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.
Highlights
Pesticide 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
Between 2002 and 2009 there were 36 110 suicides in Taiwan; 4913 (13.6%) of these were pesticide poisonings. 3950 (80.4%) of the pesticide deaths were certified as suicides, 639 (13.0%) as undetermined deaths and 324 (6.6%) as accidents
In 2002-2009 pesticide poisoning was the third most commonly used method in Taiwan, following hanging (30.2%) and poisoning using non-domestic gases (25.0%); pesticide poisoning accounted for 69% of all suicides from poisoning using solid or liquid substances
Summary
Pesticide 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. Pesticide self-poisoning is one of the most commonly used suicide methods worldwide, accounting for 250 000-370 000 deaths every year - around one third of the world’s suicides [1] Most of these deaths occur in rural areas of South and East Asia and many are preventable by simple measures such as legislative bans on the import and sale of the most toxic pesticides [2]. The geographic distribution of pesticide suicides in relation to markers of access to pesticides has received little attention in the research literature, previous studies have documented substantial area variations in pesticide poisoning mortality in the US [9], Sri Lanka [10] and South Korea [11,12]. Improved knowledge of geographic patterning of pesticide suicides may inform targeted prevention strategies
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