Injury deaths in NYC

Young and middle-aged adults (ages 15 to 44) do not typically die from the natural causes that kill older adults. Injuries, both intentional — violence or suicide — and unintentional, dominate as causes of death. These premature deaths are tragic, unnecessary and preventable.

Below we focus on homicide and suicide, reflecting areas of focus in the NYC Health Department’s recently released HealthyNYC, which identifies the major drivers of decreasing life expectancy and health equity in our city and identifies strategies to reduce each driver’s impact.

Suicide and homicide do not just affect the immediate victims. The impacts radiate, potentially widening disparities and causing stress, trauma and other negative health effects for victims’ friends, neighbors, colleagues and family members. In communities where New Yorkers are more likely to experience either homicide or suicide, violence is both a personal and public health concern. Below we focus on homicide and suicide.

For each subgroup within young and middle-aged New Yorkers — ages 15 to 24, 25 to 34, and 35 to 44 — the homicide and suicide patterns look slightly different.

Ages 15 to 24: Homicides and suicides are the second- and third-leading causes of death.

From 2017 to 2019, Black New Yorkers between the ages of 15 to 24 died by homicide at a higher rate than people of other racial and ethnic groups of the same age. White and Asian people this age had a homicide rate of close to zero.

Racial disparities signal historical and structural origins that have and continue to deny resources to people of color. These include things like social structures that limit access to basic needs (such as health care) which are perpetuated by racism, residential segregation — like redlining — and systematic disinvestment in neighborhoods. Disinvestment can be things like denying people access to loans to buy homes, housing neglect, underfunded schools, fewer job opportunities and lower-paying jobs, emphasis on policing over pro-social resources, and others. Over time, disinvestment puts residents in high-poverty neighborhoods at a greater risk of experiencing violence.

Among 15- to 24-year-olds from 2017 to 2019, we also see disparities in homicide rates across boroughs. The Bronx has the highest homicide rate of any borough, followed by Brooklyn. The Bronx’s homicide rate for people ages 15 to 24 is more than double that of Manhattan, Queens or Staten Island.

Although somewhat broad, we hypothesize that borough differences in homicides may signal unique histories of the neighborhoods that make up each borough. We know there is a history of disinvestment and investment that varies by NYC neighborhood, creating different resources and opportunities. Distribution of homicide by place offers a glimpse into the broader physical, social and economic context — namely, housing and park quality and availability, access to schools, jobs, opportunities and health care. To learn more about differences in injuries from violence, refer to the 2016 community-district level data.

Among New Yorkers ages 15 to 24, suicide rates are similar across race/ethnicity and across boroughs. However, within this age group of young adults, Staten Island has a lower suicide rate (less than half) than the other boroughs.

Both homicide and suicide among people ages 15 to 24 are much more common among young males than young females. Males in this age group have homicide rates that are six times the rate of females and suicide rates that are three times the rate of females.

Ages 24 to 34: More suicides than any other age group.

From 2017 to 2019, there were over 110 suicides each year among these young adults, ranking as the third most common cause of death. This is one out of every five suicides across all ages, and two out of five of suicides among 15- to 44-year-olds.

While Staten Island has a lower rate of suicide among young people ages 15 to 24, its suicide rate for people ages 25 to 34 is higher than any other borough.

Within this age group of 25-to-34-year-olds, the suicide rate is highest among Black non-Hispanic New Yorkers and lowest among Latinos.

Among 25- to 34-year-olds, homicides are the fourth-leading cause of death. Racial/ethnic, geographic, and sex disparities in homicide rates for adults ages 25 to 34 mirror those for ages 15 to 24, with the highest rates among Black males.

Ages 35 to 44: Suicide ranks as the fifth-leading cause of death.

White New Yorkers had a suicide death rate roughly twice that of other race/ethnicity groups in this age group.

Among New Yorkers ages 35 to 44, the suicide rate among men is more than double the rate among women. In addition, in this age group, Staten Island ranks highest of all boroughs for suicide deaths, followed by Queens.

Homicides are less prevalent within this age group, ranking ninth among all causes of death (PDF).

Prevention: By understanding what mechanisms (or means) people use for homicides and suicides, we can take steps to prevent these deaths.

In NYC, most homicide deaths among young and middle-aged adults occur with guns. Nationwide, guns account for about 8 out of every 10 homicide deaths. Stabbing was the second most common mechanism of homicide deaths in NYC.

Hanging is the leading mechanism of suicides among young and middle-aged New Yorkers, whereas guns are the leading mechanism of suicides nationwide. Guns are responsible for relatively few suicides among adults ages 15 to 44 in NYC.

Access to means is a key risk factor for suicide, and how easily and how often certain suicide means are used are shaped by our environments. Means reduction— removing access to ways people can attempt suicide — is a key part of a comprehensive suicide prevention strategy. Many people who attempt suicide do so during a short-term crisis and, therefore, spend relatively little time thinking about the attempt before taking action. (According to one study of suicide attempt survivors, nearly half spent less than 10 minutes). For these people especially, the availability of lethal means (for example, access to a firearm or jumping from a building) can be the difference between thinking about suicide and making an attempt. The more lethal the means, the more likely a person will not survive an attempt.

The means reduction approach applies to homicides, too. Data show that where there are more guns, there is more homicide. New York has had stricter gun laws than many other places in the United States, and that may help explain why New York City’s homicide rate is lower than other places in the country and below the national average. Whether the 2022 Supreme Court decision in NYS Rifle and Pistol Association v. Bruen — which struck down New York State’s longstanding, protective gun law — will result in an increase gun availability and in rates of suicide and homicide is still unknown. When there are fewer guns, however, we can expect to see fewer homicide deaths; and as access to guns increases, we can expect to see the reverse.

Prevention’s greatest impacts will come when integrating multiple approaches. Means reduction is a critical part of prevention, including restricting, relocating, or removing lethal means like certain medications, firearms and sharp objects, or placing protective barriers on decks or rooftops. This prevention approach should be combined with examining and remediating the upstream drivers of homicide and suicide — such as quality and availability of housing, education, jobs, opportunities, health care, parks, strong social networks and more.

Each of these deaths is a tragedy — but solutions exist. Limiting access to mechanisms of homicide and suicide can be a critical tool in preventing deaths among young and middle-aged adults.

Further resources and reading:

Suicide Prevention Resource Center

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