Ambient Air Pollution and Completed Suicide in 26 South Korean Cities: Effect Modification by Demographic and Socioeconomic Factors

Abstract

Air pollution has been associated with suicide mortality. However, limited studies have examined possible effect modification of the association by various demographic and socioeconomic factors, despite their crucial roles on suicide risk. In 73,445 completed suicide cases from 26 South Korean cities from 2002–2013, we studied the association of suicide risk with exposure to particles <10 µm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO), using a city-specific conditional logistic regression analysis with a case-crossover design. Random effects meta-analysis pooled the results. We considered a delayed effect of air pollution by constructing lags up to 7 days. We explored effect modification by demographic and socioeconomic factors (sex, age, education level, job, and marital status) as well as place of death, method of suicide, and season, through stratified subgroup analyses. Among five pollutants, NO2 showed the strongest association at immediate lags (percent change in odds ratio; PM10: 1.2% [95% CI, 0.2%, 2.3%]; NO2: 4.3% [95% CI, 1.9%, 6.7%]; SO2: 2.2% [95% CI, 0.7%, 3.8%]; O3: 1.5% [95% CI, −0.3%, 3.2%]; and CO: 2.4% [95% CI, 0.9%, 3.8%] per interquartile range increase at lag0). In subgroup analyses by socioeconomic factors, stronger associations were observed in the male sex, the elderly, those with lower education status, white-collar workers, and the married; the largest association was an 11.0% increase (95% CI, 4.1%, 18.4%) by NO2 among white-collar workers. We add evidence of effect modification of the association between air pollution exposure and suicide risk by various demographic and socioeconomic factors. These findings can serve as the basis for suicide prevention strategies by providing information regarding susceptible subgroups.