Jeffrey R. Miller, BS¹, Tinka Markham Piper, MPH, CSW¹, Jennifer Ahern, MPH¹, Melissa Tracy, BA¹, Kenneth J. Tardiff, MD, MPH², David Vlahov, PhD¹, and Sandro Galea, MD, MPH, DrPH¹. (1) Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 347-693-1023, jeffrey.miller@mssm.edu, (2) Department of Psychiatry, New York Presbyterian Hosptial, 525 East 68th Street Box 140, New York, NY 10021

Most studies of suicide have examined individual or social determinants. There have been few multilevel studies of suicide. Income inequality, a measure of neighborhood income distribution, may be associated with psychosocial stress, lower social capital, and fewer salutary resources. We collected data from the New York City Office of the Chief Medical Examiner for all fatal injuries in 1996, among persons aged 15-64, to conduct a multilevel case control study using suicides (n=374) as cases, and non-overdose accidental death (n=453) as controls. We used 1990 US Census data to determine neighborhood income distribution, calculating the Gini coefficient and the percent of total income earned by the lowest earning 70% of households in each neighborhood. Multilevel logistic regression models were constructed to assess the relation between neighborhood income distribution and risk of suicide. Suicide decedents were more likely than accident controls to reside in neighborhoods with greater income inequality even after controlling for individual characteristics and neighborhood income. Persons living in neighborhoods with the highest decile of income inequality were 1.9 times more likely to die from suicide than persons living in neighborhoods with the lowest decile of income inequality. The effect of income inequality was modified by age; neighborhood income inequality was associated with an increased likelihood of suicide among decedents aged 15-34 years but not among decedents aged 35-64. These data suggest that neighborhood characteristics and in particular income inequality may be either a marker of or contribute to suicide in younger adults; suggesting targeting of suicide prevention strategies.

Learning Objectives:

• 1. Distinguish between individual and social determinants of suicide.
• 2. Articulate how multilevel study designs are different from individual or ecological study designs of suicide.
• 3. Discuss the observed relationship between income inequality and suicide.
• 4. Develop hypotheses for how income inequality may affect risk of suicide.
• 5. Develop research designs for future studies.

Keywords: Suicide, Social Inequalities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.