The global burden of fatal self-poisoning with pesticides, 2006-2015: A systematic review.

Background: Agricultural pesticide poisoning is a major contributor to the global burden of suicide. Over the last
decade there has been a marked decrease in the incidence of suicide worldwide. It is unclear whether pesticide
poisoning still plays a significant role in the global incidence of suicide.
Methods: WHO method-specific suicide data were supplemented by a systematic review of the literature between
2006 and 2015, including searches of thirteen electronic databases and Google, citation searching and a review
of reference lists and personal collections. Our primary outcome was the proportion of total suicides due to
pesticide poisoning. Weighted estimates were calculated for seven WHO regional and income strata.
Results: We identified data from 108 countries (102 from WHO data, 6 from the literature). A conservative
estimate based on these data indicates that there were approximately 110,000 pesticide self-poisoning deaths
each year from 2010 to 2014, comprising 13.7% of all global suicides. A sensitivity analysis accounting for
under-reporting of suicides in India resulted in an increased estimate of 168,000 pesticide self-poisoning deaths
annually, that is, 19.7% of global suicides. The proportion of suicides due to pesticide self-poisoning varies
considerably between regions, from 0.9% in low- and middle-income countries in the European region to 48.3%
in low- and middle-income countries in the Western Pacific region.
Limitations: High quality method-specific suicide data were unavailable for a number of the most populous
countries, particularly in the African and Eastern Mediterranean regions. It is likely we have underestimated
incidence in these regions.
Conclusion: There appears to have been a substantial decline in fatal pesticide self-poisoning in recent years,
largely driven by a reduction in overall suicide rates in China. Nonetheless, pesticide self-poisoning remains a
major public health challenge, accounting for at least one-in-seven suicides globally.