Air Pollution and Suicide in 10 Cities in Northeast Asia: A Time-Stratified Case-Crossover Analysis

Research output: Contribution to journalJournal articleResearchpeer-review


  • Yoonhee Kim
  • Chris Fook Sheng Ng
  • Yeonseung Chung
  • Ho Kim
  • Yasushi Honda
  • Yue Leon Guo
  • Lim, Youn-Hee
  • Bing-Yu Chen
  • Lisa A Page
  • Masahiro Hashizume

BACKGROUND: There is growing evidence suggesting an association between air pollution and suicide. However, previous findings varied depending on the type of air pollutant and study location.

OBJECTIVES: We examined the association between air pollutants and suicide in 10 large cities in South Korea, Japan, and Taiwan.

METHODS: We used a two-stage meta-analysis. First, we conducted a time-stratified case-crossover analysis to estimate the short-term association between nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter [aerodynamic diameter ≤10μm (PM10), aerodynamic diameter ≤2.5μm (PM2.5), and PM10–2.5] and suicide, adjusted for weather factors, day-of-week, long-term time trends, and season. Then, we conducted a meta-analysis to combine the city-specific effect estimates for NO2, SO2, and PM10 across 10 cities and for PM2.5 and PM10–2.5 across 3 cities. We first fitted single-pollutant models, followed by two-pollutant models to examine the robustness of the associations.

RESULTS: Higher risk of suicide was associated with higher levels of NO2, SO2, PM10, and PM10–2.5 over multiple days. The combined relative risks (RRs) were 1.019 for NO2 (95% confidence interval [CI]: 0.999, 1.039), 1.020 for SO2 (95% CI: 1.005, 1.036), 1.016 for PM10 (95% CI: 1.004, 1.029), and 1.019 for PM10–2.5 (95% CI: 1.005, 1.033) per interquartile range (IQR) increase in the 0-1 d average level of each pollutant. We found no evidence of an association for PM2.5. Some of the associations, particularly for SO2 and NO2, were attenuated after adjusting for a second pollutant.

CONCLUSIONS: Our findings suggest that higher levels of air pollution may be associated with suicide, and further research is merited to understand the underlying mechanisms.

Original languageEnglish
Article number037002
JournalEnvironmental Health Perspectives
Issue number3
Number of pages9
Publication statusPublished - 2018
Externally publishedYes

    Research areas

  • Air Pollutants/toxicity, Air Pollution/adverse effects, Environmental Exposure, Humans, Nitrogen Dioxide/toxicity, Particulate Matter/toxicity, Republic of Korea, Suicide/statistics & numerical data, Sulfur Dioxide/toxicity

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