Table 1.
Overall suicide rates and the proportion of suicides attributable to pesticide self-poisoning across 20 countries
| Overall suicide rate in 2017 (per 100 000) | Proportion of suicides attributable to pesticide self-poisoning (uncertainty range)* | Source | |
|---|---|---|---|
| LLMICs | |||
| Bangladesh | Males: 5·88; females: 6·02 | Both: 20·9% (range 10·5–31·4) | 2014 country-specific estimate from Chowdhury et al;19 assume 50% uncertainty |
| Ethiopia | Males: 7·34; females: 2·54 | Both: 24·0% (range 12·0–36·0) | AFRO regional estimate;27† assume 50% uncertainty |
| Guatemala | Males: 9·21; females: 2·32 | Males: 16·8% (n=352); females: 27·1% (n=144) | 2015 estimate from WHO mortality database |
| India | Males: 16·97; females: 13·49 | Males: 34·0% (range 23·8–44·2); females: 29·0% (range 20·3–37·7) | Adjusted‡ country-specific estimate from Patel et al28 |
| Indonesia | Males: 4·63; females: 1·47 | Both: 11·3% (range 5·7–17·0) | SEARO regional estimate;2 assume 50% uncertainty |
| Nigeria | Males: 5·40; females: 2·53 | Both: 24·0% (range 12·0–36·0) | AFRO regional estimate;27† assume 50% uncertainty |
| Pakistan | Males: 3·97; females: 4·53 | Both: 7·1% (range 3·6–10·7) | EMRO regional estimate;2 assume 50% uncertainty |
| Philippines | Males: 8·16; females: 2·53 | Males: 3·4% (n=1411); females: 4·4% (n=409) | 2008 estimate from WHO mortality database |
| Ukraine (out of scope)§ | Males: 56·66; females: 8·38 | Both: 0·9% (range 0·5–1·4) | EURO regional estimate;2 assume 50% uncertainty |
| Vietnam | Males: 10·67; females: 4·90 | Both: 11·3% (range 5·7–17·0) | SEARO regional estimate;2 assume 50% uncertainty |
| UMHICs | |||
| China | Males: 10·67; females: 7·47 | Both: 49·0% (n=120 730) | 2013 country-specific estimate from Page et al29 |
| Germany (out of scope)§ | Males: 22·06; females: 7·49 | Males: 0·2% (n=7397); females: 0·1% (n=2681) | 2015 estimate from WHO mortality database |
| Iran | Males: 8·29; females: 3·25 | Males: 5·8%; (n=1669); females: 7·1% (n=706) | 2015 estimate from WHO mortality database |
| Japan (out of scope)§ | Males: 31·87; females: 13·50 | Males: 0·8% (n=16 202); females: 1·4% (n=6950) | 2015 estimate from WHO mortality database |
| Mexico | Males: 10·10; females: 2·13 | Males: 3·0% (n=5031); females: 7·0% (n=1251) | 2015 estimate from WHO mortality database. |
| Russia (out of scope)§ | Males: 52·88; females: 10·18 | Both: 1·7% (range 0·9–2·6) | HIC regional estimate.2 Assume 50% uncertainty |
| South Africa | Males: 18·35; females: 4·59 | Males: 2·9% (n=377); females: 6·7% (n=105) | 2015 estimate from WHO mortality database |
| Thailand | Males: 20·15; females: 5·02 | Males: 15·5% (n=3283); females: 22·4% (n=848) | 2016 estimate from WHO mortality database |
| Turkey (out of scope)§ | Males: 5·67; females: 1·43 | Males: 0·1% (n=1135); females: 0·8% (n=397) | 2015 estimate from WHO mortality database |
| USA (out of scope)§ | Males: 23·61; females: 6·70 | Males: 0·0% (n=33 959); females: 0·1% (n=10 186) | 2015 estimate from WHO mortality database |
LLMICs=low-income and lower-middle-income countries. AFRO=African region. SEARO=southeast Asian region. EMRO=eastern Mediterranean region. EURO=European region. UMHICs=upper-middle-income and high-income countries. HIC=high-income country.
In the uncertainty analysis, proportions with uncertainty ranges denoted by range were modelled using the PERT distribution, with arguments comprising the minimum, most likely, and maximum values. Conversely, proportions with uncertainty ranges denoted by N were modelled using the beta distribution (ie, the conjugate prior of the binomial distribution).
AFRO regional estimates were from the 2007 systematic review by Gunnell et al27 instead of the 2017 systematic review by Mew et al.2 The 2017 AFRO regional estimate was likely to be a significant underestimate given that data were only available for South Africa and Mauritius, which were not representative of the broader AFRO region. The previous 2007 AFRO regional estimate was estimated to be between 15% and 33%, the average of which was used for the current study.
The original study was based on data from a 2001–03 survey that estimated the proportion of suicides due to pesticides in India was 39% among males and 35% among females. These estimates were adjusted downwards based on the expert opinion of two study authors (ME and DG) to account for declining trends in the proportion of suicides due to pesticides, which have been observed in national police report data (ie, the Government of India National Crime Records Bureau).
Six out-of-scope countries were excluded from the economic evaluation because they involved a proportion of suicides due to pesticide self-poisoning that was less than 2% (ie, the threshold below which it would not be worthwhile to implement a national ban of highly hazardous pesticides).