The impact of pesticide suicide on the geographic distribution of suicide in Taiwan: a spatial analysis

Abstract

BackgroundPesticide self-poisoning is the most commonly used suicide method worldwide, but few studies have investigated the national epidemiology of pesticide suicide in countries where it is a major public health problem. This study aims to investigate geographic variations in pesticide suicide and their impact on the spatial distribution of suicide in Taiwan.MethodsSmoothed standardized mortality ratios for pesticide suicide (2002-2009) were mapped across Taiwan's 358 districts (median population aged 15 or above = 27 000), and their associations with the size of agricultural workforce were investigated using Bayesian hierarchical models.ResultsIn 2002-2009 pesticide poisoning was the third most common suicide method in Taiwan, accounting for 13.6% (4913/36 110) of all suicides. Rates were higher in agricultural East and Central Taiwan and lower in major cities. Almost half (47%) of all pesticide suicides occurred in areas where only 13% of Taiwan's population lived. The geographic distribution of overall suicides was more similar to that of pesticide suicides than non-pesticide suicides. Rural-urban differences in suicide were mostly due to pesticide suicide. Areas where a higher proportion of people worked in agriculture showed higher pesticide suicide rates (adjusted rate ratio [ARR] per standard deviation increase in the proportion of agricultural workers = 1.58, 95% Credible Interval [CrI] 1.44-1.74) and overall suicide rates (ARR = 1.06, 95% CrI 1.03-1.10) but lower non-pesticide suicide rates (ARR = 0.91, 95% CrI 0.87-0.95).ConclusionEasy access to pesticides appears to influence the geographic distribution of suicide in Taiwan, highlighting the potential benefits of targeted prevention strategies such as restricting access to highly toxic pesticides.

Suicide attempts in a emergency hospital

“…The identification of the profile of the SA could contribute to strategic planning that would make possible the prevention of the use of certain SA methods or help to design plans of care for subjects who have used methods. Several studies have reported which are the more commonly used means of SA [11][12][13] . The ingestion of medication, hanging and the use of cutting objects in SAs must be taken into consideration in the planning of care for the studied population.…”

Mortalidad debida a intoxicación por plaguicidas en Colombia entre 1998 y 2011

“…En Colombia, se ha informado que las tendencias en las tasas de mortalidad por suicidios en hombres mostraron tasas específicas más elevadas en los grupos de 20 a 29 años de edad, entre 1985 y 2002 (47). Además, teniendo en cuenta que esas tasas fueron más altas en el área rural, los resultados parecen indicar una relación directa entre las labores agrícolas y la exposición a plaguicidas, como lo informaron Chang, et al, quienes encontraron que en las áreas con mayor proporción de personas ocupadas en actividades agrícolas, se reportaban las tasas más altas de mortalidad por intoxicación con plaguicidas autoinfligida intencionalmente (39).…”

Geographical epidemiology of common methods of suicide and suicide attempts during the years 2010-2013 in Fars Province, Iran

“…Nevertheless, the frequency of common methods in terms of gender were low in some cities; therefore, the most common methods of suicide (self-immolation, use of drugs, and hanging) and suicide attempts (use of drugs, pesticide poisoning, use of cold weapons) were generally determined at the provincial level, and then, in the 27 cities of the province. Then, for each of the three common methods of suicide and suicide attempts, raw standardized mortality ratio (SMR) was calculated using indirect method based on the following formula: SMR = The number of observed cases/The number of expected cases The number of expected cases was calculated using the following formula (12): The number of expected cases = (The number of cases in the province/Population of the province) × The population of the city In order to calculate the rate of suicide and suicide attempts, the demographics information of the 2012 census was used (13). Due to the small population and reduced incidence of suicide in some cities and also to show a clear spatial pattern of suicide and suicide attempt before mapping (14), Bayesian hierarchical models and smoothed SMR (12) were calculated to separate the common methods of suicide and suicide attempts.…”

“…Then, for each of the three common methods of suicide and suicide attempts, raw standardized mortality ratio (SMR) was calculated using indirect method based on the following formula: SMR = The number of observed cases/The number of expected cases The number of expected cases was calculated using the following formula (12): The number of expected cases = (The number of cases in the province/Population of the province) × The population of the city In order to calculate the rate of suicide and suicide attempts, the demographics information of the 2012 census was used (13). Due to the small population and reduced incidence of suicide in some cities and also to show a clear spatial pattern of suicide and suicide attempt before mapping (14), Bayesian hierarchical models and smoothed SMR (12) were calculated to separate the common methods of suicide and suicide attempts. The Bayesian hierarchical models for observed cases of suicide were based on the Poisson assumption which allows the possibility of random effects for nonstructural diversity (heterogeneity in all regions of the area under consideration) and structural variation (the correlation between neighboring areas) (14,15).…”