Academic journal article Environmental Health Perspectives

Air Pollution and Suicide in 10 Cities in Northeast Asia: A Time-Stratified Case-Crossover Analysis

Academic journal article Environmental Health Perspectives

Air Pollution and Suicide in 10 Cities in Northeast Asia: A Time-Stratified Case-Crossover Analysis

Article excerpt


Suicide is a significant public health concern. An estimated 804,000 people worldwide died by suicide in 2012, accounting for 1.4% of all deaths; suicide constitutes the 15th most common cause of death (WHO 2014). Among a broad range of contributing factors to suicide, attention has been given to environmental factors that may be associated with suicide (Sinyor et al. 2017). Numerous studies have reported evidence of a seasonal peak in suicide in spring and early summer (Christodoulou et al. 2012; Coimbra et al. 2016). Some studies have investigated the association between weather and suicide, suggesting that increases in ambient temperature are associated with increased risk of suicide (Deisenhammer 2003; Kim et al. 2016; Likhvar et al. 2011; Page et al. 2007). In addition, the association with sunlight or sunshine hours has been studied (Vyssoki et al. 2014; White et al. 2015), although it remains controversial because the association was attenuated after adjusting for the seasonality of suicide (White et al. 2015).

Emerging evidence suggests that air pollution may be another potential environmental factor associated with suicide. Several epidemiological studies have reported that higher levels of air pollutants, such as particulate matter with aerodynamic diameter [less than or equal to] 10 [micro]m (P[M.sub.10]) and [less than or equal to] 2.5 [micro]m (P[M.sub.2.5]), nitrogen dioxide (N[O.sub.2]), sulfur dioxide (S[O.sub.2]), and carbon monoxide (CO), are associated with suicide (Kim et al. 2010, Bakian et al. 2015, Lin et al. 2016, Ng et al. 2016) and with suicide attempts (Szyszkowicz et al. 2010). These studies used time-stratified case-crossover analysis, which is widely used to examine short-term associations between air pollution and health; this method is also considered the least biased method in the case-crossover design (Janes et al. 2005).

However, previous findings varied depending on the type of air pollutant and on the study location. For example, there were consistent findings of positive associations for P[M.sub.2.5] and N[O.sub.2] in three studies (Bakian et al. 2015; Kim et al. 2010; Lin et al. 2016). Other pollutants, such as P[M.sub.10] and S[O.sub.2], were found to be associated with suicide in two of the studies (Kim et al. 2010; Lin et al. 2016) but not in the third (Bakian et al. 2015). This discrepancy may be attributed to geographical variations (e.g., the sources and components of air pollution, climate conditions, cultural backgrounds, socioeconomic factors, and suicidal behaviors). Moreover, different modeling strategies make it difficult to compare results across studies. To gain a better understanding of air pollution and suicide, a study to investigate multiple locations with a unified modeling strategy is merited.

In the present study, we examined the association between air pollution and suicide in 10 large cities in three countries in Northeast Asia: South Korea, Japan, and Taiwan. The three countries share, in part, traditional cultural backgrounds, and have recorded relatively high suicide rates (31.0, 24.0, and 17.6 per 100,000 population in 2009 in South Korea, Japan, and Taiwan, respectively, compared with the global rate of 11.2 per 100,000 population in 2010) (Chen et al. 2012; WHO 2017). We conducted a two-stage analysis to examine the city-specific association and the combined association. To our knowledge, this is the first study of the association between air pollution and suicide comparing multiple cities in multiple countries using a unified analytical framework.



We collected the data on suicide, air pollutants (N[O.sub.2], S[O.sub.2], and P[M.sub.10]) and weather in four cities in South Korea from 1 January 2001 to 31 December 2010 (10 y), in three cities in Japan from 1 April 1979 to 31 March 2009 (30 y), and in three cities in Taiwan from 1 January 1994 to 31 December 2007 (14 y) (Figure 1). …

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