008 alone, the rate for rural counties was 13.55 — the highest the average in Iowa has been since 2000 — and it was 11.46 in urban counties.
The article did not cite a source, but I will use the Iowa Department of Health, Vital Statistics and the closest population numbers I found were at Iowa population by County, 2006 One problem with statistics is when you use a roaming number "N" and going county by county you will skew the "per 100,000" number and inflate it, and that's exactly what happens. With counties having small population, one death will produce a high rate.

In 2008, Monona county (pop. < 10,000) there were 4 suicides which placed it with the highest rate in the state, while Polk county (pop. 400,000+) had 70 which placed it in the middle. By using the rate of 13.55 per 100,000, in my county (Iowa, pol. 16,000+) we should have had 85 suicides in 2008. According to the state, there were three. I'm going to make a leap here and guess that they added the percentages up and divided by 89 in order to get the 13.55 rate. Without some concrete numbers, there's no way to tell.

The arbitrary lines that were drawn up in the 1840's cannot be used in statistics any more than an arbitrary definition of "urban" or "rural". Another thing to consider is that emergency response times are generally much better in cities than in the back gravel roads where it could take an ambulance 30 minutes just to get there after receiving the call. The suicide attempt/success ratio in urban vs. rural areas is not looked at.

The article also throws out this bone to the anti-gun crowd:
The problem may be compounded by the prevalence of guns in rural areas.

Of the 1,568 deaths in rural counties since 2000, 846 were by firearms. In urban areas, 580 have killed themselves with guns. In Johnson County, firearms also accounted for the largest number of suicides — 59 out of 139.
No other methods were mentioned. In the last 22 years I personally know of two men who took their lives, one by hanging and the other man used his car in his garage. (And I know anecdotes do not make good science.)

Statistics can be used to push any sort of agenda and my impression is that the author is advocating more funding for rural mental health services. Which may not be a bad thing, especially with the economic climate we face. I would like a more honest and open analysis in the urban/rural numbers that are tossed like bread crumbs to the public.

One suicide is bad enough. Ask some of us left behind.

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