Statement of Purpose This study evaluates the risk of suicide by employment and occupational group among adults aged 18–64 in the United States using linked data from the National Center for Health Statistics.

Methods Data from the National Health Interview Survey (NHIS) linked to the National Death Index (NDI) was used to examine the risk of suicide among adults ages 18–64 by employment status and occupational group. Only working-age NHIS respondents with complete occupation information were included. Occupations were categorized by the Census Bureau’s Standard Occupational Classification System and grouped as: managerial, professional, teaching/social service, services, sales, and production. Suicides were defined using the International Classification of Diseases, Tenth Revision underlying cause-of-death codes U03, X60-X84, and Y87.0. Cox proportional hazards regression models were fitted to estimate hazard ratios. All estimates incorporate the complex design of the survey.

Results Of the 257,861 sample-adult NHIS participants in 2005 - 2015, 93% (239,382) did not die, and 7% (18,479) died by December 31, 2015. Of those who died, 1.3% (237) were to suicide. Working-age participants in the sales occupational group were at increased risk of suicide (HR=1.97, 95% CI=1.02 – 3.80) compared to those in the professional occupational group, after controlling for age and sex. Non-employed participants were at increased risk of suicide compared to employed participants (HR=1.57, 95% CI=1.06–2.33) after controlling for age and sex.

Conclusions Occupational and employment status may affect risk of suicide. NHIS linked to NDI offers a unique opportunity to examine risk of suicide by both.

Significance and Contributions to Injury and Violence Prevention Science Suicide is the tenth leading cause of death in the U.S., and national studies of suicide by occupation are limited. Understanding suicide by occupation can help inform targeted strategies to prevent suicides in the United States.