Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
권호 표지

Suicide Trend of Standardized Mortality Ratio and Age Standardized Proportion Mortality Ratio According to Occupational Groups in Korea:1993-2007

우리나라에서 직업군에 따른 자살의 표준화사망비와 연령보정 비례사망비의 추세:1993-2007년

  • Yoon, Jin-Ha (Department of Preventive Medicine, Wonju College of Medicine, Yonsei University) ;
  • Lee, Ki-Hyun (Department of Preventive Medicine, Wonju College of Medicine, Yonsei University) ;
  • Hahn, Kyu-Yeon (Department of Preventive Medicine, Wonju College of Medicine, Yonsei University) ;
  • Chang, Ei-Jin (Department of Preventive Medicine, Wonju College of Medicine, Yonsei University) ;
  • Cha, Bong-Suk (Department of Preventive Medicine, Wonju College of Medicine, Yonsei University) ;
  • Min, Seong-Ho (Department of Preventive Medicine, Wonju College of Medicine, Yonsei University) ;
  • Lee, Kyung-Suk (Department of Psychiatry, Wonju College of Medicine, Yonsei University) ;
  • Chae, Hye-Seon (Rural Development Administration) ;
  • Hye-Seon, Chae (Rural Development Administration) ;
  • Koh, Sang-Baek (Department of Nursing, Mokpo National University) ;
  • Sang-Baek, Koh (Department of Preventive Medicine, Wonju College of Medicine, Yonsei University)
  • 윤진하 (연세대학교 원주의과대학 예방의학교실 및 직업및환경의학연구소) ;
  • 이기현 (연세대학교 원주의과대학 예방의학교실 및 직업및환경의학연구소) ;
  • 한규연 (연세대학교 원주의과대학 예방의학교실 및 직업및환경의학연구소) ;
  • 오성수 (연세대학교 원주의과대학 예방의학교실 및 직업및환경의학연구소) ;
  • 장세진 (연세대학교 원주의과대학 예방의학교실 및 직업및환경의학연구소) ;
  • 차봉석 (연세대학교 원주의과대학 예방의학교실 및 직업및환경의학연구소) ;
  • 민성호 (연세대학교 원주의과대학 정신과학교실) ;
  • 이경숙 (농촌진흥청) ;
  • 채혜선 (농촌진흥청) ;
  • 엄애용 (목포대학교 간호학과) ;
  • 고상백 (연세대학교 원주의과대학 예방의학교실 및 직업및환경의학연구소)
  • Published : 2011.06.30
⟨ Previous Next ⟩

Abstract

Objectives: A number of studies on the trends of socioeconomic differences in suicide mortality have indicated that these inequality gaps have widened over time and highlight that certain occupations have more suicide risk than others. However suicide rates according to occupation based socioeconomic position have not been frequently studied in Korea. The purpose of this study is to report trends and inequality of suicide according to occupation based social class during 1993-2007 in Korea and to identify occupations with significantly high standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs) for both men and women. Methods: Korean census records for the years 1995, 2000, and 2005 were linked with the cause of death records from Korean National Statistical Office (KNSO) for the periods 1993-1997, 1998-2003, and 2004-2007 respectively. This data was used to calculate age adjusted proportional mortality ratios (PMRs) and standardized mortality ratios (SMRs) for both men and women aged 25~54 years according to five occupation based socioeconomic positions. Results: Among men, the agricultural-fishery-forestry group had the greatest suicide rate (SMR: 341) with a high PMR (113) and the manual labor group showed the highest PMR (118), while the managersprofessional occupation group showed the lowest sPMR (78) and SMR (21). Among women, the agricultural- fishery group had the highest score in SMR (316) and PMR (130), and the technical-artificer group showed the lowest sPMR (71) and SMR (27). The inequality gaps in the suicide mortality rate according to occupation had widened during 1998-2002, but showed a recovery trend plot after 2003. Conclusions: Although the occupation based socioeconomic inequalities show a recovery trend after 2003, the excess inequality from suicide remains as high as it was prior to the 2002 year in some occupational groups. The results of the current study indicate that the manual and agricultural-fishery-forestry groups were high risk groups of suicide.

목적: 본 연구는 1993년 부터 2007년 까지의 직업군별 자살 사망률 추이를 비교하여, 타 직업군에 비해 높은 표준사망비와 비례사망비를 갖은 집단을 찾고자 하였다. 방법: 대한민국 통계청의 1993-1997, 1998-2003, 2004-2007년 기간의 전국민 사망자료를 각각 1995, 2000, 2005년의 대한민국의 전국민 센서스 자료와 짝을 이루게 구성하였다. 자살은 고의적 자의에 의한 상해가 원인이 되는 모든 사망으로 정하였고, 사망외인 코드 중 X60-X84 및 Y870에 해당하는 것으로 정의 하였다. 남녀별 5개의 직업군에 따라 연령보정비례사망비(sPMR)와 연령보정표준사망비(SMR)를 구하였다. 결과: 남성의 경우, 가장 높은 SMR은 농림어업군이었고 (SMR: 341, 95% CI: 331~346), 가장 높은 sPMR은 단순노무직이었다 (sPMR: 118, 95% CI:113~121). 가장 낮은 SMR과 sPMR은 관리-전문가 집단이었다 [SMR(95% CI): 21(19~1), sPMR(95% CI) :78 (75~80)], . 여성의 경우, 가장 높은 SMR과 sPMR이 농림어업군이었다 [SMR (95%CI): 316(296~327), sPMR(95% CI): 130(122~135)]. 가장 낮은 SMR과 sPMR은 기능-기술직이었다[SMR(95%CI): 27(23~30), sPMR (95% CI) :71(61~77)]. 전체적으로는, 1993년부터 2002년 까지 직업군별 자살의 차이는 증가 되었으나, 2003년 이후 점차 감소하였다. 결론: 본 연구는 남자 단순 노무직의 높은 자살을 나타냈고, 농림어업 군은 전체 직업군에 비해 매우 높은 자살수준을 보이다가 2003년 이후에는 급격하게 감소 하였으나 여전히 가장 높은 자살을 보이는 집단임이었다.

Keywords

References

  1. Chang SS, Gunnell D, Sterne JA, Lu TH, Cheng AT. Was the economic crisis 1997-1998 responsible for rising suicide rates in East/Southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Soc Sci Med 2009;68(7):1322-31. https://doi.org/10.1016/j.socscimed.2009.01.010
  2. Khang YH, Lynch JW, Kaplan GA. Impact of economic crisis on cause-specific mortality in South Korea. Int J Epidemiol 2005;34(6):1291-301. https://doi.org/10.1093/ije/dyi224
  3. Kim H, Chung WJ, Song YJ, Kang DR, Yi JJ, Nam CM. Changes in morbidity and medical care utilization after the recent economic crisis in the Republic of Korea. Bull World Health Organ 2003;81(8):567-72.
  4. Khang YH, Lynch JW, Yun S, Lee SI. Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures. J Epidemiol Community Health 2004;58(4):308-14. https://doi.org/10.1136/jech.2003.012989
  5. Kaga M, Takeshima T, Matsumoto T. Suicide and its prevention in Japan. Leg Med (Tokyo) 2009;11 Suppl 1:S18-21.
  6. Kondo N, Subramanian SV, Kawachi I, Takeda Y, Yamagata Z. Economic recession and health inequalities in Japan: analysis with a national sample, 1986-2001. J Epidemiol Community Health 2008;62(10):869-75. https://doi.org/10.1136/jech.2007.070334
  7. Nishimura M, Terao T, Soeda S, Nakamura J, Iwata N, Sakamoto K. Suicide and occupation: further supportive evidence for their relevance. Prog Neuropsychopharmacol Biol Psychiatry 2004;28(1):83-7. https://doi.org/10.1016/j.pnpbp.2003.09.023
  8. Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemstrom O, Valkonen T, Kunst AE. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol 2003;32(5):830-7. https://doi.org/10.1093/ije/dyg209
  9. Woo JM, Postolache TT. The impact of work environment on mood disorders and suicide: Evidence and implications. Int J Disabil Hum Dev 2008;7(2):185-200.
  10. Maki NE, Martikainen PT. Socioeconomic differences in suicide mortality by sex in Finland in 1971-2000: a register-based study of trends, levels, and life expectancy differences. Scand J Public Health 2007;35(4):387-95. https://doi.org/10.1080/14034940701219618
  11. Hawton K, Clements A, Simkin S, Malmberg A. Doctors who kill themselves: a study of the methods used for suicide. QJM 2000;93(6):351-7. https://doi.org/10.1093/qjmed/93.6.351
  12. Steven S. Occupation and Suicide. Soc Sci Q 2001;82(2):384-96. https://doi.org/10.1111/0038-4941.00030
  13. Wilhelm K, Kovess V, Rios-Seidel C, Finch A. Work and mental health. Soc Psychiatry Psychiatr Epidemiol 2004;39(11):866-73. https://doi.org/10.1007/s00127-004-0869-7
  14. Kwon JW, Chun H, Cho SI. A closer look at the increase in suicide rates in South Korea from 1986-2005. BMC Public Health 2009;9:72. https://doi.org/10.1186/1471-2458-9-72
  15. KOSIS. Korean Statistical Information Service. The cause of death on certificate. Available: http://www.nso.go.kr/eng2006/emain/index.html [cited 11 Aug 2009].
  16. Stack S. Occupation and suicide. Social Science Quarterly 2001;82(2):384-96. https://doi.org/10.1111/0038-4941.00030
  17. Cohen GR, Yang SY. Mid-P confidence intervals for the Poisson expectation. Stat Med 1994;13(21):2189-203. https://doi.org/10.1002/sim.4780132102
  18. Checkoway HP, N. Kriebel, D. In: Checkoway, H (eds) Research Methods in Occupational Epidemiology. 2nd ed. Oxford University Press, Inc. New York. 2004. pp 70-72.
  19. Kupper LL, McMichael AJ, Symons MJ, Most BM. On the utility of proportional mortality analysis. J Chronic Dis 1978;31(1):15-22. https://doi.org/10.1016/0021-9681(78)90077-2
  20. Park JS, Lee JY, Kim SD. A study for effects of economic growth rate and unemployment rate to suicide rate in Korea. Korean J Prev Med 2003;36(1):85-91. (Korean) https://doi.org/10.1006/pmed.2002.1127
  21. Compton MT, Thompson NJ, Kaslow NJ. Social environment factors associated with suicide attempt among low-income African Americans: the protective role of family relationships and social support. Soc Psychiatry Psychiatr Epidemiol 2005;40(3):175-85. https://doi.org/10.1007/s00127-005-0865-6
  22. Lee WJ, Cha ES, Park ES, Kong KA, Yi JH, Son M. Deaths from pesticide poisoning in South Korea: trends over 10 years. Int Arch Occup Environ Health 2009;82(3):365-71. https://doi.org/10.1007/s00420-008-0343-z
  23. Taylor R, Morrell S, Slaytor E, Ford P. Suicide in urban New South Wales, Australia 1985-1994: socioeconomic and migrant interactions. Soc Sci Med 1998;47(11):1677-86. https://doi.org/10.1016/S0277-9536(98)00243-3
  24. Kim YK, Park C, K. A Study on Occupations and Life Chance-The Case of Chonbuk Province. The Population Association of Korea 1997;20(1):129-59.
  25. Meltzer H, Griffiths C, Brock A, Rooney C, Jenkins R. Patterns of suicide by occupation in England and Wales: 2001-2005. Br J Psychiatry 2008;193(1):73-6. https://doi.org/10.1192/bjp.bp.107.040550
  26. Kim MD, Hong SC, Lee SY, Kwak YS, Lee CI, Hwang SW, Shin TK, Lee SM, Shin JN. Suicide risk in relation to social class: a national register-based study of adult suicides in Korea, 1999?2001. International journal of social psychiatry 2006;52(2):138. https://doi.org/10.1177/0020764006061254
  27. Muller A. Education, income inequality, and mortality: a multiple regression analysis. BMJ 2002;324(7328):23-5. https://doi.org/10.1136/bmj.324.7328.23
  28. Agerbo E, Gunnell D, Bonde JP, Mortensen PB, Nordentoft M. Suicide and occupation: the impact of socio-economic, demographic and psychiatric differences. Psychol Med 2007;37(8):1131-40. https://doi.org/10.1017/S0033291707000487
  29. Choi S, Park H. A study on the effects of employees' socio-emotional problems on stress, depression, and self-esteem. Korean Journal of Social Welfare 2005;57:177-96.
  30. Kposowa AJ. Suicide mortality in the United States: differentials by industrial and occupational groups. Am J Ind Med 1999;36(6): 645-52. https://doi.org/10.1002/(SICI)1097-0274(199912)36:6<645::AID-AJIM7>3.0.CO;2-T
  31. Mortensen PB, Agerbo E, Erikson T, Qin P, Westergaard-Nielsen N. Psychiatric illness and risk factors for suicide in Denmark. Lancet 2000;355(9197):9-12. https://doi.org/10.1016/S0140-6736(99)06376-X
  32. Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981-1997. Am J Psychiatry 2003;160(4):765-72. https://doi.org/10.1176/appi.ajp.160.4.765
  33. Appleby L, Cooper J, Amos T, Faragher B. Psychological autopsy study of suicides by people aged under 35. Br J Psychiatry 1999;175:168-74. https://doi.org/10.1192/bjp.175.2.168
  34. Jenkins R, Bhugra D, Meltzer H, Singleton N, Bebbington P, Brugha T, Coid J, Farrell M, Lewis G, Paton J. Psychiatric and social aspects of suicidal behaviour in prisons. Psychol Med 2005;35(2):257-69. https://doi.org/10.1017/S0033291704002958