Assistant Professor Loma Linda University School of Medicine Loma Linda, California, United States
Background: Suicide is a leading cause of premature mortality among U.S. children and adolescents. Risk for poor mental health reflects not only biological components but also environmental influences. The Child Opportunity Index (COI) is a composite measure that combines multiple indicators relevant to healthy child development. Objective: To assess whether pediatric populations in counties with lower COI scores have a higher burden of suicide. Design/Methods: County-level suicide fatality data were obtained from CDC WISQARS for ages 0-19 in 2023, extracting age-adjusted years of potential life lost (YPLL) to age 75 per 100,000 youth. Counties with suppressed or unstable estimates were excluded. COI 3.0 scores by county for 2023 were obtained from diversitydatakids.org. Regression analyses were used to assess the association between COI and youth suicide YPLL rates. Results: Youth suicide YPLL rates were available for 1099 of 3143 counties (35.0%). Of these, matched COI scores were available for 1084 counties (98.6%). There was an inverse relationship between opportunity scores and age-adjusted YPLL rates (p < 10^-15). This disparity was best fitted by a power model, y = 2079 × x^(-0.32). On the low end of the opportunity axis, a 1-point improvement in COI score was associated with a decrease of 414 potential years lost per 100,000 children, whereas in the middle of the axis, a 10-point increase in COI score only decreases the YPLL by 38 per 100,000 youth.
Conclusion(s): County opportunity levels are meaningfully related to premature mortality from suicide among U.S. youth. Communities with lower opportunity experience disproportionately greater YPLL due to suicide, underscoring the need to address structural determinants alongside individual-level risk. Targeted approaches with place-based strategies, together with clinical prevention and crisis services, may help improve youth mental health on a population level and reduce the profound loss of life years from suicide.
