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Adam J. Kalkstein, Miloslav Belorid, P. Grady Dixon, Kyu Rang Kim, and Keith A. Bremer

Abstract

South Korea has among the highest rates of suicide in the world, and previous research suggests that suicide frequency increases with anomalously high temperatures, possibly as a result of increased sunshine. However, it is unclear whether this temperature–suicide association exists throughout the entire year. Using distributed lag nonlinear modeling, which effectively controls for nonlinear and delayed effects, we examine temperature–suicide associations for both a warm season (April–September) and a cool season (October–March) for three cities across South Korea: Seoul, Daegu, and Busan. We find consistent, statistically significant, mostly linear relationships between relative risk of suicide and daily temperature in the cool season but few associations in the warm season. This seasonal signal of statistically significant temperature–suicide associations only in the cool season exists among all age segments, but especially for those 35 and older, along with both males and females. We further use distributed lag nonlinear modeling to examine cloud cover–suicide associations and find few significant relationships. This result suggests that that high daily temperatures in the cool season, and not exposure to sun, are responsible for the strong temperature–suicide associations found in South Korea.

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P. G. Dixon, D. M. Brommer, B. C. Hedquist, A. J. Kalkstein, G. B. Goodrich, J. C. Walter, C. C. Dickerson IV, S. J. Penny, and R. S. Cerveny

Studies, public reports, news reports, and Web sites cite a wide range of values associated with deaths resulting from excessive heat and excessive cold. For example, in the United States, the National Climatic Data Center's Storm Data statistics of temperature-related deaths are skewed heavily toward heat-related deaths, while the National Center for Health Statistics Compressed Mortality Database indicates the reverse—4 times more people die of “excessive cold” conditions in a given year than of “excessive heat.” In this study, we address the fundamental differences in the various temperature-related mortality databases, assess their benefits and limitations, and offer suggestions as to their use. These datasets suffer from potential incompleteness of source information, long compilation times, limited quality control, and the subjective determination of a direct versus indirect cause of death. In general, these separate mortality datasets should not be combined or compared, particularly with regard to policy determination. The use of gross mortality numbers appears to be one of the best means of determining temperature-related mortality, but those data must be detrended into order to remove a persistent winter-dominant death maximum and are difficult to obtain on a regional daily basis.

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