Suicide and Ambient Temperature: A Multi-Country Multi-City Study
Suicide and Ambient Temperature: A Multi-Country Multi-City Study
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DOI：
10.1289/ehp4898
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发表时间：
2019-11-01
影响因子：
10.4
通讯作者：
Hashizume, Masahiro
中科院分区：
文献类型：
--
作者：
Kim, Yoonhee;Kim, Ho;Hashizume, Masahiro
背景：先前的文献表明，较高的环境温度可能会增加自杀的风险。然而，没有一项跨国研究探索了不同地区中高温和极端高温的关联形式和作用。目的：我们利用收集自12个国家341个地点的每日时间序列数据，从4年到40年，研究了短期温度自杀的关系。首先，我们进行了特定地点的时间分层病例交叉分析，以检查每个地点的温度自杀关联。然后，我们使用多元元回归将所有地点和国家的特定地点滞后累积非线性关联结合起来。结果：本研究共纳入1320148例自杀者。一般来说，较高的环境温度与自杀风险增加有关，我们观察到27℃时的最高风险呈非线性关联（倒j形曲线）。与第一个百分位的风险相比，最高风险的相对风险（RR）为1.33 （95% CI: 1.30, 1.36）。具体国家的结果显示，非线性关联在东北亚（日本、韩国和台湾）更为明显。自杀风险最高的温度在东北亚国家的第87到88个百分位数之间，而在西方国家（加拿大、西班牙、瑞士、英国和美国）和南非，这个值是第99个百分位数，在这些国家，估计几乎是线性相关的。国家特异性rr范围从美国的1.31 （95% CI: 1.19, 1.44）到1.65 （95% CI: 1.40, 1）。讨论：我们的研究结果表明，在许多国家，自杀风险随着环境温度的升高而增加，但程度不同，不一定呈线性。这种温度自杀关联应谨慎解释，并需要进一步的关系和修正因素的证据。
BACKGROUND: Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multicountry study has explored the shape of the association and the role of moderate and extreme heat across different locations.OBJECTIVES: We examined the short-term temperature suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y.METHODS: We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country.RESULTS: A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27 degrees C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United Slates) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain.DISCUSSION: Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed.