Deaths from Despair Part 3: Across US Metropolitan Areas

When I was analyzing suicide data, I subdivided the data by a variety of factors, both by single factors and multiple factors. One of those factors that proved itself as something of interest was the metropolitan area where the suicide victim resided. What I found was that the smaller the metropolitan area, the higher the suicide rate relative to the other metropolitan areas in each year. This was particularly true in more recent years. Since, death by suicide is one of measurements included in death from despair it makes sense to examine this data using as a factor in the analysis, metropolitan area. 

The figure below shows the death rate from despair for the six 2013 US metropolitan areas. The death rate for all metropolitan areas is shown as a dashed line.

Several things jump out from the figure above:

• The rate of death from despair from 1999 to 2018 has doubled and no metropolitan area has been spared.
• Death rates dropped from 2017 to 2018 except for large metropolitan and noncore areas.
• In 1999 large central metropolitan areas had the highest rate of death from despair. However, by 2018, they had the lowest rate. 
• In 1999 large fringe metropolitan areas had the lowest rate of deaths from despair while the other metropolitan areas were more tightly bunched.
• Over time, two clusters have developed: 1) large metropolitan areas and 2) medium-small metropolitan areas. Large metropolitan areas fall under the overall rate while the medium-small metropolitan areas are over the overall rate.

The figure below shows the year to year trends for large and medium-small metropolitan areas. And the figure that follows shows the year to year differences between the rates of death from despair for medium-small and the large metropolitan areas. 

These two figures show that while death rates from despair have increased dramatically in both clusters, the gap between large and medium-small metropolitan areas has grown over time with more deaths from despair occurring more frequently in medium-small metropolitan areas than in large metropolitan areas.

One of the reasons for the difference in rates of death may in part be due to the fact that economic opportunities have continued to shift to large metropolitan areas and economic opportunities continue to diminish in medium-small areas. That may help explain the difference we're seeing between large and medium-small areas. However, deaths from despair continue to increase in all metropolitan areas at an alarming rate. If economic opportunity were the explanation, then one would expect large metropolitan areas to be showing a dramatically lower rate of increase or no increase at all or maybe even a decrease in the rate of death from despair, but that's not what we're seeing. 

Deaths from despair have been increasing, but they have been increasing at a faster pace in medium-small than in large metropolitan areas in the US.