Increased Risk of Suicide Among Individuals with Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study in Korea

초록

Background: Previous studies established that individuals with chronic obstructive pulmonary disease (COPD) have an increased risk for suicidal behaviors compared to those without COPD. Methods: We analyzed data from the Korean National Health Insurance Service. The exposure was COPD, and the outcome was death by suicide. Multivariable Cox proportional hazards regression models were used to determine the associations between COPD and death by suicide. Results: During a median follow-up of 11.3 years (interquartile range, 11.1–11.6 years), individuals with COPD had an increased risk of death by suicide compared to those without (adjusted hazard ratio [aHR] = 1.35, 95% confidence interval [CI] = 1.22–1.49). This increased risk remained significant even among never-smokers (aHR = 1.43, 95% CI = 1.24–1.64). In the stratified analysis based on potential suicidal risk factors, individuals with COPD who had depression (aHR = 3.46, 95% CI = 2.79–4.30), a current heavy smoking habit (aHR = 1.99, 95% CI = 1.61–2.45), were underweight (aHR = 1.96, 95% CI = 1.44–2.69), or had cancer (aHR = 1.67, 95% CI = 1.17–2.38) had a significantly higher risk of death by suicide. Conclusions: Regardless of smoking status, COPD increased the risk of death by suicide. This risk was particularly pronounced when depression, current heavy smoking, underweight, or cancer coexisted with COPD.