Citation

Lee H, Myung W, Kim SE, Kim DK, Kim H. Sci. Total Environ. 2018; 639: 944-951.

Affiliation

Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea; Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea. Electronic address: hokim@snu.ac.kr.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.scitotenv.2018.05.210

PMID

29929333

Abstract

Air pollution has been recently 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 to 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 was used to pool the results. We considered a delayed effect of air pollution by constructing lags of 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.

Copyright © 2018 Elsevier B.V. All rights reserved.

Language: en

Keywords

Air pollution; Ambient air pollutants; Effect modification; Socioeconomic status; Suicide