Rising rates of suicide among older adults drove the number of such deaths to a historic high in the United States last year, even as suicide declined among youth, according to a report released Wednesday by researchers at the Centers for Disease Control and Prevention.

More than 49,000 people died by suicide in 2022 across the country, the highest tally recorded for the nation, according to federal figures. It’s the latest evidence of a troubling trend in the U.S., where suicide has been on the rise for much of the 21st century.

The U.S. suicide rate fell somewhat between 2018 and 2020, but then resumed its upward trend, alarming health officials. After adjusting the raw numbers to account for the age distribution of Americans, CDC researchers found that the nation’s suicide rate last year was 14.3 deaths per 100,000 residents — a level not seen since 1941.

The rate is based on preliminary figures for suicide deaths, which are expected to increase as 2022 deaths continue to be assessed and more of them are classified as suicides.

The growing numbers were propelled by rising rates of suicide among people 35 or older, federal figures indicate. Between 2021 and 2022, rates actually fell among those younger than 25, but rose significantly for many groups of older adults, the report shows.

“It’s somewhat different than what we’ve seen in past years,” said Sally C. Curtin, a statistician at the CDC’s National Center for Health Statistics and one of the authors of the new report. Suicide rates have increased across many demographic groups, but “if there’s a bright spot in the report, it is that decline for some of the younger groups which had been marching steadily up.”

The gender gap remained wide in 2022, with 23.1 deaths per 100,000 men and 5.9 deaths per 100,000 women. Elderly men were at especially high risk: Among men ages 75 and older, the suicide rate (43.7 deaths per 100,000) was roughly twice as high as for young males ages 15 to 24 (21.6 deaths per 100,000).

“People don’t realize that depression is not a normal part of aging” and that older people can access treatment for it, said Jill Harkavy-Friedman, senior vice president of research for the American Foundation for Suicide Prevention. Older people often face chronic conditions and pain and may also endure social isolation, which can also be affected by hearing loss, she said. “Connection is really important.”

Though suicide was much less common among women than men, the age-adjusted rate for women rose 4% between 2021 and 2022, compared with 1% for men. Among women, the age range at highest risk of suicide was 45 to 54, with 8.9 such deaths per 100,000, according to the new report.

And there have been marked differences in suicide rates by race and ethnicity, with American Indian and Alaska Native people at highest risk (26.7 deaths per 100,000), followed by non-Hispanic white people (17.6 deaths per 100,000), according to the report.

Suicide rates have been significantly lower among other racial and ethnic groups in the U.S., including Black people, whose rate was 9 such deaths per 100,000. But other studies have questioned whether misclassification of deaths among Black people might affect the accuracy of those numbers.

The U.S. has seen suicides rise even as rates fell in many other countries. Experts have suggested a range of factors that might play a role, including the opioid epidemic, economic uncertainty and access to firearms, but there has been ongoing debate and scant consensus about the causes.

“We don’t know why the rate has been going up,” Harkavy-Friedman said. She stressed, however, that suicide is preventable, and “we do have things that we can do that we know work.”

The new report did not examine the specific manner in which people died, but a KFF analysis this year found that firearm-related suicides continued to rise in the U.S., accounting for 55% of all suicides in 2021 and 2022. Reducing access to such “lethal means” has become one focus for suicide prevention.

For suicide prevention, “firearms are the low-hanging fruit here” in the U.S., said Dr. Gonzalo Martinez-Ales, a psychiatrist and epidemiologist at Harvard University and Mt. Sinai Hospital in New York. Purchasing a firearm greatly increases the risk of death by suicide for anyone living in the same household, Martinez-Ales said.

Many people in crisis are suicidal for only a short period — as brief as five to 10 minutes — which means that if they didn’t have something highly lethal at hand, they would be at much lower risk, he said.

In addition, getting help can be more difficult in the U.S. than in other countries since “it can be challenging to navigate the healthcare system,” Martinez-Ales said. In the throes of a crisis, “making access to care easy in that moment might save your life.”

The U.S. surgeon general issued a call to action in 2021, saying that suicide prevention “requires a comprehensive approach that combines multiple strategies to reduce risk and strengthen protective factors at the individual, relationship, community, and societal levels.” That includes addressing “upstream factors” that affect suicide, increasing the use of mobile crisis teams, and keeping people safe from “lethal means,” the surgeon general’s report says.

Harkavy-Friedman urged people to educate themselves on warning signs. “If you are worried about someone, you can ask them directly if they’re thinking of taking their life, and they will feel better under most circumstances because they don’t have to keep it a secret,” she said.

“It makes a difference if we connect with people when they’re struggling. Run towards them rather than running away from them,” she advised.

“Everybody can play a role and we can make a difference.”

If you or someone you know is struggling with suicidal thoughts, seek help from a professional and call 988. The first nationwide three-digit mental health crisis hotline will connect callers with trained mental health counselors. Or text “HOME” to 741741 in the U.S. and Canada to reach the Crisis Text Line.

For Briana Jones, a young Black mother in San Francisco, a city program called the Abundant Birth Project has been a godsend.

Designed to counter the “obstetric racism” that researchers say leads a disproportionate number of African American mothers to die from childbirth, the project has provided 150 pregnant Black and Pacific Islander San Franciscans a $1,000 monthly stipend.

The money enabled Jones, 20, to pay for gas to drive to prenatal clinics, buy fresh fruits and vegetables for her toddler son and herself and remain healthy as she prepared for the birth of her second child last year.

But the future of the Abundant Birth Project is clouded by a lawsuit alleging that the program, the first of its kind in the nation, illegally discriminates by giving the stipend only to people of a specific race. The lawsuit also targets San Francisco guaranteed-income programs serving artists, transgender people and Black young adults.

The litigation is part of a growing national effort by conservative groups to eliminate racial preferences in a range of institutions after a U.S. Supreme Court ruling that found race-conscious admissions to colleges and universities to be unconstitutional.

In healthcare, legal actions threaten efforts to provide scholarships to minority medical school students and other initiatives to create a physician workforce that looks more like the nation.

The lawsuits also endanger other measures designed to reduce documented racial disparities. Black women are three to four times more likely than white women to die in labor or from related complications in the U.S., and Black infants are twice as likely as white infants to be born prematurely and to die before their first birthdays. Racial and ethnic minorities also are more likely to die from diabetes, high blood pressure, asthma and heart disease than their white counterparts, according to the Centers for Disease Control and Prevention.

A handful of activist nonprofit groups and law firms are leading the charge. Do No Harm, a nonprofit formed in 2022, has sued health commissions, pharmaceutical companies and public health journals to try to stop them from choosing applicants based on race. Do No Harm claims more than 6,000 members worldwide and partners with nonprofit legal organizations, most notably the Pacific Legal Foundation, which garnered national attention when it defended California’s same-sex marriage ban.

Another nonprofit, the Californians for Equal Rights Foundation, together with a Dallas-based law firm called the American Civil Rights Project, filed the lawsuit against the city of San Francisco and the state of California over the Abundant Birth Project, alleging the program violates the equal protection clause of the Constitution’s 14th Amendment by granting money exclusively to Black and Pacific Islander women. The 14th Amendment was passed after the Civil War to give rights to formerly enslaved Black people.

The lawsuit calls public money used for the project and the three other guaranteed-income programs “discriminatory giveaways” that are “illegal, wasteful and injurious.”

“The city and county of San Francisco crafted the Abundant Birth Project with the express intention of picking beneficiaries based on race,” Dan Morenoff, executive director of the American Civil Rights Project, said in a phone interview. “It’s unconstitutional. They can’t legally do it, and we are optimistic that the courts will not allow them to continue to do it.”

San Francisco and state officials declined to discuss the case because of the pending litigation, but the city defended the program in its initial response to the lawsuit. The Abundant Birth Project started in June 2021 and plans to make a second round of grants to pregnant mothers this fall, the response says.

The project strives to improve maternal and infant health outcomes by easing the economic stress on pregnant Black and Pacific Islander San Franciscans. People in those groups face some of the worst outcomes in the U.S., where more women die as a result of pregnancy and childbirth than in other high-income nations. The state of California last year awarded $5 million to expand the program to include Black mothers in four other counties.

Khiara Bridges, a Berkeley law professor and anthropologist who has talked to beneficiaries of the Abundant Birth Project but is not directly involved with it, said the Supreme Court ruling on college affirmative action could actually support the argument that the program is legal.

The court struck down affirmative action in part because the majority said Harvard and the University of North Carolina failed to show measurable outcomes justifying race consciousness in college admissions. While statistics on potential benefits from the Abundant Birth Project are not publicly available, Bridges and others familiar with the program expect researchers to demonstrate it saves and improves lives by comparing the health outcomes of families that received the stipend with those of families that did not. The outcomes could justify employing race to choose program participants, Bridges said.

Bridges also drew another distinction between the role of race in college admissions and the role of race in health disparities.

“If you don’t get into Harvard, there’s always Princeton or Columbia or Cornell,” she said. “Maternal death — the stakes are a little bit higher.”

In California, a voter initiative, Proposition 209, has prohibited race-based selection in public education and employment since 1996. California Assemblymember Mia Bonta (D-Alameda) has co-authored a pending bill that would amend the proposition to allow municipalities to grant benefits to specific groups of vulnerable people if they use research-based measures that can reduce health and other disparities.

Bonta, a law school graduate, said the litigation against the Abundant Birth Project is the result of “conservative groups who want to exist in a world that doesn’t exist, where communities of color have not had to suffer the generational harm that comes from structural racism.”

In the U.S., Black women are far more likely than white women to report that healthcare providers scolded, threatened or shouted at them during childbirth, research shows. They also face other forms of obstetric racism, including barriers to quality care and cumulative stress from lifelong discrimination.

Growing up Black in predominantly white and Asian San Francisco has been a struggle for Jones. But, while carrying her second baby last year, she learned from her mother about the Abundant Birth Project. Within a month, her race and address in Bayview Hunters Point, where some of the city’s poorest residents live, qualified her to receive the $1,000 a month during her pregnancy and for six months postpartum.

“I really did feel like it was God helping me,” she said.

For Morenoff, though, it’s just another form of discrimination, and he says the city must either open the Abundant Birth Project to all pregnant women or close it down. “The whole point of the 14th Amendment is to require America to treat all Americans as Americans with the same equal rights,” he said.

Jones had high blood pressure, leading to swollen ankles and dizziness, during both her pregnancies. In her more recent one, the stipend helped her quit couch surfing and move into an apartment, and she gave birth to a healthy boy named Adonis.

“It’s known that people of color struggle way harder than other races,” Jones said. “Where I live, it’s nothing but struggle here, people trying to make ends meet.

“For them to try to take this program away from us,” she said, “it’s wrong.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues.

A star neuroscientist at USC is facing allegations of misconduct after whistleblowers submitted a report to the National Institutes of Health that accused the professor of manipulating data in dozens of research papers and sounded alarms about an experimental stroke medication his company is developing.

The accusations against Berislav V. Zlokovic, professor and chair of the department of physiology and neuroscience at the Keck School of Medicine of USC, were made by a small group of independent researchers and reported in the journal Science.

The report identifies allegedly doctored images and data in 35 research papers in which Zlokovic is the sole common author. It also raised questions about findings in Phase II clinical trials of a drug called 3K3A-APC, an experimental stroke treatment sponsored by ZZ Biotech, the Houston-based company Zlokovic co-founded.

Preclinical data appeared to have been manipulated, the report authors allege. In addition, the Phase II results appear to contain errors that would skew interpretation of the data in favor of the drug.

An attorney for Zlokovic said the neuroscientist takes the accusations “extremely seriously” and was “committed to fully cooperating” with a USC inquiry into the matter. However, he said his client could not comment on the allegations while the review was pending.

“Professor Zlokovic would normally welcome addressing every question raised, insofar as allegations are based on information and premises Professor Zlokovic knows to be completely incorrect,” attorney Alfredo X. Jarrin wrote in an email. “And other questions address work not performed at his lab or papers where he was not the senior author or contact author and his role was limited.”

The university also issued a statement saying it takes allegations of research integrity seriously. “Consistent with federal regulations and USC policies, the university forwards any such allegations to its Office of Research Integrity for careful review,” the university said in a statement. “Under USC policy, this review is required to be confidential. As a result, we are unable to provide any further information.”

Last year, USC’s Keck School of Medicine received from NIH the first $4 million of a planned $30-million grant to conduct Phase III trials of the experimental stroke treatment on 1,400 people.

Given the serious issues outlined in their report, the whistleblowers say those trials should be stopped immediately.

“It should certainly be paused in my opinion,” said Matthew Schrag, an assistant professor of neurology at Vanderbilt and co-author of the whistleblower report. “There are red flags about the safety of that treatment.”

He said that evidence from the USC-led phase II trial of the drug, which was published in 2018 and called RHAPSODY, raised questions of patient safety. Patients in that trial were more likely to die in the week after treatment, and more likely to be disabled 90 days later than those who were given a placebo.

In addition, Schrag said, some patients given the placebo had to wait longer for the standard stroke treatment of the drug tPA or surgery to dissolve the blood clot.

“The faster you’re able to intervene to either restore blood flow with the drug or restore blood flow by removing the clot, the more brain cells survive,” he said.

He added that he did not believe the delay was intentional but that it had the effect of “skewing the results in favor of the drug.”

Schrag previously raised questions about the integrity of other neurological research, work he said was separate from his employment at Vanderbilt.

Scientists have questioned Zlokovic’s research anonymously for years, Schrag said. Many of these concerns were published on PubPeer, a website on which anonymous contributors can examine scientific papers and highlight potential flaws.

Yet scientists working with Zlokovic did not complain publicly, he said, allowing the studies to continue for years and succeed at attracting tens of millions of dollars in taxpayer funding.

“I think people are concerned about the potential for backlash for harm to their own careers,” Schrag said. “And so I think that motivates people to just go along.”

In its report, the journal Science interviewed four former employees of Zlokovic’s lab who said that Zlokovic routinely pressured them to manipulate data. Two said they were told to discard notebooks with results that didn’t fit preferred conclusions he hoped to reach.

“There were clear examples of him instructing people to manipulate data to fit the hypothesis,” one former employee told the journal.

The severity of the data manipulation charges merits a thorough investigation of Zlokovic’s data, said Elisabeth Bik, a microbiologist and scientific integrity consultant who co-wrote the whistleblower report.

“Appropriate steps would be for USC to ask Zlokovic to give them the lab’s notebooks and data,” Bik said. “For example, for images where it appears that certain parts might have been duplicated or erased, the original images as they came off a scanner or microscope need to be compared to the published figure panels.”

Bik is among a subset of the report’s authors who are considering filing a federal whistleblower lawsuit. Should the NIH deem that any federal grant money was used improperly, a successful suit would entitle the plaintiffs to a portion of the money the government can claw back.

Zlokovic has received roughly $93 million in NIH funding, according to Science. A spokesperson for NIH’s Office of Extramural Research would not comment on the specifics of the case.

“We take concerns related to research integrity very seriously, and this may include allegations of research misconduct,” the office said in a statement.

Over the years, Zlokovic has created several biotech companies aimed at commercializing his scientific work. In 2007, he co-founded ZZ Biotech, which has been working to gain federal approval of 3K3A-APC.

Last year, Kent Pryor, ZZ Biotech’s chief executive, called the drug “a potential game-changer.”

“I believe, based on the positive clinical results to date, our 3K3A-APC will potentially create the first new drug class to treat ischemic stroke since 2003,” Pryor said.

On Tuesday, Pryor declined to comment on the details in the whistleblowers’ report. “I don’t want to get into particular explanations right now because of the ongoing investigations,” he said.

He said the Phase III clinical trial had not yet begun.

Zlokovic is a leading researcher on the blood-brain barrier, with particular interest in its role in stroke and dementia. He received his medical degree and doctorate in physiology at the University of Belgrade and joined the faculty at USC’s Keck School of Medicine after several fellowships in London.

A polyglot and amateur opera singer, Zlokovic left USC and spent 11 years at the University of Rochester before returning in 2011. He was appointed director of USC’s Zilkha Neurogenetic Institute the following year.

“My role will be to enhance an already very strong neuroscience base and try to make USC the No. 1 place in the neurosciences in the country and the world,” Zlokovic said upon rejoining the USC faculty. “It’s a big goal, but I think, with what’s going on right now, it’s actually moving in that direction. I think that could be my greatest contribution.”