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Edwards AC, Abrahamsson L, Crump C, Sundquist J, Sundquist K, Kendler KS. Alcohol use disorder and risk of specific methods of suicide death in a national cohort. Acta Psychiatr Scand 2024; 149:479-490. [PMID: 38556255 PMCID: PMC11065572 DOI: 10.1111/acps.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is among the strongest correlates of suicide death, but it is unclear whether AUD status is differentially associated with risk of suicide by particular methods. METHODS The authors used competing risks models to evaluate the association between AUD status and risk of suicide by poisoning, suffocation, drowning, firearm, instruments, jumping, or other means in a large Swedish cohort born 1932-1995 (total N = 6,581,827; 48.8% female). Data were derived from Swedish national registers, including the Cause of Death Register and a range of medical registers. RESULTS After adjusting for sociodemographic factors and familial liability to suicidal behavior, AUD was positively associated with risk of suicide for each method evaluated (cumulative incidence differences: 0.006-1.040 for females, 0.046-0.680 for males), except the association with firearm suicide in females. AUD was most strongly associated with risk of suicide by poisoning. Sex differences in the effects of AUD and family liability were observed for some, but not all, methods. Furthermore, high familial liability for suicidal behavior exacerbated AUD's impact on risk for suicide by poisoning (both sexes) and suffocation and jumping (males only), while the inverse interaction was observed for firearm suicide (males only). CONCLUSIONS AUD increases risk of suicide by all methods examined and is particularly potent with respect to risk of suicide by poisoning. Differences in risk related to sex and familial liability to suicidal behavior underscore AUD's nuanced role in suicide risk. Future research should investigate targeted means restriction effectiveness among persons with AUD.
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Affiliation(s)
- Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US
| | - Linda Abrahamsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Casey Crump
- Departments of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center, Houston, TX, US
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US
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Rosenberg YJ, Garcia K, Diener J, Gerk W, Donahue S, Mao L, Lees J, Jiang X, Urban LA, Sullivan D. The impact of solvents on the toxicity of the banned parathion insecticide. Chem Biol Interact 2023; 382:110635. [PMID: 37453609 PMCID: PMC10574261 DOI: 10.1016/j.cbi.2023.110635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
The aerial crop dusting and spraying of fields with the phosphorothioate insecticide parathion in the late 1900s, significantly improved crop yields but resulted in high levels of occupational toxicity in handlers and agricultural workers, as well as cases of intentional self-harm poisoning, culminating in its banning in many western countries by early 2000s. However because of the low solubility and volatility of parathion, most available products were formulated using organic solvents e.g. xylene, to increase the efficacy of the aerosols and dusts. In the present study, the toxicity of parathion was assessed when formulated in an aqueous solvents (ethanol/PBS (1:9)), and delivered to macaques as an aerosol. Doses of 780 μg/kg and 1.56 mg/kg were delivered one day apart, using a modified nebulizer calculated to result in lung deposition of ∼480 μg/kg with a similar or larger amount being swallowed; these doses being similar to the estimated lethal oral dose 286ug/kg - 1.43 mg/kg of formulated parathion in humans. Surprisingly, this dose (a combined amount of ∼14 mg) caused only low AChE inhibition and moderate BChE inhibition with no clinical symptoms, indicating that the use of organic solvents may have previously played a critical role in the severity of parathion toxicity following inhalation exposure. In addition, unlike constitutively toxic OPs, which are highly toxic when inhaled, these results are consistent with the idea that phosphorothioate insecticides appear to be more intoxicating following oral than inhalation exposure. However, this still remains uncertain because the presence of organic solvents in the ingested parathion studies was not always known.
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Sun P, Zhang L, Han L, Zhang H, Shen H, Zhu B, Wang B. Application of three prediction models in pesticide poisoning. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:30584-30593. [PMID: 35000167 PMCID: PMC8742696 DOI: 10.1007/s11356-021-17957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
To establish a reasonable prediction model of pesticide poisoning and predict the future trend of pesticide poisoning in Jiangsu Province, so as to provide the basis for rational allocation of public health resources and formulation of prevention and control strategies, the number of pesticide poisoning in Jiangsu province from 2006 to 2020 was collected. Grey model (GM(1,1)) model, autoregressive integrated moving average model (ARIMA) model and exponential smoothing model were used for prediction and comparative analysis. Finally, the model with the best fitting effect was selected. The average relative errors of ARIMA(0,1,1)(0,1,0)12 model, Holt-Winters multiplicative model and GM(1,1) were 0.096, 0.058 and 0.274 separately. The fitting effect of GM model is the worst, while the fitting effect of ARIMA(0,1,1) (0,1,0)12 model and Holt-Winters multiplication model is relatively good, which can be basically used for prediction. Holt-Winters multiplicative model has the best fitting effect and the highest accuracy in predicting the number of pesticide poisoning. The numbers of pesticide poisonings in the next 3 years are 454, 410 and 368, with a total of 1232, according to the Holt-Winters multiplicative model. Through the prediction of the number of pesticide poisoning in the next 3 years, this paper also provides a basis for the formulation of pesticide-related policies in the future.
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Affiliation(s)
- Peng Sun
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu, China.
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, 210000, Jiangsu, China.
| | - Ludi Zhang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu, China
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, 210000, Jiangsu, China
| | - Lei Han
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, 210000, Jiangsu, China
| | - Hengdong Zhang
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, 210000, Jiangsu, China
| | - Han Shen
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, 210000, Jiangsu, China
| | - Baoli Zhu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu, China.
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, 210000, Jiangsu, China.
| | - Boshen Wang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu, China.
- Institute of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, No. 172 Jiangsu Road, Nanjing, 210000, Jiangsu, China.
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Lim JS, Buckley NA, Chitty KM, Moles RJ, Cairns R. Association Between Means Restriction of Poison and Method-Specific Suicide Rates. JAMA HEALTH FORUM 2021; 2:e213042. [PMID: 35977165 PMCID: PMC8727039 DOI: 10.1001/jamahealthforum.2021.3042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Question Findings Meaning Importance Objective Evidence Review Findings Conclusions and Relevance
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Affiliation(s)
- Jessy S. Lim
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, New South Wales, Australia
| | - Nicholas A. Buckley
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, New South Wales, Australia
| | - Kate M. Chitty
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, New South Wales, Australia
| | - Rebekah Jane Moles
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rose Cairns
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, New South Wales, Australia
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Case Fatality as an Indicator for the Human Toxicity of Pesticides-A Systematic Scoping Review on the Availability and Variability of Severity Indicators of Pesticide Poisoning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168307. [PMID: 34444056 PMCID: PMC8394312 DOI: 10.3390/ijerph18168307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
Objective: To investigate if case fatality and other indicators of the severity of human pesticide poisonings can be used to prioritize pesticides of public health concern. To study the heterogeneity of data across countries, cause of poisonings, and treatment facilities. Methods: We searched literature databases as well as the internet for studies on case-fatality and severity scores of pesticide poisoning. Studies published between 1990 and 2014 providing information on active ingredients in pesticides or chemical groups of active ingredients were included. The variability of case-fatality-ratios was analyzed by computing the coefficient of variation as the ratio of the standard deviation to the mean. Findings: A total of 149 papers were identified of which 67 could be included after assessment. Case-fatality-ratio (CFR) on 66 active ingredients and additionally on 13 groups of active ingredients were reported from 20 countries. The overall median CFR for group of pesticides was 9%, for single pesticides 8%. Of those 12 active ingredients with a CFR above 20% more than half are WHO-classified as “moderately hazardous” or “unlikely to present acute hazard”. Two of seven pesticides considered “unlikely to present hazard in normal use” showed a CFR above 20%. The cross-study variability of reported case fatality was rather low. Studies most often utilized the Glasgow Coma Score for grading the severity of poisoning. Conclusion: Although human pesticide poisoning is a serious public health problem, an unexpectedly small number of publications report on the clinical outcomes within our study period. However, CFRs of acute human pesticide poisoning are available for several groups of pesticides as well as for active ingredients showing moderate cross-study variability. Our results underline that CFR is an indicator of the human toxicity of pesticides and can be utilized to prioritize highly hazardous pesticides especially since there is limited correspondence between the animal-test-based hazard classification and the human CFR of the respective pesticide. The reporting of available poisoning data should be improved, human case-fatality data are a reasonable tool to be included systematically in the periodic statutory review of pesticides and their regulation.
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Boedeker W, Watts M, Clausing P, Marquez E. The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review. BMC Public Health 2020; 20:1875. [PMID: 33287770 PMCID: PMC7720593 DOI: 10.1186/s12889-020-09939-0] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Human poisoning by pesticides has long been seen as a severe public health problem. As early as 1990, a task force of the World Health Organization (WHO) estimated that about one million unintentional pesticide poisonings occur annually, leading to approximately 20,000 deaths. Thirty years on there is no up-to-date picture of global pesticide poisoning despite an increase in global pesticide use. Our aim was to systematically review the prevalence of unintentional, acute pesticide poisoning (UAPP), and to estimate the annual global number of UAPP. METHODS We carried out a systematic review of the scientific literature published between 2006 and 2018, supplemented by mortality data from WHO. We extracted data from 157 publications and the WHO cause-of-death database, then performed country-wise synopses, and arrived at annual numbers of national UAPP. World-wide UAPP was estimated based on national figures and population data for regions defined by the Food and Agriculture Organization (FAO). RESULTS In total 141 countries were covered, including 58 by the 157 articles and an additional 83 by data from the WHO Mortality Database. Approximately 740,000 annual cases of UAPP were reported by the extracted publications resulting from 7446 fatalities and 733,921 non-fatal cases. On this basis, we estimate that about 385 million cases of UAPP occur annually world-wide including around 11,000 fatalities. Based on a worldwide farming population of approximately 860 million this means that about 44% of farmers are poisoned by pesticides every year. The greatest estimated number of UAPP cases is in southern Asia, followed by south-eastern Asia and east Africa with regards to non-fatal UAPP. CONCLUSIONS Our study updates outdated figures on world-wide UAPP. Along with other estimates, robust evidence is presented that acute pesticide poisoning is an ongoing major global public health challenge. There is a need to recognize the high burden of non-fatal UAPP, particularly on farmers and farmworkers, and that the current focus solely on fatalities hampers international efforts in risk assessment and prevention of poisoning. Implementation of the international recommendations to phase out highly hazardous pesticides by the FAO Council could significantly reduce the burden of UAPP.
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Affiliation(s)
| | - Meriel Watts
- PAN Asia Pacific, P.O. Box 1170, 10850, Penang, Malaysia
| | | | - Emily Marquez
- PAN North America, 2029 University Ave., Suite 200, Berkeley, CA, 94704, USA
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Wang L, Wu Y, Yin P, Cheng P, Liu Y, Schwebel DC, Qi J, Ning P, Liu J, Cheng X, Zhou M, Hu G. Poisoning deaths in China, 2006-2016. Bull World Health Organ 2019; 96:314-326A. [PMID: 29875516 PMCID: PMC5985423 DOI: 10.2471/blt.17.203943] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To provide a comprehensive overview of poisoning mortality patterns in China. Methods Using mortality data from the Chinese national disease surveillance points system, we examined trends in poisoning mortality by intent and substance from 2006 to 2016. Differences over time between urban and rural residents among different age groups and across external causes of poisoning were quantified using negative binomial models for males and females separately. Results In 2016, there were 4936 poisoning deaths in a sample of 84 060 559 people (5.9 per 100 000 people; 95% confidence interval: 5.6–6.2). Age-adjusted poisoning mortality dropped from 9.2 to 5.4 per 100 000 people between 2006 and 2016. Males, rural residents and older adults consistently had higher poisoning mortality than females, urban residents and children or young adults. Most pesticide-related deaths (34 996 out of 39 813) were suicides among persons older than 15 years, although such suicides decreased between 2006 and 2016 (from 6.1 per 100 000 people to 3.6 for males and from 5.8 to 3.0 for females). In 2016, alcohol caused 29.3% (600/2050) of unintentional poisoning deaths in men aged 25–64 years. During the study period, unintentional fatal drug poisoning by narcotics and psychodysleptics in individuals aged 25–44 years increased from 0.4 per 100 000 people to 0.7 for males and from 0.05 to 0.13 for females. Conclusion Despite substantial decreases in mortality, poisoning is still a public health threat in China. This warrants further research to explore causative factors and to develop and implement interventions targeting at-risk populations.
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Affiliation(s)
- Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yue Wu
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xunjie Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Moebus S, Boedeker W. Frequency and trends of hospital treated pesticide poisonings in Germany 2000-2014. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc13. [PMID: 28860960 PMCID: PMC5556595 DOI: 10.3205/000254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/22/2017] [Indexed: 12/02/2022]
Abstract
Objectives: To analyze the occurrence, trends, and patterns of hospital treated pesticide poisonings in Germany Methods: Data from the German diagnoses statistics of hospital discharges are analyzed for the years 2000–2014. ICD code specific numbers of cases as well as rates per one million and case-fatality ratios are calculated. The number of fatal pesticides poisonings is compared to the official German causes-of-death statistics. Results: During 2000 and 2014 overall 2,871 pesticides poisonings were treated in hospitals with 191 cases per year on average. The rate per 1 million dropped from 2.74 in 2000 to 1.38 in 2014. On average 5% of pesticides poisonings were fatal, this percentage also approximately halved from 2000 to 2014. The majority of pesticide poisonings occurred in men. In both sexes about 70% of all pesticide poisonings occurred below 55 years and one third of patients were younger than 25 years. With respect to fatal poisonings men shared almost 80% of incidents and more than 70% of cases occurred above 55 years of age. There is poor agreement between the different data sources studied. On average only 24% of the fatal pesticide poisoning in the mortality statistics were seen in the diagnoses statistics of hospital discharges. Conclusions: This study shows that the decrease of pesticide poisonings in Germany applies to fatal and non-fatal incidents. There seems to be a decrease also in the case fatality ratio which might point to positive preventive effects by reducing the availability of toxic pesticides. Fatal pesticides poisonings prevails in elder men while non-fatal pesticide poisoning more often affects the younger population. These different patterns should be addressed when improving preventive strategies. The discrepancy between the different data bases with respect to fatal poisoning might be explained by intoxications not admitted to a hospital. However, the difference seems rather high and calls for a deeper investigation. The ICD version 10 does not provide codes allowing for pesticide-specific analyzes of poisonings. The new ICD version 11 therefore should be adjusted to the needs of monitoring of pesticide poisonings.
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Affiliation(s)
- Susanne Moebus
- Centre for Urban Epidemiology, University Clinic, University of Duisburg-Essen, Essen, Germany
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Gunnell D, Knipe D, Chang SS, Pearson M, Konradsen F, Lee WJ, Eddleston M. Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence. LANCET GLOBAL HEALTH 2017; 5:e1026-e1037. [PMID: 28807587 DOI: 10.1016/s2214-109x(17)30299-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pesticide self-poisoning accounts for 14-20% of suicides worldwide. Regulation aimed at restricting access to pesticides or banning highly hazardous pesticides is one approach to reducing these deaths. We systematically reviewed the evidence of the effectiveness of pesticide regulation in reducing the incidence of pesticide suicides and overall suicides. METHODS We did a systematic review of the international evidence. We searched MEDLINE, PsycINFO, and Embase for studies published between Jan 1, 1960, and Dec 31, 2016, which investigated the effect of national or regional bans, and sales or import restrictions, on the availability of one or more pesticides and the incidence of suicide in different countries. We excluded other interventions aimed at limiting community access to pesticides. We extracted data from studies presenting pesticide suicide data and overall suicide data from before and after national sales restrictions. Two reviewers independently assessed papers for inclusion, extracted data, and assessed risk of bias. We undertook a narrative synthesis of the data in each report, and where data were available for the years before and after a ban, we pooled data for the 3 years before and the 3 years after to obtain a crude estimate of the effect of the ban. This study is registered through PROSPERO, number CRD42017053329. FINDINGS We identified 27 studies undertaken in 16 countries-five low-income or middle-income countries (Bangladesh, Colombia, India, Jordan and Sri Lanka), and 11 high-income countries (Denmark, Finland, Germany, Greece, Hungary, Ireland, Japan, South Korea, Taiwan, UK, and USA). Assessments largely focused on national bans of specific pesticides (12 studies of bans in six countries-Jordan, Sri Lanka, Bangladesh, Greece [Crete], South Korea, and Taiwan) or sales restrictions (eight studies of restrictions in five countries- India, Denmark, Ireland, the UK and the USA). Only five studies used optimum analytical methods. National bans on commonly ingested pesticides in five of the six countries studied, including four studies using optimum analytical methods, were followed by reductions in pesticide suicides and, in three of these countries, falls in overall suicide mortality. Greece was the only country studied that did not show a decrease in pesticide suicide following a ban. There were no high-quality studies of restricting sales to people for occupational uses; four of the seven studies (in three of the five countries studied-India, Denmark, and the USA) showed sales restrictions were followed by decreases in pesticide suicides; one of the two studies investigating trends in overall suicide mortality reported a fall in deaths in Denmark, but there were also decreases in suicide deaths from other methods. INTERPRETATION National bans on highly hazardous pesticides, which are commonly ingested in acts of self-poisoning, seem to be effective in reducing pesticide-specific and overall suicide rates. Evidence is less consistent for sales restrictions. A worldwide ban on the use of highly hazardous pesticides is likely to prevent tens of thousands of deaths every year. FUNDING None.
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Affiliation(s)
- David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Melissa Pearson
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; Pharmacology, Toxicology, & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Flemming Konradsen
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; Pharmacology, Toxicology, & Therapeutics, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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