The share of households that have guns is the single strongest predictor of how many young people commit suicide in a state, a new study shows.

At the state level, the share of households that owned guns in 2004 was strongly linked to the youth suicide rate over the next decade, researchers found, even after controlling for other factors such as depression, suicide plans and previous suicide attempts.

Overall, the youth suicide rate rose about 27 percent with each 10 percentage-point increase in household gun ownership, according to the study, published Thursday in the American Journal of Preventive Medicine.

"When a youth attempts suicide, the major determinant of whether they are successful or not is the means they use," says Dr. Michael Siegel, co-author of the study and a professor of community health sciences at Boston University School of Public Health . "We know firearms are a highly lethal means, so when someone uses a firearm for a suicide attempt, they're likely to be successful."

Across the U.S., nearly 45,000 people used guns to commit suicide in 2015 and 2016, according to a report from the Centers for Disease Control and Prevention . More than 2,000 of those deaths were among people ages 10 to 19, with 42 percent of youth suicides involving guns.

Using CDC data, Siegel and fellow researchers estimated household gun ownership in 2004 and suicide rates among people who were 10 to 19 years old between 2005 and 2015. Data for Hawaii and Rhode Island were drawn from 2003 to 2015 because both states had a low number of suicide deaths annually.

During the time period studied, the average youth suicide rate ranged from a low of 2.6 per 100,000 in New Jersey to a high of 15.2 in Alaska. Household gun ownership rates ranged from a low of 10.2 percent in Hawaii to a high of 65.5 percent in Wyoming.

An average of 52.5 percent of households owned guns in the 10 states with the highest youth suicide rates, while just 20 percent of households owned guns, on average, in the 10 states with the lowest youth suicide rates.

Previous studies have indicated that states with higher rates of household gun ownership also have higher suicide rates overall, but researchers say this is the first to account for the prevalence of youth suicide attempts across states when measuring youth suicide and gun ownership.

"We found there are states with very high levels of suicide attempts, but very low levels of actual youth suicide," Siegel says. "The likely explanation for that is they have low rates of household gun ownership, so even though more kids are trying to commit suicide, they're not being successful."

While gun ownership played the largest role in determining youth suicide rates, the rate of previous suicide attempts and the share of youth who were Native American also were positively associated with overall rates.