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Mortality in the United States from self-injury surpasses diabetes: a prevention imperative
  1. Ian R H Rockett1,
  2. Eric D Caine2,
  3. Hilary S Connery3,4,
  4. Shelly F Greenfield3,4
  1. 1 Department of Epidemiology, The Injury Control Research Center, West Virginia University, Morgantown, West Virginia, USA
  2. 2 Department of Psychiatry, The Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA
  3. 3 Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA
  4. 4 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to RockettIan R H, Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV 26506, USA; irockett{at}


This report uses an enhanced conceptualisation of self-injury mortality (SIM), which comprised registered or known suicides by any method and estimated non-suicide deaths from opioid and other drug self-intoxication. SIM surpassed diabetes as a cause of death in the USA in 2015. The gap expanded in 2016 with respective rates of 29.1 and 24.8 per 100 000 population. Facing similar social and psychologically complex health problems to SIM, the USA has initiated and sustained successful broad-based prevention efforts that have reduced deaths from cardiovascular diseases, smoking-related lung cancer, HIV and motor vehicular injury—given both necessary epidemiological understanding to define the problem and sufficient political will to address it. Development of strategies to prevent SIM will be facilitated by focusing on factors that are common risks for diverse outcomes. Like premature mortality frequently associated with diabetes, deaths from self-injurious behaviours are preventable.

  • policy
  • public health
  • poisoning
  • suicide/self?harm
  • mortality
  • drugs

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  • Contributors IRHR conceived the manuscript and obtained the data, and all authors contributed equally in the writing.

  • Funding This work was supported by Grants R49CE002109 and R49CE002093 from the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention.

  • Disclaimer The views expressed are those of the authors and do not necessarily represent the position or policy of the U.S. Centers for Disease Control and Prevention or the U.S. Government.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement The data were extracted from a publicly accessible database. Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (

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