Association between sight-threatening eye diseases and death by suicide in South Korea: a nationwide population-based cohort study
Authors and Affiliations
Authors and Affiliations
Ahnul Ha, MD 1,2∗, Su Hwan Kim, PhD 3∗, Goneui Kang, MS4, Hyung-Jin Yoon, MD, PhD 5†, Young Kook Kim, MD, PhD 4,6,7 †
1Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea
2Department of Ophthalmology, Jeju National University College of Medicine, Jeju-si, Korea
3Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
4EyeLight Data Science Laboratory, Seoul National University College of Medicine, Seoul, Korea
5Medical Bigdata Research Center, Seoul National University College of Medicine, Seoul, Korea
6Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
7Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
∗ These two authors contributed equally to the study as co-first authors.
† These two authors contributed equally to the study as co-corresponding authors
Correspondence : Primary Corresponding Author: Young Kook Kim,
Although associations between visual impairment (VI) and suicide are posited, specific risks across the sight-threatening eye disease (STED) spectrum remain to be assessed. We determined whether individuals with STED die more often by suicide than do other people and assessed the temporal associations.
A nationwide population-based cohort study
All persons aged 40 years or older and registered as living in South Korea from 2010 through 2020.
Persons diagnosed with STEDs (i.e., glaucoma, exudative age-related macular degeneration [AMD], diabetic retinopathy [DR]) were identified in the Korean National Health Insurance (NHI) service database. Both NHI health checkup records and the National Disability Registration were utilized for coexisting severe VI. Death by suicide was defined as diagnostic codes as recorded in the Korea National Statistical Office. Incidence rate ratios (IRRs) were estimated by Quasi-Poisson regressions, and were adjusted for socio-demographics, comorbidity, psychiatric diagnoses, and VI. The temporal relationship between time since first STED diagnosis and suicide risk was determined by identifying STED patients newly diagnosed during the period 2010 to 2011.
Main Outcome Measures
The IRR of death by suicide in people with STED relative to those without
Of the 2.8 million people (45% males) observed for 24300969 person-years, 13205 died by suicide. Among them, 34% (n=4514) had had a STED diagnosis, for a suicide rate of 69 per 100000 person-years (95% CI, 67-72), relative to 51 per 100000 person-years (95% CI, 50-52) for non-STED individuals. People with STED had an adjusted IRR of 1.33 (95% CI, 1.26-1.41) relative to those without. The largest excess adjusted IRR of suicide mortality was that for DR (1.40, 95% CI, 1.29-1.52). For exudative AMD, the adjusted IRR was 1.20 (95% CI, 1.04-1.39), while for glaucoma, the corresponding value was 1.09 (95% CI, 1.02-1.17). With coexisting severe VI, the IRR for any STED was 1.49 (95% CI, 1.29-1.73). The highest suicide HR was between the 3rd and 6th months post-diagnosis (5.33; 95% CI, 4.59-6.20).
In South Korea between 2010 and 2020, a significantly higher suicide rate was evident among those with diagnosed STED than for persons not so diagnosed.