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

BACKGROUND

There is growing evidence suggesting an association between air pollution and suicide. However, previous findings varied depending on the type of air pollutant and study location.

OBJECTIVES

We examined the association between air pollutants and suicide in 10 large cities in South Korea, Japan, and Taiwan.

METHODS

We used a two-stage meta-analysis. First, we conducted a time-stratified case-crossover analysis to estimate the short-term association between nitrogen dioxide (NO), sulfur dioxide (SO), and particulate matter [aerodynamic diameter ≤10μm (PM), aerodynamic diameter ≤2.5μm (PM), and PM] and suicide, adjusted for weather factors, day-of-week, long-term time trends, and season. Then, we conducted a meta-analysis to combine the city-specific effect estimates for NO, SO, and PM across 10 cities and for PM and PM across 3 cities. We first fitted single-pollutant models, followed by two-pollutant models to examine the robustness of the associations.

RESULTS

Higher risk of suicide was associated with higher levels of NO, SO, PM, and PM over multiple days. The combined relative risks (RRs) were 1.019 for NO (95% confidence interval [CI]: 0.999, 1.039), 1.020 for SO (95% CI: 1.005, 1.036), 1.016 for PM (95% CI: 1.004, 1.029), and 1.019 for PM (95% CI: 1.005, 1.033) per interquartile range (IQR) increase in the 0-1 d average level of each pollutant. We found no evidence of an association for PM. Some of the associations, particularly for SO and NO, were attenuated after adjusting for a second pollutant.

CONCLUSIONS

Our findings suggest that higher levels of air pollution may be associated with suicide, and further research is merited to understand the underlying mechanisms. https://doi.org/10.1289/EHP2223.