Differences across intersecting racial, ethnic, and gender identity in the spatiotemporal patterning of suicide clusters in the US from 2005-2020.

Objectives: To identify spatiotemporal trends in suicide clusters across multiple intersecting sociodemographic groups of US adults from 2005 to 2020. Methods: US Vital Statistics data were used to calculate county-level suicide rates in adults from 2005 to 2020. Rates were calculated for 16 intersecting sociodemographic groups, defined by mutually exclusive combinations of race (American Indian/Alaskan Native (AIAN), Asian/Pacific Islander (API), Black, White), ethnicity (Hispanic, non-Hispanic), and sex (male, female). For each group, spatiotemporal suicide clusters were identified using the SaTScan space-time statistic, based on counties where suicide rates were higher (hot clusters) or lower (cold clusters) than expected. We also calculated the average proportion of deaths contained in clusters, to quantify the importance of clusters relative to total suicide rates. Results: Overall, 275 clusters were identified, comprising 11.4 % of total suicides. Clusters ranged from 1 among non-Hispanic Black women to 135 among non-Hispanic White men. The number and magnitude of hot clusters (RR > 1) increased over time among Hispanic White men and women, and the highest magnitude clusters were observed in non-Hispanic Native American women. No clusters were identified for Hispanic AIAN women or Hispanic API men. Hot clusters were most prevalent in Western counties across all groups. Cold clusters were most prevalent in urban counties. Conclusions: Suicide rates and spatial clusters have increased since 2005, with distinct patterning between sociodemographic groups. The identification of specific communities that may be at disproportional risk for suicide highlight opportunities to tailor individual- and population-level prevention efforts in emerging high-risk groups.