Intentional self-harm mortality among 15–24 year olds in Asian American subgroups, 2005–2022: a population-based incidence study

Background: Among U.S. youth aged 15-24 years, suicide is the leading cause of death for Asian American youth, yet surveillance data are rarely disaggregated by racial subgroup. We examined whether suicide mortality differs across six Asian American subgroups. Methods: We analyzed National Center for Health Statistics mortality data for 2005 through 2022, linked with American Community Survey population denominators. Deaths from intentional self-harm (ICD-10 codes X60-X84, Y87.0) were identified among Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese youth, with non-Hispanic White and Asian Youth as comparison groups. We calculated annualized mortality rates (AMR), rate ratios (RR), proportional mortality, proportional mortality ratios, crude mortality rate (CMR) trends, and annual percentage changes (APC) using Joinpoint regression with heteroscedastic error models. Findings: Between 2005 and 2022, 2519 Asian American youth died by intentional self-harm. The AMR for Asian Youth was 8.37 per 100,000 (95% CI, 8.04-8.69), compared with 14.34 (14.23-14.46) for non-Hispanic White youth. Korean youth had the highest AMR (9.92; 8.87-10.97) and mortality (33.8%; 30.9-36.7); Chinese youth had the lowest AMR (6.38; 5.87-6.90). Among Asian Youth, Korean (RR, 1.19; 1.06-1.33), Vietnamese (1.14; 1.03-1.27), and Filipino (1.13; 1.03-1.24) youth had significantly elevated mortality. Four subgroups showed sustained CMR increases (APC, 4.9-9.1%), while Asian Indian youth rose significantly before declining. These trends contrast with a post-2018 decline among non-Hispanic White youth. State-level analysis demonstrated substantial inter-subgroup heterogeneity. Interpretation: Disaggregation reveals clinically meaningful variation in mortality that aggregated surveillance conceals. Race-specific, culturally grounded prevention strategies are needed, particularly for Korean, Vietnamese, and Filipino youth who bear a disproportionate and growing burden. Funding: This study received no external funding. The Stanford Center for Asian Health Research and Education provided institutional support; the Chi-Li Pao Foundation USA supported conference dissemination.