Trends in pesticide suicide in South Korea, 1983-2014.

Eun Shil Cha,Won Jin Lee,Yeongchull Choi,Shu-Sen Chang

doi:10.1017/s2045796019000118

Eun Shil Cha, Won Jin Lee + Show 2 more

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https://doi.org/10.1017/s2045796019000118

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Abstract

Self-poisoning using pesticides is among the major methods of suicide worldwide, and accounts for one-fifth of suicides in 2006-2010 in South Korea. We investigated long-term trends in pesticide suicide rates in South Korea and factors related to these trends. We calculated age-standardised rates of pesticide suicide in South Korea (1983-2014) using registered death data. We used graphical approach and joinpoint regression analysis to examine secular trends in pesticide suicide by sex, age and area, and a time-series analysis to investigate association of pesticide suicide rate with socioeconomic and agriculture-related factors. Age, period and cohort effects were examined using the intrinsic estimator method. Age-standardised rate of pesticide suicide fluctuated between 1983 and 2000 before it markedly increased in 2000-2003 (annual percent change 29.7%), followed by a gradual fall (annual percent change -6.3%) in 2003-2011. Following the paraquat ban (2011-2012), there was a marked reduction (annual percent change -28.2%) in 2011-2014. Trend in pesticide suicide was associated with divorce rate but not with other factors studied. Declines in pesticide suicide in 2003-2011 were most noticeable in younger groups and metropolises; by contrast, elderly adults aged 70+ living in rural areas showed an upward trend until after the 2011-2012 paraquat ban, when it turned downward. In the age-period-cohort modelling, having been born between 1938 and 1947 was associated with higher pesticide suicide rates. Pesticide suicide trend changed substantially in South Korea over the last three decades. Effective prevention should include close monitoring of trends and strong regulations of toxic pesticides.

Highlights

Suicide is a significant public health problem
Pesticide suicide rates declined in most sex/age groups after 2003/2004, they remained high in males aged 70+
The marked reduction in pesticide suicide after 2011 – when the re-registration of paraquat was cancelled – was most prominent in elderly males and females living in cities and rural areas

Summary

Introduction

In 2012, an estimated 804 000 suicide deaths occurred worldwide, representing an annual global age-standardised suicide rate of 11.4 per 100 000 population (World Health Organization, 2014). By 2012, South Korea’s suicide rate was amongst the highest globally, with that among elderly individuals aged 70 years and above reaching 116 per 100 000 (World Health Organization, 2014). Pesticide self-poisoning is a major contributor to the global burden of suicide (World Health Organization, 2014). From 2006 to 2010, the average annual number of deaths from pesticide suicide was approximately 2700, accounting for 21% of all suicides in South Korea (Cha et al, 2014a). Paraquat was the most widely used herbicide (weed killer) (Cha et al, 2014b), had the highest fatality rate (78%) and was responsible for the largest proportion (35%) of poisoning cases in Korea (Rural Development Administration, 2008). The South Korean government cancelled the re-registration of paraquat from the end of November 2011 and has banned its sale since the end of October 2012 (http://www.rda.go.kr)

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