Upload
ursula-lloyd
View
212
Download
0
Tags:
Embed Size (px)
Citation preview
CGHR.ORG/SUICIDETwitter: CGHR_org
SUICIDE MORTALITY IN INDIA
Vikram Patel, Chinthanie Ramasundarahettige, Lakshmi Vijayakumar, JS Thakur, Vendhan
Gajalakshmi, Gopalkrishnan Gururaj, Wilson Suraweera, and Prabhat Jha, for the Million
Death Study Collaborators, and in partnership with
Centre for Global Health Research (Toronto, Canada)
2
Key findings• About 0.2 million deaths at ages 15 years and older
in 2010 were due to suicide.• 54% of female and 40% of male suicides occurred at
ages 15-29 years.• A 15 year old south Indian male had a 3.5% risk of
dying from suicide before reaching 80 years, in the absence of the other causes.
• About half of suicide deaths were due to poisoning.• Age standardised suicide death rates at ages 15
years and older were two fold higher in rural areas than urban areas.
• Suicide death rates vary markedly between states.
CGHR.ORG/SUICIDETwitter: CGHR_org
3
What’s new about this research?
• Previous suicide estimates have used the National Crime Records Bureau numbers, which are based on police reports
• These data could under-report suicide, as attempted suicide is a crime in India
• The Million Death Study provides direct suicide estimates by age, gender, area and method of suicide from a nationally representative sample.
CGHR.ORG/SUICIDETwitter: CGHR_org
5
• Nationally representative sample (Sample Registration System)
• 6,671 of these small areas randomly chosen from all parts of India (each with about 1000 people per area)
How was the study done?
CGHR.ORG/SUICIDETwitter: CGHR_org
6
How was the study done?
800 Registrar General of India field workers interviewed 122 thousand families of people who had died in 2001-
2003
Written reports each coded independently by at least two physicians to attribute a probable cause of death (i.e.,
suicide)
CGHR.ORG/SUICIDETwitter: CGHR_org
Calculated proportion of all suicide deaths by age, gender, and area within the study
7
How was the study done?
Combined with national 2010 UN totals of deaths, and 2007-2009 state-specific SRS death rates
Produced national and state estimates of rates and number of suicide deaths for 2010
CGHR.ORG/SUICIDETwitter: CGHR_org
8
Deaths from all causes in India, 2010
Age at deathEstimated number of
deaths
Childhood/ early adulthood*(0-29 years)
Middle age(30-69 years)
Old age(70+ years)
Total 9.8 Million
* ~ 2 Million at ages 0-4
2.8 Million
4.0 Million
3.0 Million
9
Age specific suicide death rates in India and in high-income countries - Men
0
5
10
15
20
25
30
35
40
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Age(years)
Su
icid
e d
eath
rat
e p
er 1
00 0
00 p
op
ula
tio
n
Age standardised suicide death rate at ages 15 years or older (99%CI)
India 26.3 (24.5, 28.0)
High income 21.8 (21.6, 22.0)
10
Age specific suicide death rates in India and in high-income countries - Women
0
5
10
15
20
25
30
35
40
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Age(years)
Su
icid
e d
eath
rat
e p
er 1
00 0
00 p
op
ula
tio
n
Age standardised suicide death rate at ages 15 years or older (99%CI)
India 17.6 (16.1, 19.0) High income 6.8 (6.7, 6.9)
11
Risk of suicide is high among Indians
Cumulative risk of suicide (%)
Country Male Female
India (2010) 1.7 1.0
US (2004-07) 1.6 0.5
Canada (2004-07) 1.2 0.4
UK (2004-07) 0.5 0.2
CGHR.ORG/SUICIDETwitter: CGHR_org
12
Risk of suicide is higher in rural and southern India
Region
Male Female
Rural 2.05 1.08
Urban 0.81 0.60
South India 3.51 1.76
Rest of India 1.16 0.70
Total 1.69 0.96
Percentage probability of death of a 15 year old person before
reaching 80 years
14
Estimated suicide deaths by different regions
Region
Rural 95.1 (31.5) 57.8 (20.4)
Urban 19.7 (14.4) 14.3 (12.0)
South India 50.6 (52.9) 29.5 (32.2)
Rest of India 64.2 (18.7) 42.6 (13.3)
Total 114.8 (26.3) 72.1 (17.5)
Male Female
Estimated suicide deaths x1000 (age standardised suicide death rate per 100,000)
CGHR.ORG/SUICIDETwitter: CGHR_org
15
17 of 1000 men will die of suicide
10 of 1000 women will die of suicide
Risk of death from Suicide
For Indians aged 15 years, the risk of dying before age 80 in the absence of other diseases:
Source: Dikshit et al, Lancet 2012CGHR.ORG/SUICIDETwitter: CGHR_org
16
Suicide death rates for selected states- aged 15 years or older
CGHR.ORG/SUICIDETwitter: CGHR_org
0
10
20
30
40
50
60
70
Kerala AndhraPradesh
Delhi Bihar &Jharkhand
India
Ag
e st
and
ard
ised
su
icid
e d
eath
rat
e p
er 1
00,0
00
Men Women
17
Method of suicide among Indian men – aged 15 years or older
CGHR.ORG/SUICIDETwitter: CGHR_org
Poisoning (T=60.2, ASR=13.8)
Other (T=8.8, ASR=2.0)
Drowning (T=4, ASR=0.8)
Burns (T=5, ASR=1.1)
Hanging (T=37, ASR=8.3)
49%
8%4%
4%
35%
T = estimated suicide deaths in 1000,
ASR = age standardised suicide death rate per 100,000
18
Method of suicide among Indian women – aged 15 years or older
CGHR.ORG/SUICIDETwitter: CGHR_org
Poisoning (T=31.5, ASR=7.9)
Other (T=5, ASR=1.2)
Drowning (T=5.4, ASR=1.3)
Burns (T=13.4, ASR=3.3)
Hanging (T=17,ASR=4.2)
44%
7%8%
15%
26%
T = estimated suicide deaths in 1000,ASR = age standardised suicide death rate per 100,000
19
Significant risk factors for suicide -Men aged 15 to 69 years
Education
Secondary or higher 1•43 (1•1 - 1•8)
Primary or middle 1•60 (1•4 - 1•9)
Below primary 1•00 --
Region
Southern 2•68 (2•3 - 3•1)
Rest of India 1•00 --
Alcohol use
Yes 1•84 (1•6 - 2•2)
No 1•00 --
Residence
Rural 1•45 (1•1 - 1•9)
Urban 1•00 --
Odds ratio (suicide vs.
other deaths) (99% CI)
CGHR.ORG/SUICIDETwitter: CGHR_org
20
Significant risk factors for suicide - Women aged 15 to 69 years
Education
Secondary or higher 1•90 (1•4 - 2•6)
Primary or middle 1•43 (1•1 - 1•8)
Below primary 1•00 --
Region
Southern 2•96 (2•4 - 3•6)
Rest of India 1•00 --
Marital Status
Widower/divorced/separated 0•64 (0•4 - 0•9)
Never married 0•92 (0•7 - 1•2)
Married/ remarried 1•00 --
Odds ratio (suicide vs.
other deaths) (99% CI)
CGHR.ORG/SUICIDETwitter: CGHR_org
21
CONCLUSIONS
• Large proportion of suicide deaths occur between the ages of15 to 29 years.
• Many suicide death might be prevented by: - restricting access to pesticides - providing community or support services - providing easy access to services for
mental illness associated with suicide - reducing binge alcohol drinking through higher taxation on alcohol
CGHR.ORG/SUICIDETwitter: CGHR_org
22
Million Death Study CollaboratorsIndian Academic Partners (in alphabetical order): 1. Department of Community Medicine Gujarat Medical College, Ahmedabad: DV Bala, P Seth, KN Trivedi 2. Department of Community Medicine Kolkatta Medical College, Kolkatta: SK Roy 3. Department of Community Medicine Regional Institute of Medical Sciences, Imphal: L Usharani 4. Department of Community Medicine S.C.B. Medical College Cuttack, Orissa: B Mohapatra 5. Department of Community Medicine SMS Medical College Jaipur: AK Bharadwaj, R Gupta 6. Epidemiological Research Center, Chennai: V Gajalakshmi, CV Kanimozhi 7. Gandhi Medical College, Bhopal: RP Dikshit, S Sorangi 8. Healis-Seskarhia Institute of Public Health, Navi Mumbai: PC Gupta, MS Pednekar, S Sreevidya 9. Apollo Institute of Medical Sciences & Research, Hyderabad: P Bhatia 10. St. John’s Academy of Health Sciences, Bangalore: A Kurpad, P Mony, M Vaz, S Srinivasan, A Shet, AS Shet, D
Xavier, S Rathi 11. King George Medical College, Lucknow: S Awasthi 12. Najafgarh Rural Health Training Centre Ministry of Health Government of India, New Delhi: N Dhingra, J Sudhir,
I Rawat (until 2007) 13. Regional Medical Research Center, ICMR Institute, Bhubaneshwar: AS Karketta, SK Dar 14. School of Preventative Oncology, Patna: DN Sinha 15. School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh: N Kaur, R
Kumar, JS Thakur 16. Tata Memorial Cancer Hospital, Mumbai: RA Badwe, R Dikshit, M Mallath Lead Partners: 1. Office of the Registrar-General India, RK Puram, New Delhi India: C Chandramouli (Registrar General of India [RGI]), RC Sethi, B Mishra, S Jain (until 2008), DK Dey (until 2009), AK Saxena, MS Thapa, N Kumar, JK Banthia and DK Sikri (former RGIs) 2. Million Death Study Coordinating, Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Canada: P Jha (Principal Investigator), R Jotkar, R Kamadod, S Rao-Seshadri, P Rodriguez, P Sati, J Sudhir, C Ramasundarahettige, W Suraweera Affiliated Partners: 1. Indian Council of Medical Research, New Delhi India: VM Katoch (Director General or DG from 2008), NK
Ganguly (DG to 2008), L Kant, B Bhattacharya, B Shah, DK Shukla 2. World Health Organisation, Geneva and SEARO Office, New Delhi: T Boerma, A Fric, S Habayeb (former WHO
Representative-India), S Khanum, CD Mathers, DN Sinha, N Singh, P Singh (Deputy Regional Director) 3. Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, England: N Bhala, J
Boreham, R Peto, G Whitlock