State-level suicide mortality insights: A comparative study of VHA veterans and the whole US population

Background: Suicide is a leading cause of death in the US Comparative State-level spatial analysis between Veterans Health Administration (VHA veterans) and the whole US population can reveal differences in conditions for targeted interventions and intricate geographical patterns. Methods: The study population contains 2018 and 2019 suicide deaths of VHA veterans and the whole US population. They were used to calculate state-level rates. States were classified by whether their VHA veteran and whole US population rates were above or below respective mean rates. Local Moran's I was leveraged to examine spatial autocorrelation. Results: State-level suicide mortality rates and disparities among states were generally higher for VHA veterans (2018: 37.3 ± 7.2; 2019: 46.8 ± 8.3) than for the whole US population (2018: 16.6 ± 4.3; 2019: 16.4 ± 4.4). For both populations, there were statistically significant clusters with high suicide rates. Over one-fourth of states demonstrated inverse relationships, with rates above mean for one group but below for other. VHA veterans are at higher risk with over one-third of states had greater than average veteran suicide risk ratio. Conclusions: VHA veterans are at higher risk than the whole population across all states. Mortality disparities among states and clusters of states with high and low rates suggest targeted interventions and cooperative health strategies may help address these differences.