Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Department of Internal Medicine, Nehru Hospital, Institute of Medical Education and Research, Chandigarh, India.
BMC Public Health. 2021 Jul 22;21(1):1441. doi: 10.1186/s12889-021-11156-2.
Poisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years.
We performed a systematic literature review in Medline, Embase and Google Scholar (1999-2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study.
We identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999-2003), the number of deaths declining thereafter (to n = 1714 in 2014-2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths.
Use of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter's lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions.
在印度，中毒是一个主要问题。然而，关于在过去 20 年中按地理位置和时间划分的导致大多数死亡的主要毒物，几乎没有系统的信息。我们旨在通过文献回顾来确定在过去 20 年中在印度导致死亡人数最多的毒物类别。
我们在 Medline、Embase 和 Google Scholar（1999-2018 年）以及印度在线医学期刊上进行了系统的文献综述，以查找报告印度所有形式中毒死亡的论文，最后一次搜索时间为 2020 年 4 月 20 日。我们纳入了报告 1999 年至 2018 年间死亡人数的流行病学研究、观察性研究、随机试验、干预性研究和病例系列研究，以及表明具体毒物或毒物类别的尸检研究。还包括提供特定毒物或类别的病死率的研究，这使我们能够计算死亡人数。我们排除了由于动物咬伤和蜇伤、乙醇或甲醇中毒以及气体吸入以及仅报告一例死亡的论文（单个患者的病例研究）。我们将论文分为 5 年间隔，并确定了每篇论文中最常见的两种毒物类别。我们根据致病毒物和研究地点使用描述性统计数据来总结随时间的发现。
我们确定了 186 篇报告了 1999 年至 2018 年期间 16659 例中毒死亡的论文。每 5 年间隔的出版物数量在研究期间没有明显的趋势（连续期间分别为 48、38、67 和 36）。一半的死亡（n=8338，50.0%）发生在研究的前 5 年（1999-2003 年），此后死亡人数下降（2014-2018 年降至 1714 人）。与其他毒物类别相比，农药中毒（94.5%）在整个研究期间占据主导地位[染发剂对苯二胺中毒（2.6%）、药物过量（1.4%）或植物中毒（1.0%）]。在农药中，磷化铝在最初的 10 年是最重要的致命毒物，此后其重要性显著下降；有机磷杀虫剂在整个研究期间都很重要，随着磷化铝病例的减少，在过去十年中变得占主导地位。遗憾的是，很少有论文确定了导致死亡的具体有机磷杀虫剂。
利用已发表的文献更好地了解印度致命中毒的流行病学情况存在明显的局限性，包括出版实践和对中毒的关注的时间变化。不幸的是，印度没有长期详细的、医院和社区联合研究来提供这些信息。在缺乏这些信息的情况下，我们的综述表明，农药是印度最重要的毒物，有机磷杀虫剂在 2001 年政府监管改革降低了磷化铝的致命性后取代了磷化铝，成为关键的致命毒物。植物和染发剂中毒以及药物过量导致的死亡人数很少。磷化铝中毒死亡主要发生在印度北部各州，而有机磷杀虫剂中毒死亡则发生在印度各地。百草枯中毒在过去 10 年中已成为一个临床问题。致命农药中毒仍然令人震惊地普遍存在，这强调了需要采取额外的监管干预措施来减少印度农药中毒死亡人数。关于导致致命中毒的特定农药的更详细报告将有助于指导监管决策。
