126 - Rural-Urban Differences in Emergency Department Encounters for Suicidal Thoughts and Behaviors Among Youth, 2018–2021: Kentucky and Arkansas

Publication Number: 1116.126

Laura Prichett, Johns Hopkins School of Medicine, Baltimore, MD, United States; Susan De Luca, Metrohealth Medical Center, Cleveland, OH, United States

Background:

Background:
Suicide deaths occur nearly twice as often among rural youth as among urban youth, yet less is known about nonfatal suicidal thoughts and behaviors (STBs) that may precede these deaths. We examined rural-urban differences in emergency department (ED) encounters for STBs among children and adolescents aged 6-21 years in two predominantly rural southern states.

Objective:

Objective:
To describe demographic, clinical, and temporal patterns in STB-related ED encounters and assess differences by metropolitan status, age, sex, and the COVID-19 pandemic period.

Design/Methods:

Design/Methods:
We conducted a cross-sectional analysis of 2018-2021 State Emergency Department Databases (HCUP-SEDD) from Kentucky and Arkansas. STB encounters were identified using ICD-10-CM codes for suicidal ideation, suicide attempt, or deliberate self-harm. Metropolitan status was defined using the National Center for Health Statistics urban-rural classification. Descriptive comparisons examined encounter characteristics and mechanisms. Mixed multilevel logistic regression models adjusted for age, sex, and time period (2018-2019 vs 2020-2021), included state as a random effect and an interaction between sex and pandemic period.

Results:

Results:
Among 33,104 STB-related ED encounters (59% urban, 41% rural), rural youth were more likely to be non-Hispanic white (87% vs 74%, p < 0.001), and from the lowest income quartile (86% vs 43%, p < 0.001), while urban youth were more often Black (18% vs 9%) or Hispanic (5.1% vs 2.3%, p < 0.001). Mean length of stay was longer in urban settings. Suicidal ideation accounted for 73% of encounters, with slightly higher rates among urban males (p < 0.001, Table 1). Intentional overdoses comprised 19% of cases; prescription drug overdoses were significantly more common among urban children aged 6-12 (p < 0.001, Table 2). In adjusted models, females had higher odds of STB-related encounters in the COVID years compared with pre-COVID (interaction aOR 1.13, 95% CI 1.08,1.18), particularly in urban settings (Table 3).

Conclusion(s):

Conclusions:
Between 2018 and 2021, STB-related ED encounters increased across rural and urban areas, with notable demographic and modality difference. Rural youth were more likely to be non-Hispanic white and low-income, and preadolescent urban youth had higher rates of prescription overdoses. The sharp COVID-era rise among urban females highlights an urgent need for sex- and context-specific prevention strategies, including safe medication and firearm storage and improved access to mental health care across geographic settings.

Table 1
Characteristics of suicide-related emergency department encounters, 2018-2021, Kentucky and Arkansas, by urban/rural status, n (%)

Table 2
Modalities of suicide related ED encounters, 2018-2021, Kentucky and Arkansas, by urban/rural status, gender and age group

Table 3
Adjusted mixed multilevel logistic regression analysis of suicide-related ED encounters, gender and COVID-19 years among rural and urban youth in Kentucky and Arkansas ages 6-21 (adjusted for age, gender, time period, including an interaction term for pre- vs post-COVID-19, patient and state are nested levels)