Asthma Increases Long-Term Risk of Death by Suicide: A Nationwide Population-Based Cohort Study

Abstract

Background

Previous studies have identified an increased risk of suicidal behaviors among individuals with asthma.

Objective

To evaluate the long-term risk and factors related to suicide in the adult population with asthma.

Methods

This study used the Korean National Health Insurance Service data. We investigated the risk of suicide concerning the presence or absence of asthma and potential risk factors for suicide among 3,914,041 adults aged 20 years or more.

Results

During a median follow-up of 12.3 years (interquartile range, 12.1-12.6 years), 1383 (0.48%) individuals with asthma died by suicide. Individuals with asthma had an increased risk of suicide compared with controls (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.19-1.33). Suicide risk was especially high in individuals with asthma phenotypes: hospitalization-prone (aHR, 1.61; 95% CI, 1.40-1.84), nonobese (aHR, 1.37; 95% CI, 1.27-1.64), and asthma-chronic obstructive pulmonary disease overlap (aHR, 1.47; 95% CI, 1.22-1.76). Coexisting underweight status (aHR, 2.54; 95% CI, 2.05-3.16), mental health disorders (schizophrenia [aHR, 3.38; 95% CI, 2.28-5.02], depression [aHR, 3.24; 95% CI, 2.85-3.68], and anxiety disorder [aHR, 2.47; 95% CI, 2.00-3.05]), and cancers (aHR, 2.22; 95% CI, 1.73-2.84) further increased the suicide risk.

Conclusions

Asthma was associated with an increased risk of suicide, particularly in hospitalization-prone, nonobese, and asthma-chronic obstructive pulmonary disease overlap phenotypes. The risk was further increased when asthma coexisted with underweight status, mental health disorders, or cancers.