Research Paper
Impact of disability status on suicide risks in South Korea: Analysis of National Health Insurance cohort data from 2003 to 2013

https://doi.org/10.1016/j.dhjo.2016.06.008Get rights and content

Abstract

Background

The elevated risk of suicide in people with disability has been suggested in the previous studies; however, the majority of study results have been limited to specific disability types, and there is a lack of research comparing the risk of suicide in people with disability in general.

Objectives

To examine the hazard ratio of suicide according to the presence and the types of disability and identify patterns in the results.

Methods

In this study, we used National Health Insurance Service-National Sample Cohort data on 990,598 people, and performed analysis on the cause of death from 2003 through 2013. A Cox proportional hazard model was used to estimate the hazard ratio of suicide associated with disability and its types.

Results

The hazard ratio of suicide among people with disability was 1.9-folds higher compared to people without disability. The risk of suicide among different disability types was higher in mental disorder, renal failure, brain injury and physical disability. The hazard ratio of suicide in people with disability was not varied by income. The time to death by suicide for people with disability from the onset of their disability was 39.8 months on average.

Conclusions

Our findings suggest that when the government plans suicide prevention policies, early and additional interventions specific to people with disability are needed. Disability due to mental disorder, renal failure should be given priority.

Section snippets

Ethics statement

The study was reviewed by the Seoul National Hospital Institutional Review Board (IRB No: 11627-2016-001), and it did not undergo the patients' approval process because it used publicly available secondary data and an experiment with human subjects was not conducted. All data were coded to protect each individual's identity.

Data

We used the National Health Insurance Service-National Sample Cohort data provided by the National Health Insurance Service, which was built on the basis of the National

Results

Overall, 990,598 people were included in the analysis, and of those, 2586 (0.26%) died by suicide during the follow-up period. Table 1 shows the demographic characteristics of all the study subjects, including their sex, age, region, income level, and disability type. There were 953,939 people without disability (96.3%) and 36,659 people with disability (3.7%). Regarding age, 12.9% were under 10 years, 14.0% were in their 10s, 16.3% in their 20s, 18.3% in their 30s, 16.5% in their 40s, 9.4% in

Discussion

The goals of the study were to assess the risk of suicide associated with disability and different disability types; examine differences in the risk of suicide for different sexes, ages, and income levels; and assess a trend for when suicide occurs. First, the results showed that the risk of suicide is higher for people with disability than people without disability. The HR of suicide in people with disability was higher in both sexes and in all age groups. The HRs of suicide were different for

Conclusions

The present study showed that the risk of suicide was higher in people with disability compared to people without disability, and the distribution of time to death by suicide of people with disability was skewed toward earlier points. This suggests that the time when disability occurs is more important in people with disability; therefore, suicide prevention policies should focus on early interventions. In addition, this study found that despite a high-income level, people with disability are

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    Conflict of interest: On behalf of all authors, the corresponding author states that there is no conflict of interest.

    Funding: This study was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Grant No. HI13C0729).

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