Translational Australian Clinical Toxicology, Faculty of Medicine and Health, The University of Sydney, Australia.
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.
JAMA Netw Open. 2024 Aug 1;7(8):e2426209. doi: 10.1001/jamanetworkopen.2024.26209.
Deliberate self-poisoning using pesticides as a means of suicide is an important public health problem in low- and middle-income countries. Three highly toxic pesticides-dimethoate, fenthion, and paraquat-were removed from the market in Sri Lanka between 2008 and 2011. In 2015, less toxic pesticides (chlorpyrifos, glyphosate, carbofuran, and carbaryl) were restricted. Subsequent outcomes have not been well described.
To explore the association of pesticide bans with pesticide self-poisonings and in-hospital deaths.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study with an interrupted time series design, data were prospectively collected on all patients with deliberate self-poisonings presenting to 10 Sri Lankan hospitals between March 31, 2002, and December 31, 2019, and analyzed by aggregated types of poisoning. The correlates of pesticide bans were estimated within the pesticide group and on self-poisonings within other substance groups. The data analysis was performed between April 1, 2002, and December 31, 2019.
Implementation of 2 sets of pesticide bans.
The main outcomes were changes in hospital presentations and in-hospital deaths related to pesticide self-poisoning as measured using segmented Poisson regression.
A total of 79 780 patients (median [IQR] age, 24 [18-34] years; 50.1% male) with self-poisoning from all causes were admitted to the study hospitals, with 29 389 poisonings (36.8%) due to pesticides. A total of 2859 patients died, 2084 (72.9%) of whom had ingested a pesticide. The first restrictions that targeted acutely toxic, highly hazardous pesticides were associated with an abrupt and sustained decline of the proportion of poisonings with pesticides (rate ratio [RR], 0.85; 95% CI, 0.78-0.92) over the study period and increases in poisonings with medications (RR, 1.11; 95% CI, 1.02-1.21) and household and industrial chemicals (RR, 1.20; 95% CI, 1.05-1.36). The overall case fatality of pesticides significantly decreased (RR, 0.33; 95% CI, 0.26-0.42) following the implementation of the 2008 to 2011 restrictions of highly hazardous pesticides. Following the 2015 restrictions of low-toxicity pesticides, hospitalizations were unchanged, and the number of deaths increased (RR, 1.98; 95% CI, 1.39-2.83).
These findings support the restriction of acutely toxic pesticides in resource-poor countries to help reduce hospitalization for and deaths from deliberate self-poisonings and caution against arbitrary bans of less toxic pesticides while more toxic pesticides remain available.
蓄意使用农药自杀作为一种自杀手段，是中低收入国家的一个重要公共卫生问题。在 2008 年至 2011 年间，斯里兰卡将三种剧毒农药（乐果、倍硫磷和百草枯）从市场上撤出。2015 年，毒性较低的农药（毒死蜱、草甘膦、呋喃丹和carbaryl）受到限制。随后的结果并没有得到很好的描述。
探讨农药禁令与农药自杀和院内死亡的关系。
设计、设置和参与者：在这项具有中断时间序列设计的横断面研究中，前瞻性地收集了 2002 年 3 月 31 日至 2019 年 12 月 31 日期间在斯里兰卡的 10 家医院就诊的所有蓄意自杀患者的数据，并按中毒的聚合类型进行分析。在农药组内以及其他物质组内的自我中毒事件中，对农药禁令的相关性进行了估计。数据分析于 2002 年 4 月 1 日至 2019 年 12 月 31 日进行。
实施了两套农药禁令。
主要结果是使用分段泊松回归测量与农药自杀相关的医院就诊和院内死亡的变化。
共有 79780 名（中位数[IQR]年龄，24[18-34]岁；50.1%为男性）因各种原因入院的自我中毒患者，其中 29389 例（36.8%）因农药中毒。共有 2859 名患者死亡，其中 2084 名（72.9%）摄入了农药。首次限制急性毒性、高度危险农药的措施与研究期间农药中毒比例的急剧和持续下降（比率比[RR]，0.85；95%CI，0.78-0.92）以及药物（RR，1.11；95%CI，1.02-1.21）、家庭和工业化学品（RR，1.20；95%CI，1.05-1.36）中毒的增加有关。农药的总体病死率显著下降（RR，0.33；95%CI，0.26-0.42），紧随 2008 年至 2011 年高毒性农药限制措施的实施。2015 年低毒性农药限制措施实施后，住院人数保持不变，死亡人数增加（RR，1.98；95%CI，1.39-2.83）。
这些发现支持在资源匮乏的国家限制使用剧毒农药，以帮助减少蓄意自杀的住院和死亡，并告诫不要在更有毒的农药仍然可用的情况下任意禁止毒性较低的农药。
