Lee Hwa-Young, Shin Dong Wook, Han Kyung-Do, Kawachi Ichiro
Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea.
Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea.
Int J Epidemiol. 2024 Oct 13;53(6). doi: 10.1093/ije/dyae163.
The Republic of Korea has reported the highest suicide rate globally since 2018. Previous studies have highlighted disability as a significant risk factor for suicide. However, comprehensive examination on the association between suicide mortality and severities and types of disabilities, and on how these associations vary according to sociodemographic characteristics, health behaviours and comorbidity profiles has never been performed.
We performed a retrospective cohort study of a nationally representative sample of 3 591 398 individuals subject to the health check-up provided by the Korean National Health Insurance in 2009, including individuals with (n = 126 508) and without (n = 3 734 890) disabilities, and followed-up until December 2021.
Overall, the presence of disability was associated with an increased risk of suicide mortality [hazard ratio (HR), 1.38; 95% confidence interval (CI), 1.30-1.47] compared to the absence of disability. This risk was more pronounced in individuals with Grade 1-3 disabilities (HR, 1.68; 95% CI, 1.52-1.85) than those with Grade 4-6 disabilities (HR, 1.28; 95% CI, 1.20-1.47). Among various types of disabilities, individuals with a disability associated with a mental disorder had the highest HR (HR, 4.49; 95% CI, 3.38-5.97), followed by those with visual impairment (HR, 1.47; 95% CI, 1.26-1.73), brain damage (HR, 1.45; 95% CI, 1.18-1.79), hearing impairment (HR, 1.35; 95% CI, 1.15-1.58) and extremity disability (HR, 1.30; 95% CI, 1.21-1.40). Stratified analyses revealed that the suicide risk associated with disabilities was more pronounced in individuals with specific sociodemographic characteristics and health behaviours.
Our findings highlight the need to prioritize policy efforts to address suicide mortality among people with disabilities, considering the distinct risks associated with disability types and severity.
自2018年以来，大韩民国报告的自杀率在全球最高。以往研究强调残疾是自杀的一个重要风险因素。然而，从未对自杀死亡率与残疾严重程度和类型之间的关联，以及这些关联如何根据社会人口学特征、健康行为和合并症情况而有所不同进行过全面研究。
我们对2009年韩国国民健康保险提供的全国代表性样本3591398人进行了一项回顾性队列研究，其中包括有残疾（n = 126508）和无残疾（n = 3734890）的个体，并随访至2021年12月。
总体而言，与无残疾相比，残疾的存在与自杀死亡率风险增加相关[风险比（HR），1.38；95%置信区间（CI），1.30 - 1.47]。这种风险在1 - 3级残疾个体中（HR，1.68；95% CI，1.52 - 1.85）比4 - 6级残疾个体中（HR，1.28；95% CI，1.20 - 1.47）更为明显。在各种残疾类型中，与精神障碍相关的残疾个体的HR最高（HR，4.49；95% CI，3.38 - 5.97），其次是视力障碍个体（HR，1.47；95% CI，1.26 - 1.73）、脑损伤个体（HR，1.45；95% CI，1.18 - 1.79）、听力障碍个体（HR，1.35；95% CI，1.15 - 1.58）和肢体残疾个体（HR，1.30；95% CI，1.21 - 1.40）。分层分析显示，与残疾相关的自杀风险在具有特定社会人口学特征和健康行为的个体中更为明显。
我们的研究结果强调，考虑到与残疾类型和严重程度相关的不同风险，需要优先采取政策措施来解决残疾人群体中的自杀死亡率问题。
