臺灣農藥中毒自殺之特徵：全國死因檔案與北台灣一所醫學中心之病歷研究

The characteristics of pesticide poisoning suicide in Taiwan: an investigation based on national cause-of-death data files and hospital records from a medical center in North Taiwan

田匯鋆(Hwei Yuen Chang)

指導教授 ： 張書森

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2018年)

https://doi.org/10.6342/NTU201802159

摘要

背景：
服用農藥自殺是全球主要自殺方法之一， 估計一年造成 11-17 萬人死亡， 占全球自殺死亡的 14-20%。近十五年來， 服用農藥是台灣自殺身亡者當中，第三常見的自殺方式， 一年約有 450-500 人因農藥中毒身亡，其中約 150-200 人是使用除草劑巴拉刈自殺身亡，巴拉刈為台灣導致農藥中毒身亡的主要農藥。分析農藥中毒自殺身亡或企圖者的特徵以及所使用的農藥，有助於了解農藥自殺的成因與擬定防治策略，但國內外少有相關研究。本研究目的為分析台灣全國農藥自殺身亡者，以及曾在一家醫學中心治療之農藥自殺企圖者的特徵。
方法：
本研究包含兩部分：（1） 農藥自殺身亡者研究： 資料來自 1987、 1992、 1997、2002-2012 年包含死因診斷資料之全國死亡檔，分析歷年使用農藥種類的變化，以及農藥自殺與非農藥自殺者、使用巴拉刈與非巴拉刈中毒身亡者的特徵差異；（2） 農藥自殺企圖者病歷回溯研究：收集與分析於 2016 年因使用農藥意圖自殺而到北部一家醫學中心接受治療者使用農藥的種類、 特徵、以及使用巴拉刈與非巴拉刈企圖自殺兩者之差異。 統計分析使用描述性統計以及邏吉斯迴歸分析。
結果：
台灣歷年來自殺身亡者（ n=56361），農藥自殺占 15.5%（ n=8713）。與非農藥自殺者相較下，農藥自殺者較可能為男性（校正後勝算比=1.22， 95% 信賴區間1.16-1.29）、較年長(校正後 24-44 歲勝算比=0.64， 95% 信賴區間 0.59-0.69; 45-64 歲勝算比 0.84， 95%信賴區間 0.81-0.92)。 在農藥自殺者當中，使用農藥以不明種類為最多（死因診斷僅寫農藥自殺而未註明使用農藥種類），但比例從69.7%（ 1987）減少到 44.7%（ 2012）；其次為巴拉刈，在所有農藥種類資料之自殺者中占 17.8-38.0%。與非巴拉刈自殺者（ n=1512）相較下，巴拉刈自殺者（ n=2269）較年輕(年齡層以 65 歲以上位對照組， 15-24 歲校正後勝算比=2.36，95% 信賴區間 1.60-3.48； 25-44 歲校正後勝算比=1.99， 95% 信賴區間 1.62-1.33）、較常見台灣北部與東部 (地區分佈以南部為對照組， 北部校正後勝算比=1.41， 95% 信賴區間 1.18-1.68; 東部校正後勝算比=2.82， 95% 信賴區間 2.05-3.88)。因服用農藥企圖自殺而就醫之 53 位病患中，共 10 人死亡（ 18.9%）。使用之農藥包括除草劑（ n=27， 50.9%）、殺蟲劑（ n=20， 37.7%），與其它農藥（ n=6， 11.3%）。除草劑中以巴拉刈為最多（ n=20），其次為醯胺系的除草劑（ n=6）；殺蟲劑中以有機磷最多（ n=5）。與非巴拉刈自殺企圖者（ n=32，60.4%）相較下，巴拉刈自殺企圖者（ n=21， 39.6%）傾向較年輕 (年齡以 45 歲以上為對照組，校正前 15-44 歲勝算比=5.8， 95%信賴區間 1.72-19.57， p=0.05;校正性別後， 15-44 歲勝算比=4.79， 95%信賴區間 0.68-33.72， p=0.12)。
結論：
臺灣農藥自殺身亡者當中，巴拉刈為主要致死農藥。與非巴拉刈自殺身亡或企圖者相較下，使用巴拉刈者較常是男性與較年輕。台灣於 2019 年全面禁用巴拉刈後，使用農藥自殺身亡者預期將大幅減少，但人口學特性可能會有所改變。將來應繼續監測使用農藥自殺者之特徵、使用農藥，與預後，並考慮進一步禁用其它經常使用於自殺之高致死性農藥

關鍵字

農藥中毒 ； 農藥自殺 ； 自殺防治

並列摘要

Introduction:
Suicide by pesticide ingestion is one of the main methods of suicide globally. It is estimated that it causes 110,000-170,000 deaths annually, which accounts for 14%-20% of global suicide. In the past 15 years, pesticide ingestion is the third most common method of suicide in Taiwan, taking 450-500 lives per year. Paraquat is the pesticide that causes most deaths (around 150-200 deaths per year). Analyses of the characteristics of completed and attempted suicides by pesticide poisoning and the type of pesticides used will help with a better understanding of the causes of pesticide suicides and inform prevention strategies. However, such analyses are limited in the local and international literature. This study was aimed to analyze the characteristics of suicides by pesticide ingestion in Taiwan and of those who attempted suicide by pesticide ingestion and were treated at a medical center in northern Taiwan.

Methods:
This study included two parts:
1. The study of people who died by pesticide ingestion: Data were from the Taiwan national cause-of-death data files with text information about causes of death for years 1987, 1992, 1997, and 2002-2012. We analyzed trends in the types of pesticides ingested and the differences in characteristics between pesticide and non-pesticide suicides and between paraquat and non-paraquat pesticide suicides.
2. The retrospective study of suicide attempters who ingested pesticides based on hospital records: We collected and analyzed data of suicide attempters who ingested pesticides and were treated at a medical center in northern Taiwan in 2016. We investigated patient characteristics, types of pesticides ingested, and the differences between attempters who ingested paraquat and non-paraquat pesticides. Descriptive statistics and logistic regression analyses were used.

Results:
Suicides by pesticide ingestion accounted for 15.5% (n=8713) of suicide deaths by all methods in Taiwan (n=56361) during the study period. Compared to non-pesticide suicides, pesticide suicides were more likely to be male (adjusted odds ratio [aOR]=1.22, 95% confidence interval [CI] 1.16-1.29) and from the older age groups (aOR=0.64, 95% CI 0.59-0.69 for 24-44 years old; aOR=0.84，95% CI 0.81-0.92 for 45-64 years old; reference group = 65+ years old). Among pesticide suicides, the type of pesticide used was predominantly recorded as unknown; however, the proportion of suicides ingesting pesticides recorded as unknown decreased from 69.7% (1987) to 44.7% (2012). Among pesticide suicides with a known pesticide agent, paraquat was the most commonly used pesticide, accounting for 17.8-38.0% of these cases across years. Compared to suicides by ingesting non-paraquat pesticides (n=1512), suicides by paraquat ingestion (n=2269) tend to be younger (65 years old and above as the reference group; aOR for 15-24 years old=2.36, 95% CI 1.60-3.48; aOR for 25-44 years old =1.99, 95% CI 1.62-1.33), more likely to occur in northern and eastern Taiwan (southern Taiwan as reference group; aOR for northern Taiwan =1.41, 95% CI 1.18-1.68; aOR for eastern Taiwan =2.82, 95% CI 2.05-3.88). Among the 53 patients who attempted suicide by pesticide ingestion, 10 patients died (18.9%). The types of pesticides ingested included herbicides (n=27, 50.9%), insecticides (n=20, 37.7%) and others (n=6, 11.3%). Paraquat was the most common herbicide ingested (n=20), followed by carbamate herbicides (n=6). Organophosphates were the most common type of insecticide ingested (n=5). Compared to patients who attempted suicide by ingesting non-paraquat pesticides (n=32, 60.4%), patients who
ingested paraquat (n=21, 39.6%) tended to be younger (45 years old and above as the reference group; unadjusted OR=5.8, 95% CI 1.72-19.57, p=0.05; sex-adjusted OR = 4.79, 95% CI 0.68-33.72, p=0.12).

Conclusions:
Paraquat was the leading pesticide ingested among pesticide suicides in Taiwan. Compared to completed or attempted suicides by ingesting non-paraquat pesticides, those who ingested paraquat were more likely to be male and younger. After the ban on the sale and use of paraquat in 2019, the number of deaths caused by pesticide ingestion is expected to fall substantially, and the demographic characteristics of suicide completers and attempters might change accordingly. It is important to monitor the characteristics of people who attempted suicide by pesticide poisoning and the type of pesticides ingested. Future suicide prevention strategies should consider banning other high-lethality pesticides commonly used in self-poisoning.

並列關鍵字

pesticide suicide ； pesticide intoxication ； suicide prevention

參考文獻

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