This study aimed to investigate the association between charcoal-burning suicide attempts and the risk of developing dementia. A nationwide, matched cohort, population-based study enrolled a total of 4103 patients with newly diagnosed charcoal-burning suicide attempts, between 2000 and 2010, which were selected from the National Health Insurance Research Database of Taiwan, along with 12,309 controls matched for sex and age. After adjusting for confounding factors, Fine and Gray’s competing risk analysis was used to compare the risk of developing dementia during the 10-year follow-up period. Of the enrolled patients (n=16,412), dementia developed in 303 (1.85%), including 2.56% in the study group (105 in 4103) and 1.61% (198 in 12,309) in the control group. The Fine and Gray’s survival analysis revealed that the patients with charcoal-burning suicide attempts were likely to develop dementia, with a crude HR of 5.170 (95% CI 4.022 to 6.644, p<0.001). After adjusting for age, sex, comorbidity, geographic area and urbanization level of residence, and monthly insured premium, the adjusted HR was 4.220 (95% CI 3.188 to 5.586, p<0.001). Suicide attempts were associated with an increased risk of degenerative dementia in this study. Patients with charcoal-burning suicide attempts had a fourfold risk of dementia than the control group.
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Contributors S-YC and N-ST conceived of the study, participated in its design and coordination, data interpretation, performed the statistical analysis, and drafted the manuscript. W-CC, C-HC, and H-WY participated in the design of the study and data interpretation. H-AC and Y-CK participated in the design of the study and data interpretation. C-KP, C-HS, and Y-CC participated in the statistical analysis and data interpretation. S-YC wrote the paper. All authors have read and approved the final manuscript as submitted.
Funding This work was supported by Tri-Service General Hospital Research Foundation grant numbers TSGH-C105-130, TSGH-C106-002, and TSGH-C107-004. Data for this study were based on the National Health Insurance Research Database provided by the National Health Insurance Administration of the Ministry of Health and Welfare, Taiwan, and managed by the National Health Research Institutes, Taiwan. The interpretation and conclusions contained in this article do not represent those of the National Health Insurance Administration, the Ministry of Health and Welfare, or the National Health Research Institutes.
Competing interests None declared.
Patient consent Not required.
Ethics approval This study was conducted in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). The Institutional Review Board of the Tri-Service General Hospital approved this study and waived the need for individual consents since all the identification data were encrypted in the NHIRD (IRB No 1-104-05-145).
Provenance and peer review Not commissioned; externally peer reviewed.
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