Racialized economic segregation and Black youth suicide in the US.

Between the early 2000s and 2020s, the suicide prevalence among non-Hispanic (NH) Black youth increased more than three-fold, making suicide the second leading cause of death in this population. Structural factors such as poverty and place-based racial inequities may contribute to the high prevalence of suicide among this population. We examine whether changes in racialized economic segregation correspond with changes in Black youth suicide prevalence, over time. As our exposure, we utilize longitudinal measures of the Index of the Concentration of the Extremes (ICE) race/income. As the outcome, we use counts of suicides among NH Black youth aged 5-19, across three epochs (2000-2004, 2006-2010, 2014-2018) in 703 counties in the US. We use county-level fixed effects Poisson models that include population offsets and adjust for time trends, percent poverty, unmarried households, educational attainment, and public assistance. A standard deviation increase in ICE race/income, or less concentrated Black poverty, coincides with a 7% decline in NH Black youth suicide over time (Incidence Rate Ratio [IRR]: 0.93, 95% CI: 0.87 - 0.99). Despite overall increases in Black youth suicide in the US, reductions in concentrated Black poverty may attenuate this trend.