Suicide mortality in Nicaragua, 2018–2025: distribution by sex, age, and territory

Abstract

Introduction: Nicaragua has no single official source that continuously publishes suicide mortality disaggregated by sex, age, and territory. Objective: To describe registered suicide mortality in 2018–2025, to test its distribution by sex in 2020, to estimate departmental rates with confidence intervals, and to compare three data sources. Methods: Ecological, observational, retrospective study using official secondary data (Ministry of Health, National Police, National Institute of Development Information, United Nations Population Division, and World Health Organization). A chi-square goodness-of-fit test (H0: parity) was applied to the 324 cases from 2020 with a recorded sex, with a sensitivity analysis for 20 cases lacking sex. Crude rates per 100,000 inhabitants were calculated with exact 95% Poisson confidence intervals (CI), together with rate ratios against the rest of the country. Results: Between 2018 and 2022, 330 to 426 deaths were recorded annually (401 in 2025; no comparable data for 2023–2024). National rates were 5.33 (2021) and 5.77 (2025) per 100,000. In 2020 there were 273 male and 51 female deaths (ratio 5.4:1; χ² = 152.11; p < 0.0001), a conclusion robust to the sensitivity analysis (ratio between 3.8 and 5.7). Overall, 66.3% of cases were aged 18–45 years. Madriz had the highest rate (13.73 per 100,000; 95% CI: 8.80–20.44; rate ratio versus the rest of the country 2.76; 95% CI: 1.74–4.18); Managua, with the largest absolute number, was close to the national average (5.69). The Ministry of Health and the National Police differed by 4.2% in 2020, and the WHO estimate was 27.0% and 30.0% lower than both registries, respectively. Conclusions: Available records show a marked male predominance, more cases at ages 18–45, and a higher relative risk in Madriz and Matagalpa. These findings are ecological, based on crude single-year rates, and must be read alongside the discontinuity and heterogeneity of official sources.