Impact of pesticide regulations on mortality from suicide by pesticide in China: an interrupted time series analysis

Yongfu Yan; Yingying Jiang; Rong Liu; Michael Eddleston; Chuanjiang Tao; Andrew Page; Lijun Wang; Guoshuang Feng; Shiwei Liu

doi:10.3389/fpsyt.2023.1189923

Impact of pesticide regulations on mortality from suicide by pesticide in China: an interrupted time series analysis

Front Psychiatry. 2023 Sep 4:14:1189923. doi: 10.3389/fpsyt.2023.1189923. eCollection 2023.

Authors

Yongfu Yan^#¹, Yingying Jiang^#², Rong Liu³, Michael Eddleston⁴, Chuanjiang Tao⁵, Andrew Page⁶, Lijun Wang², Guoshuang Feng⁷, Shiwei Liu¹

Affiliations

¹ Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China.
² National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
³ The George Institute for Global Health, Faculty of Medicine, The University of New South Wales (UNSW), Sydney, NSW, Australia.
⁴ Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, United Kingdom.
⁵ Institute for the Control of Agrochemicals, Ministry of Agriculture and Rural Affairs, Beijing, China.
⁶ Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
⁷ Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.

^# Contributed equally.

Abstract

Background: Pesticide bans and regulatory restrictions have been shown to be effective strategies for preventing suicide in several countries. Suicide and suicide by pesticides have decreased significantly in China over the past two decades. However, whether the reduction was associated with pesticide regulation is unknown.

Methods: The monthly data on suicide and suicide by pesticide from 2006 to 2018 were obtained from China's Disease Surveillance Point (DSP) system. Information on China's pesticide regulations since 1970 was obtained from Pesticide Action Network International (PAN International), Joint Meeting on Pesticide Management Highly Hazardous Pesticides (JMPM HHP) lists, the website of the Ministry of Agriculture of China, Pesticide Information Network of China, and the Wan Fang database. Change point detection and policy analysis were combined to identify the time of any trend change breakpoint of suicide and suicide by pesticide. Interrupted time series analysis was used to investigate the pre- and post-breakpoint trends of monthly standardized rates in suicide and suicide by pesticide.

Results: The standardized pesticide suicide rate decreased by 60.5% from 6.50 in 2006 to 2.56 per 100,000 in 2018. Larger declines were evident among people in urban areas (67.3%), female individuals (63.5%), and people aged 15-44 years (68.1%). The effect of policies banning highly hazardous organophosphorus pesticides (HHOP) [rate ratio (RR) = 0.993, 95% CIs (0.991-0.994)] in December 2008 and stopping domestic sales and use of paraquat aqueous solution (RR = 0.992, 95% CIs: 0.990-0.994) in July 2016 were more pronounced than regulating the paraquat-related products (RR = 1.003, 95% CIs: 1.002-1.004) in April 2012.

Conclusion: Declines in suicide by pesticide in China occurred contemporaneously with regulatory bans and restrictions implemented on several pesticides, particularly in urban areas, among female individuals, and the relatively low age profile. These findings indicate the potential influence of these bans on trends of suicide by pesticides.

Keywords: epidemiology; impact evaluation; interrupted time series design; pesticide; suicide.

Grants and funding

This study was supported by Beihang University and Capital Medical University Advanced Innovation Center for Big Data-Based Precision Medicine Plan [No. BHME-201901]. The Centre for Pesticide Suicide Prevention is funded by a grant from Open Philanthropy, at the recommendation of GiveWell, USA.