Suicide mortality among older adults in the Americas, 2000-2023.

Abstract

Objectives: To characterize trends, demographic and geographic variation, suicide methods, and GDP-related inequalities in suicide mortality among older adults in the Americas, and to describe cross-country heterogeneity.

Design: Population-based ecological study using segmented regression, robust Poisson regression, annual Slope and Relative Indices of Inequality, and complementary descriptive analyses of registered suicide methods.

Setting: Thirty-eight countries and territories in the Americas, 2000-2023.

Participants: Adults aged 60 years and older represented in Global Burden of Disease 2023 estimates; method-specific deaths came from the PAHO/WHO mortality database.

Measurements: Mortality trends, adjusted rate ratios, suicide-method distributions, GDP-related absolute and relative inequalities, and descriptive contrasts across income groups, subregions, and selected countries.

Results: Deaths increased from 13,567 in 2000-27,792 in 2023, while the regional rate changed only modestly from 14.46 to 14.95 per 100,000. Men had 5.22 times (95% CI 5.03-5.41) the adjusted rate of women, and mortality was highest at the oldest ages. Firearms accounted for 47.8% of registered method-specific deaths. In 2023, the full-regional Slope Index of Inequality was 13.15 per 100,000 (95% CI 6.22-20.08) and the Relative Index of Inequality was 2.40 (95% CI 1.40-4.11); after excluding the United States and Canada, these attenuated to 0.72 (95% CI -9.05-10.50) and 1.06 (95% CI 0.46-2.48), respectively. High-income countries had an increasing trend, whereas upper-middle- and lower-middle-income groups declined; within North America, mortality increased in the United States but declined in Canada.

Conclusions: Suicide deaths increased substantially despite relatively stable regional rates, alongside rapid growth of the older-adult population. The burden was heterogeneous by sex, age, method, and country. The full-regional GDP gradient was strongly influenced by the United States and attenuated to the null after excluding the United States and Canada. Prevention should integrate age-responsive mental-health care, follow-up, locally appropriate means safety, surveillance, and equity monitoring, while evaluating how income security and coordination between health and social-protection systems may contribute in different settings.