Role of age-sex as underlying risk factors for death in acute pesticide self-poisoning: a prospective cohort study

Abstract

Background

There is growing evidence in the literature that patients’ age is associated with increased risk of death in acute pesticide poisoning. However, few studies have investigated whether the age effect differs between males and females. We aimed to examine the association between age-sex and risk of death in acute pesticide self-poisoning.

Methods

A prospective cohort of deliberate pesticide-poisoned patients admitted to ten rural Sri Lankan hospitals between March 2002 and December 2019. The pesticide ingested was identified based on identification of container or history. A mixed effects logistic regression was fitted to investigate the effect of age-sex on death in acute pesticide self-poisoning adjusting for clinical symptoms on admission, measured by Glasgow Coma Scale and Poison Severity Score, and controlling for clustering among hospital sites.

Results

In total, 201 different pesticides were ingested by patients. 6,643 patients ingested an unknown pesticide. A single pesticide was co-ingested with alcohol by 4,603 patients. Of the 28,303 patients enrolled, 2,028 patients died, resulting in case fatality of 7.2% (95% CI 6.9–7.5). The effect of age on case fatality was stronger for males after 21 years of age. The odds of dying for each 5 years increase in age was 1.26 (95% CI 1.23–1.28) times higher for males versus 1.14 (95% CI 1.10–1.19) times higher for females. Missing data were handled by multiple imputation.

Conclusion

Patient’s age-sex are important risk factors for death in acute pesticide self-poisoning even after controlling for clinical effects. The age effect on the odds of dying was significantly different for males and females, with this effect being stronger for males. Given that patient’s age and sex are very easy to collect on admission, our study highlights the need for incorporating these risk factors in policy and clinical decisions.

Keywords:

• Pesticide self-poisoning
• mortality
• age
• sex
• risk factors

Acknowledgments

We thank all the staff of the study hospitals for their assistance and support in running this cohort. We also thank all the patients who participated in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was conducted by the South Asian Clinical Toxicology Research Collaboration within a long running cohort study. The major sources of funding for the pesticide poisoning cohort have been provided by the Wellcome Trust and the National Health and Medical Research Council of Australia.