Gunnell David, Eddleston Michael, Phillips Michael R, Konradsen Flemming
Department of Social Medicine, University of Bristol, Bristol, UK.
BMC Public Health. 2007 Dec 21;7:357. doi: 10.1186/1471-2458-7-357.
Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown.
We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990-2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.
We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.
Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.
越来越多的证据表明，农药自杀是全球最常用的自杀方式之一，但该问题的严重程度以及这些死亡的全球分布情况尚不清楚。
我们系统地回顾了全球文献，以估计世界卫生组织六个区域中每个区域的农药自杀人数以及农药致死性自我中毒的全球负担。我们使用了以下数据来源：Medline、EMBASE和psycINFO（1990 - 2007年）、检索到的出版物中引用的论文、万维网（使用谷歌）以及我们个人收集的论文和书籍。我们的目的是确定能够使我们估计一个国家因农药自我中毒导致的自杀比例的论文。
我们保守估计，全球每年有258,234例（合理范围为233,997至325,907例）农药自我中毒死亡，占全球自杀人数的30%（范围为27%至37%）。印度的官方数据可能低估了自杀发生率；对印度官方数据应用基于证据的校正后，我们对全球农药自杀人数的估计增加到371,594例（范围为347,357至439,267例）。使用农药自杀的人数在所有自杀人数中所占比例从欧洲区域的4%到西太平洋区域的超过50%不等，但这一比例与每个区域销售的农药数量并不一致；影响它们被用于致命性自我伤害行为可能性的是农药使用模式和产品毒性，而非使用量。
农药自我中毒约占全球自杀人数的三分之一。流行病学和毒理学数据表明，如果（a）限制对人类毒性最大的农药的使用，（b）农药能够在农村社区安全储存，以及（c）改善中毒护理的可及性和质量，许多此类死亡可能会得到预防。
