Suicide rates among youths and young adults living in rural areas are almost twice as high as those living in urban areas, a recent study has found.

The disproportion increased between 1996 and 2010, “suggesting widening rural-urban disparities,” says the study, published in the peer-reviewed journal, JAMA Pediatrics on March 9.

“Suicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time,” the study states.

Researchers compared death records from people ages 10 to 24 in all U.S. counties. Between 1996 and 2010, 66,595 of the youths died by suicide. Significantly more males died by suicide than females.

In rural areas, 19.93 males and 4.40 females died by suicide per 100,000 people. But in urban areas, the rate was 10.31 males and 2.39 females.

Gun suicide rates declined, but the rates of hanging or suffocation for both males and females increased. Still, the rates of suicide by firearm or suffocation were disproportionately higher in rural areas.

The study concludes by saying that further research should explore how living in rural areas may increase suicide risk for youths and should “consider suicide-prevention efforts specific to rural settings.”