Pesticide poisoning in Zhejiang, China: a retrospective analysis of adult cases registration by occupational disease surveillance and reporting systems from 2006 to 2010

The long-term changing patterns of suicide mortality in China from 1987 to 2020: continuing urban-rural disparity

BACKGROUND

Over the past three decades, China has experienced significant changes in urban-rural, gender, and age-specific suicide mortality patterns. This study aimed to investigate the long-term trends in suicide mortality in China from 1987 to 2020.

METHODS

Suicide mortality data were obtained from China's National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modeling to estimate age, period, and cohort effects on suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated.

RESULTS

Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987 to 2020, with a more pronounced decrease in rural areas (net drift = -7.07%, p<0.01) compared to urban areas (net drift = -3.41%, p<0.01). The decline curve of urban areas could be divided into three substages. Period and cohort effects were more prominent in rural areas. Suicide risk was highest among individuals aged 20-24 and gradually increased after age 60. Females, particularly those of childbearing age, had higher suicide risk than males, with a reversal observed after age 50. This gender reversal showed distinct patterns in urban and rural areas, with a widening gap in urban areas and a relatively stable gap in rural areas.

CONCLUSIONS

Suicide mortality in China has consistently declined over the past three decades. However, disparities in age, gender, and urban-rural settings persist, with new patterns emerging. Targeted suicide prevention programs are urgently needed for high-risk groups, including females of childbearing age and the elderly, and to address the slower decrease and reversing urban-rural gender trends.

Impact of pesticide regulations on mortality from suicide by pesticide in China: an interrupted time series analysis

Background

Pesticide bans and regulatory restrictions have been shown to be effective strategies for preventing suicide in several countries. Suicide and suicide by pesticides have decreased significantly in China over the past two decades. However, whether the reduction was associated with pesticide regulation is unknown.

Methods

The monthly data on suicide and suicide by pesticide from 2006 to 2018 were obtained from China's Disease Surveillance Point (DSP) system. Information on China's pesticide regulations since 1970 was obtained from Pesticide Action Network International (PAN International), Joint Meeting on Pesticide Management Highly Hazardous Pesticides (JMPM HHP) lists, the website of the Ministry of Agriculture of China, Pesticide Information Network of China, and the Wan Fang database. Change point detection and policy analysis were combined to identify the time of any trend change breakpoint of suicide and suicide by pesticide. Interrupted time series analysis was used to investigate the pre- and post-breakpoint trends of monthly standardized rates in suicide and suicide by pesticide.

Results

The standardized pesticide suicide rate decreased by 60.5% from 6.50 in 2006 to 2.56 per 100,000 in 2018. Larger declines were evident among people in urban areas (67.3%), female individuals (63.5%), and people aged 15-44 years (68.1%). The effect of policies banning highly hazardous organophosphorus pesticides (HHOP) [rate ratio (RR) = 0.993, 95% CIs (0.991-0.994)] in December 2008 and stopping domestic sales and use of paraquat aqueous solution (RR = 0.992, 95% CIs: 0.990-0.994) in July 2016 were more pronounced than regulating the paraquat-related products (RR = 1.003, 95% CIs: 1.002-1.004) in April 2012.

Conclusion

Declines in suicide by pesticide in China occurred contemporaneously with regulatory bans and restrictions implemented on several pesticides, particularly in urban areas, among female individuals, and the relatively low age profile. These findings indicate the potential influence of these bans on trends of suicide by pesticides.

Could pesticide exposure be implicated in the high incidence rates of depression, anxiety and suicide in farmers? A systematic review

Pesticide exposure and poisoning may rise the risk of mental health problems and suicidal tendencies. To explore the potential connection between chronic occupational exposure to pesticides and depression, anxiety, and suicide-related outcomes in farmers, a systematic review was performed. Systematic review protocol is available in PROSPERO registration number CRD42022316285. A total of fifty-seven studies met inclusion criteria: twenty-nine on depression or other mental disorders, twelve on suicide (two of them on both depression and suicide), and fourteen on pesticide poisoning or self-poisoning and death. Among the fifty-seven selected studies, eighteen were conducted in Asia, seventeen in North America, fourteen in South America, seven in European Union, one in Africa, and one in Australia/Oceania. Selected studies demonstrated an increased prevalence of depressive disorders in farmworkers exposed to pesticides as well as an increased self-reported prevalence of depression in this population. Moreover, previous pesticide poisoning increased the risk estimates for depression or other mental disorders as compared with chronic pesticide exposure. Severe pesticide poisoning and multiple poisoning showed increased risks of depressive symptoms compared with milder cases. In addition, financial difficulties and poor health were positively correlated with depression. Among studies on suicide, nine of them found that suicide rates increased in areas devoted to agriculture with intensive pesticide consumption. Moreover, studies demonstrate a higher suicide risk among farmers. The present review suggests more attention to the farmer's mental health and more detailed studies on occupational exposure to the mixture of these compounds.

Gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students

BACKGROUND

Depression and aggression are related to the risk of suicide. Previous studies have associated different characteristics with depression and aggression in separate gender groups. The main aim of this study was to investigate the gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students.

METHODS

A total of 2004 first-year undergraduates (80.5 % female, mean age = 19.4 ± 0.8 years) were surveyed by a battery of questionnaires that contained the Chinese version of the Beck scale for Suicide Ideation, the Chinese version of the 12-item Aggression Questionnaire, and the Center for Epidemiologic Studies Depression scale.

RESULTS

(1) Depression severity was significantly associated with the suicidality risk (r = 0.090, p < 0.01). (2) Suicide risk correlated positively with physical aggression, verbal aggression, anger, and hostility in the aggression questionnaire (r = 0.308, 0.227, 0.284, 0.277, p < 0.01). (3) A possible gender difference was noted for suicide risk in that depression degree was a significant risk factor for females but not males (R2 = 0.095, F = 41.554, p < 0.01), whereas anger was a significant predictor of suicide risk for males but not for females (R2 = 0.21, F = 25.75, p < 0.01).

CONCLUSIONS

Gender differences exist in the predictive effect of depression and aggression on suicide risk among first-year college students.

Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study

Objectives

Intoxication with pesticides is a well-known public health problem. We aimed to describe the demographic and toxico-clinical characteristics and outcomes of patients with pesticide poisoning.

Methods

This retrospective cross-sectional study was performed in Khorshid Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. All patients with pesticide poisoning (insecticides, herbicides, fungicides, rodenticides, and acaricides) were evaluated. The patients' demographic, toxicological, clinical, and laboratory findings from March 2016 until March 2021 were collected and analyzed.

Results

During the study period, 25,659 patients with acute poisoning were admitted, of which, 1567 (6.1% of the total poisoning) with pesticide poisoning were included. The mean ± SD age of the patients was 31.34 ± 13.7 years and 55.3% were men (male/female ratio = 1.23). In approximately 75% of the patients, poisoning occurred by suicidal attempts, while in 14.3% (n = 224), it was accidental. Insecticides caused about 51.30% of the poisonings. However, rodenticides were most commonly used in completed suicide attempts (79.9%). The frequency of previously attempted suicide, and self-harming was different among the patients with respect to the type of pesticide poisoning (p < 0.05). Previous suicidal attempts (35.3%) and self-harming (17.3%) were reported more in patients poisoned with the combination of pesticides. Half of the patients were employed. Nausea and vomiting (56.7%, n = 889) were the most common clinical manifestations; 8.3% (n = 130) of the patients died, 64 of whom had rodenticide poisoning.

Conclusion

The prevalence of pesticide poisoning was relatively low; most were insecticide poisoning. Poisoning occurred most through attempted suicide. Rodenticides and herbicides had higher mortality rates than other pesticides. Patients with previously attempted suicide and self-harming behavior may use a combination of pesticides.

Pesticide poisoning risk attributable to ambient temperature: a time series analysis in Qingdao China during 2007-2018

Pesticide poisoning prevention has become a public health issue of great concern. We estimated the association between temperature and attributable risk of pesticide poisoning using 3,545 pesticide poisoning cases in Qingdao China from June 2007 to July 2018. A distributed lag non-linear model was applied to estimate the temperature-pesticide poisoning associated with the assessment of attributable number and fraction. The hot temperature is responsible for the pesticide poisoning incidence, with backward and forward attributable fractions, respectively, 7.79% and 7.61%. Most of the pesticide poisoning burden (backward attributable fraction 5.30% and forward attributable fraction 5.06%) was caused by mild hot (22°C-26°C), whereas the burden due to extreme hot (27°C-31°C) was small (backward attributable fraction 2.94% and forward attributable fraction 2.69%).

Application of three prediction models in pesticide poisoning

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.

The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review

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.

Self-poisoning with pesticides in Jiangsu Province, China: a cross-sectional study on 24,602 subjects

BACKGROUND

With an estimated > 800,000 suicide-related deaths and potentially several attempts for each death in the world. The purpose of this study was to determine the epidemiological characteristics of self-poisoning with pesticides within the Jiangsu province in China.

METHODS

Suicide rate was calculated the Routine Surveillance System by Jiangsu Provincial Center for Disease Control and Prevention, stratified by gender, age and region, combined with socioeconomic and agriculture-related factors to investigate trends in suicide over the study period. A logistic regression model was used to investigate the associations between pesticide types and pesticide-related deaths.

RESULTS

In recent years, Jiangsu Province has witnessed a decrease in pesticide self-poisoning cases and consequent deaths. Among all suicides by deliberate ingestion of pesticides, the proportion of cases were mainly in the age 40, accounting for 3.43% of all cases with pesticide suicide. The proportion of suicide due to pesticide poisoning in females was markedly higher than that in males (p < 0.001). Suicide using organophosphate and carbamate insecticides was most common, with 10,303 reported cases accounting for 42.02% of all suicides.

CONCLUSIONS

For national responses to be effective, the characteristics of pesticide suicides should be comprehensively investigated for the formulation of corresponding prevention strategies. At present, more pesticide suicide prevention policies for the elderly people and women should be implemented, and stronger pesticide management policies should be implemented for rural areas.

A 9-year retrospective study of poisoning-related deaths in Southwest China (Sichuan)

Poisoning is an increasing and significant burden that causes morbidity and mortality worldwide. In this retrospective study, poisoning-related cases that occurred in 19 cities and prefectures in Sichuan, Southwest China, between 2010 and 2018 were collected from the West China Forensic Medical Center of Sichuan and Public Security Bureaus. A total of 782 poisoning-related deaths were recorded, and their demographic characteristics, season of death, type of poison, and manner and cause of death were analysed. Of these cases, the victims were predominantly male (65.3%), and the 21∼50-year-old age group included the most victims (63.2%). The rural incidence was 71%. The most common poisoning agent was pesticide (40%), followed by toxic gases (32%), and there were cases of poisoning by poisonous animals and plants that are not common in other regions of China. The predominant manner of poisoning death was accident (50%), followed by suicide (38.3%) and homicide (5.0%). In this study, relevant information on poisoning-related cases was collected and compared with the poisoning data from other areas of China and foreign countries to provide guidance for the formulation of public health policies in Sichuan, Southwest China.

Ambient temperature and pesticide poisoning: a time-series analysis

Limited studies have explored the association between ambient temperature and the disease burden of pesticide poisoning. Our study aims to estimate associations between daily mean temperature and pesticide poisoning incidence with lag effect. A distributed lag nonlinear model with Poisson distribution was used to examine the nonlinear lagged effects of ambient temperature on pesticide poisoning incidence. Overall, the estimated effects of temperature on pesticide poisoning incidence were non-linear, with higher relative risks (RRs) at hotter temperatures. It was found that the high temperature had acute and short-term effects and then declined rapidly along the lag days with the maximum risk occurring 0 day of exposure. Considering the 5-day cumulative RR for daily mean temperature, the temperature generally showed a positive association with the pesticide poisoning incidence, achieving the maximum risk at 31°C. In general, pesticide poisoning incidence increased with higher temperatures, with the strongest effects occurring shortly.

Types of Exposure Pesticide Poisoning in Jiangsu Province, China; The Epidemiologic Trend between 2006 and 2018

BACKGROUND

Pesticide poisoning is an important issue in rural China, and is also a major public health problem that affects the health of farmers. The purpose of this paper is to explore the epidemiology of pesticide poisoning in Jiangsu Province, and to put forward the relevant suggestions on the logical and discerning utilization of the pesticides.

METHODS

According to the data of the pesticide poisoning report card established by the health hazard detection information system, the cases of pesticide poisoning in Jiangsu Province from 2006 to 2018 were exported to Excel, and the database of pesticide poisoning was established. Furthermore, the imported data was screened and collected. A descriptive statistical analysis had been employed on this data utilizing SPSS 20.0.

RESULTS

Between the years 2006 and 2018, 38,513 pesticide poisoning cases were registered in Jiangsu Province, with a downward trend. Meanwhile, 77.83% of poisoning cases involved insecticide poisoning, followed by herbicide and rodenticide. The greater part of the diverse sorts of studied insecticide poisoning cases involved people aged between 30 and 59 years (57.51%). Poisoning cases caused by rodenticide accounted for a large proportion of people aged between 0 and 14 years (23.72%) in non-occupational pesticide poisoning. Regarding seasons, it was distinguished that more insecticide cases were reported in autumn (46.95% of the total number of cases). Pesticide poisoning was reported in 13 cities of Jiangsu Province, and among these, insecticide poisoning was reported mainly from the northern Jiangsu area, which was the same as rodenticide and herbicide.

CONCLUSIONS

Although there is a decreased risk for pesticide poisoning among farmworkers in Jiangsu Province, the number of farmworkers with pesticide poisoning is still high. Further management of the pesticide utilization is necessary, especially insecticide. More attention ought to be paid to the protection of vulnerable groups, including children and the elderly.

Epidemiological characteristics of pesticide poisoning in Jiangsu Province, China, from 2007 to 2016

To investigate the characteristics of pesticide poisoning in Jiangsu province and provide a scientific basis for measures for the prevention of pesticide poisoning. Information from pesticide poisoning report cards from 2007 to 2016 was derived from the Occupational Disease and Occupational Health Information Monitoring System, and the characteristics of pesticide poisoning patients were assessed via descriptive analysis. A total of 30,789 pesticide poisoning cases were reported in Jiangsu Province. Of these cases, 23,557 were non-occupational poisonings, accounting for 76.5% of the reported cases. There were 1705 deaths from pesticide poisoning, and the fatality rate was 5.5%. Numerous cases occurred in northeast Jiangsu. Pesticide poisoning cases were primarily concentrated in individuals 36-60 years of age. Pesticide poisoning primarily occurred in the summer. The top types of pesticides causing poisoning were organophosphates. The fatality rate of intentional pesticide poisoning was the lowest among the age group of 0 to 14 years, while the highest was noted among people over 61 years. Therefore, pesticide poisoning is a major problem in Jiangsu Province. We need to strengthen the management of highly toxic pesticides and implement effective health education on the use of pesticides.

Changing of suicide rates in China, 2002-2015

BACKGROUND

The overall suicide rate in China has dropped substantially since the 1990s, with patterns changing significantly. This study aims to further explore the latest changes in suicide rates in China.

METHODS

Data on gender-age-specific suicide rates for rural and urban residents aged 15 years and above were retrieved from official records. Joinpoint regression analyses were applied to analyze time trends of suicide rates.

RESULTS

Overall, suicide rates in China dropped significantly from 2002 to 2015. However, the national suicide rates have decreased at a slower pace since 2006. Joinpoints on time trends of suicide rates were also observed among rural males, rural females and urban males in 2005, 2006 and 2008, respectively. Declines in suicide rates of a majority of groups aged 25-54 slowed around 2007, and even reversed among males aged 25-34 in both areas and rural males aged 45-54. Male suicide rates were increasingly higher than females' after 2006. Rural suicide rates were about twice those of urban groups in recent years.

LIMITATIONS

Data on suicide is based on a large-sampled surveillance system, which may suffer from some quality flaws. Improvements in the quality of suicide rate data may lead to bias. Information on other potential differences in suicide rates over time is not available.

CONCLUSIONS

Although the suicide rate in China dropped significantly from 2002-2015, a slowdown in the decrease and even a reversing trend was observed in some certain groups, which highlights the urgent need for targeted suicide prevention programs.

Features for medically serious suicide attempters who do not have a strong intent to die: a cross-sectional study in rural China

OBJECTIVE

Previous studies have implied that there were many Chinese suicide attempters who did not want to die by suicide. In the current study, we explored the factors which were associated with low levels of suicide intent. We also examined features for medically serious suicide attempters who do not have a strong intent to die in rural china.

DESIGN

Cross-sectional study.

SETTING

The interviews occurred between May 2012 and July 2013 in 13 rural counties in Shandong and Hunan provinces, China.

PARTICIPANTS

Subjects were 791 medically serious suicide attempters whose injury and wounds were so serious they required hospitalisation or immediate medical care.

RESULTS

The results supported that less years of education (β=-0.11, p=0.037), religious beliefs (β=1.20, p=0.005), living alone (β=1.92, p=0.017), negative life events (β=0.29, p=0.003), low levels of impulsivity (β=-0.10, p=0.013) and mental disorders (β=2.82, p<0.001) were associated with higher levels of suicide intent.

CONCLUSION

Results imply that there are some medically serious suicide attempters with a higher education and/or exhibit impulsivity who do not want to die by suicide. These findings can inform practice to prevent suicide in rural China.

Acute poisoning in Shenyang, China: a retrospective and descriptive study from 2012 to 2016

OBJECTIVES

Up-to-date information on the patterns of acute poisoning is crucial for the proper management of poisoning events. The objectives of this study were to analyse the characteristics of patients suffering from acute poisoning admitted to the emergency department (ED) in a tertiary medical centre in Northeast China and to compare these characteristics with those of a previous comparable study.

DESIGN

Retrospective and descriptive study.

SETTING

Data were collected from the hospital information system in Shengjing Hospital, China, from January 2012 to December 2016.

PARTICIPANTS

All cases aged ≥11 years old with a diagnosis of acute poisoning.

RESULTS

In total, 5009 patients aged ≥11 years presented to the ED with acute poisoning during the study period. The average age of the patients was 36.0±15.1 years and over half (52.7%) were in the 20-39age group. The female to male ratio was 1.2:1. Patients with acute poisoning mainly lived in rural areas rather than in urban areas. The majority of patients consumed poison as suicide attempts (56.7%). Men were more commonly poisoned by drug abuse than women, but women outnumbered men in suicidal poisoning. The most common form of poison intake was ingestion (oral intake; 86.2%). The five most common toxic agent groups, in descending order, were therapeutic drugs (32.6%), pesticides (26.9%), alcohol (20.7%), fumes/gases/vapours (11.4%) and chemicals (3.6%). Sedatives/hypnotics in the therapeutic drugs group and paraquat in the pesticides group were the most common toxic agents, respectively. The mortality rate of study participants was 1.3%, with 64 deaths.

CONCLUSIONS

The results of this study indicate the need to strengthen education on the rational and safe use of drugs in Shenyang.

Pesticide poisoning in Chitwan, Nepal: a descriptive epidemiological study

Background

Globally, there is a growing concern over pesticides use, which has been linked to self-harm and suicide. However, there is paucity of research on the epidemiology of pesticides poisoning in Nepal. This study is aimed at assessing epidemiological features of pesticides poisoning among hospital-admitted cases in selected hospitals of Chitwan District of Nepal.

Methods

A hospital-based quantitative study was carried out in four major hospitals of Chitwan District. Information on all pesticides poisoning cases between April 1 and December 31, 2015, was recorded by using a Pesticides Exposure Record (PER) form.

Results

A total of 439 acute pesticides poisoning cases from 12 districts including Chitwan and adjoining districts attended the hospitals during the 9-month-long study period. A majority of the poisoned subjects deliberately used pesticides (89.5%) for attempted suicide. The total incidence rate was 62.67/100000 population per year. Higher annual incidence rates were found among young adults (111.66/100000 population), women (77.53/100000 population) and individuals from Dalit ethnic groups (98.22/100000 population). Pesticides responsible for poisoning were mostly insecticides (58.0%) and rodenticides (20.8%). The most used chemicals were organophosphates (37.3%) and pyrethroids (36.7%). Of the total cases, 98.6% were hospitalized, with intensive care required for 41.3%. The case fatality rate among admitted cases was 3.8%.

Conclusions

This study has indicated that young adults, females and socially disadvantaged ethnic groups are at a higher risk of pesticides poisoning. Pesticides are mostly misused intentionally as an easy means for committing suicide. It is recommended that the supply of pesticides be properly regulated to prevent easy accessibility and misuse. A population-based study is warranted to reveal the actual problem of pesticides exposure and intoxication in the community.

Childhood pesticide poisoning in Zhejiang, China: a retrospective analysis from 2006 to 2015

Background

Pesticide poisoning in children has been a serious public health issue around the world, especially in the developing countries where agriculture is still one of the largest economic sectors. The purpose of this study was to analyze epidemiological characteristics of acute pesticide poisoning in children from Zhejiang province, China.

Methods

The pesticide poisoning cases for children were retrieved from Occupational Disease Surveillance and Reporting System, Zhejiang Provincial Center for Disease Control and Prevention, China. The incident cases, deaths, and fatality rate of child pesticide poisoning from 2006 through 2015 were calculated.

Results

During the study period, totally 2952 children were poisoned by pesticides, with 66 deaths, resulting in a fatality rate of 2.24%. Among them, there were 1607 male cases with 28 deaths, and 1345 female cases with 38 deaths. Most of the cases occurred in preschool children (1349) and adolescent age group (1269). Organophosphate and carbamate insecticides were the cause of most poisonings (1130), leading to 34 deaths. The highest fatality rate (3.13%) was due to poisoning by herbicides and fungicides, causing 14 deaths out of 448 cases. Poisoning occurred mostly in rural areas (78%). And most pesticide poisoning occurred in the summer (896) and fall (811), while fewest poisoning cases in the winter (483) but with the highest fatality rate (3.52%).

Conclusions

This study shows that pesticide poisoning of children is a major health problem in Zhejiang, suggesting preventive strategies should be conducted to control childhood pesticide poisoning.

Suicide by pesticide poisoning remains a priority for suicide prevention in China: Analysis of national mortality trends 2006-2013

BACKGROUND

Despite recent declines, suicide remains a priority for China. Ease of availability of high-lethality suicide methods, such as pesticides and firearms, contributes to the overall incidence and is an important target for suicide prevention. This study investigates whether changes in the distribution of methods of suicide have contributed to the recent reduction in suicide in China.

METHOD

Suicide rates (2006-2013) were calculated using the Chinese Disease Surveillance Points system, stratified by gender, age group, and urban-rural residence, to investigate trends in suicide over the study period. Multilevel negative binomial regression models were used to investigate associations between socio-demographic factors and method-specific suicide.

RESULTS

The most common method of suicide in China for both males and females was pesticide poisoning, followed by hanging. All methods declined over the study period, with the exception of suicide by jumping in males. Suicide rates for pesticide poisoning and for hanging increased exponentially with age in those aged over ≥45 years in both sexes. Pesticide poisoning declined from 55% to 49% of all suicides, while hanging increased from 27% to 31%.

LIMITATIONS

This was an ecological study of a time series of suicide rates, with risk factor adjustment being limited to population-level point estimates derived from a single census.

CONCLUSIONS

Suicide by pesticide poisoning and hanging remain the leading methods of suicide in China. Changes to the safe use of pesticides and targeted prevention initiatives to restrict access, along with socio-economic development and urbanisation, are likely contributors to declines in suicide by pesticide poisoning.

Rates and characteristics of elderly suicide in China, 2013-14

BACKGROUND

The number of older adults (OAs) is growing rapidly and the elderly suicide rate (ESR) is highest among all age-groups in China. Examining the epidemiology of elderly suicide (ES) may facilitate population-specific suicide prevention efforts, however, little is known about the patterns of ES in China.

OBJECTIVE

To describe the rates and characteristics of ES in China during 2013-14.

METHODS

Suicide mortality data by gender, quinquennial age-group, residence (urban/rural) and geographic location (east/central/west) were obtained from China's Integrated National Mortality Surveillance System for 2013-14. Crude ESRs of OAs aged 65 years or above were standardized to the 2010 China's Census population and adjusted for under-reporting.

RESULTS

While OAs comprised 8.9% of the Chinese population, they represented 38.2% of suicide deaths. The average annual ESR in China was 34.5 per 100000 in 2013-14. ESRs varied widely across OA subgroups, with the highest rates in central rural men (67.1) and women (53.1), and the lowest rate in eastern urban women (13.6). Male gender (incident rate ratio [IRR]=1.47), every five-year increase in age (IRR=1.33), rural residence (IRR=1.83), and geographic location of central China (IRR=1.93) were significantly associated with increased number of ESs.

LIMITATIONS

Information on means of ES are lacking in the data source.

CONCLUSIONS

ESs disproportionately account for a large portion of China's current total suicides, and ESR, particularly in central rural OAs, is very high in China. Prevention of ES should be given priority as an important public health issue in China. Central rural OAs are key target population for current ES prevention.

Distribution and Predictors of Pesticides in the Umbilical Cord Blood of Chinese Newborns

Rates of pesticide use in Chinese agriculture are five times greater than the global average, leading to high exposure via the diet. Many are neurotoxic, making prenatal pesticide exposure a concern. Previous studies of prenatal exposure in China focused almost entirely on organochlorines. Here the study goals were to characterize the exposure of Chinese newborns to all classes of pesticides and identify predictors of those exposures. Eighty-four pesticides and 12 metabolites were measured in the umbilical cord plasma of 336 infants. Composite variables were created for totals detected overall and by class. Individual pesticides were analyzed as dichotomous or continuous, based on detection rates. Relationships between demographic characteristics and pesticides were evaluated using generalized linear regression. Seventy-five pesticides were detected. The mean number of detects per sample was 15.3. Increased pesticide detects were found in the cord blood of infants born in the summer (β = 2.2, p = 0.01), particularly in July (β = 4.0, p = 0.03). Similar trends were observed for individual insecticide classes. Thus, a summer birth was the strongest predictor of pesticide evidence in cord blood. Associations were more striking for overall pesticide exposure than for individual pesticides, highlighting the importance of considering exposure to mixtures of pesticides, rather than individual agents or classes.

Profile of adult acute cholinesterase inhibitors substances poisoning - a 30 years analysis

Objectives

The objective of this study was to assess the pattern and outcome of acute cholinesterase inhibitors substances (CIS) poisoning cases, in a cohort from a regional tertiary care hospital.

Methods

cases admitted in the Toxicology Clinic of “Sf. Spiridon” Emergency Clinic Hospital Iasi, Romania between 1983 and 2013 were studied.

Results

a total number of 606 patients were included. The reason for exposures was intentional in 70% of cases and the commonest route of poisoning was oral in 92.2%. The highest percent of cases was females (56.4), the age group 20–29 (25.4%) and the majority (66.7%) coming from rural areas, 28.2% being agricultural workers. 36.6% of cases were severe clinical forms. Overall mortality rates were 3.8%, more than half of the death patients (65.2%) had concomitant alcohol intake. It was a significant statistical association between decrease level of serum cholinesterase on admittance and severe forms (p 0.000) and between survival and deaths groups (p 0.000). The pattern of poisoning described by our retrospective study suggests that CIS poisoning are mainly preventable. The main effective goals for prevention are restriction in free accessibility to toxic pesticides, together with sustained efforts in education concerning the life-threatening danger of pesticide poisoning.