The Epidemic Spread of Charcoal-burning Suicide in East Asia: a Time Trend Analysis

Abstract

Objective: Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 years in the early 2000s. Methods: We used data for suicides by gases other than domestic gas in Hong Kong, Japan, South Korea (1995-2010), Taiwan (1995-2011), and Singapore (1996-2011) to systematically investigate the spread of this method in East Asia. Graphical and joinpoint regression analyses were used to examine suicide trends and Poisson regression analysis to study sex- and age-specific patterns. Results: In 1995/1996, charcoal-burning suicides accounted for < 1% of all suicides in all study countries, except around 5% in Japan, but they increased to account for 14%, 28%, 13%, 4.3%, and 3.4% of all suicides in Hong Kong, Taiwan, Japan, South Korea, and Singapore respectively in 2010. Rises were first seen in Hong Kong in 1999, followed by Singapore in 2000, Taiwan in 2001, Japan in 2003, and South Korea in 2008. There was some evidence for an impact on overall suicide trends in Hong Kong, Taiwan, and Japan (females), but not in Japan (males), South Korea, and Singapore. Rates of change did not differ by sex/age group in Taiwan and Hong Kong but were greatest in young people in Japan and middleaged men and young women in South Korea. Conclusion: Variations in the timing, scale and sex/age pattern of the epidemic appear to be influenced by the media reporting of charcoal-burning suicide, whilst other factors such as the characteristics of the first or first few cases, language and ulture, familiarity and accessibility with the method, and socio-economic conditions may also play a role. Strategies to limit the epidemic spread of new suicide methods include surveillance to enable the early identification of the emergence of such methods, responsible media reporting and restrictions on Internet sites giving technical information about the method.