Sex Differences in Life-Course Suicide Rates by State Firearm Policy Environment.

Abstract

Male sex and permissive state firearm policy environments have been independently associated with suicide mortality. Few recent studies quantify how these factors interact, or how interactions vary across the life course. This study investigates how state firearm policy environments moderate sex differences in firearm, nonfirearm, and overall suicide rates across the life course. Employing Center for Disease Control and Prevention data, linear regression was used to model sex differences in firearm, nonfirearm, and total suicide mortality rates per 100,000 across the life course and interactions with state firearm policy environments (categorized as permissive versus strict using Giffords Gun Law Scorecard Grades). Data were collected in 2018-2022 and analyzed in 2024-2025. Across all ages and state policy environments, male sex was associated with higher firearm (18.95; 95% CI=16.97, 20.92), nonfirearm (7.07; 95% CI=6.63, 7.14), and total (26.02; 95% CI=23.94, 28.10) suicide rates. Compared with strict state policy environments, permissive environments were associated with increased firearm (5.84; 95% CI=3.84, 7.84) and total suicide rates (5.96; 95% CI=3.32, 8.60). In interacted models, permissive environments augmented the associations of male sex with higher firearm (9.02; 95% CI=5.75, 12.29) and total (9.24; 95% CI=5.96, 12.52) suicide rates. Sex also moderated the associations of age with suicide rates. Males die from suicide at higher rates than females across the life course, exhibiting particularly high rates within states that implement permissive firearm policies. At older ages, dramatically higher male suicide rates are seen in both permissive and strict state environments, suggesting that males face unique challenges associated with aging that require focused clinical attention.