The majority of suicide cases were men (n=12 548; 63.2%) and aged 40 to 60 years (n=10 877; 54.7%; table 1). In the study selleck chemicals llc population, 3% (n=592) of suicide cases had a history of hospitalisation for COPD by the date of suicide compared with 1% (n=3087) of population controls. A larger proportion of suicide cases had a history of psychiatric illness (n=8744; 44.0%) compared with the population controls (n=19 413; 6.0%). Suicide cases were also more frequent than the controls who had a physical illness other than COPD (68.1% vs 48.8%). At the same time, 36.5% of suicide cases had a yearly income at the lowest quartile level against 24.6%

of the comparison controls. Moreover, suicide cases were mostly single (52.2%), whereas the comparison controls were mostly married or cohabited with a partner (72.2%; table 1). Table 1 Characteristics of suicide cases and matched population controls Suicide risk associated with COPD We found that patients with a history of COPD hospitalisation were at a significantly increased risk of suicide compared with individuals without such a history (crude OR 2.6, 95% CI 2.3 to 2.8; table 2). The associated risk was attenuated slightly but

remained highly significant after adjustment for psychiatric history, moreover adjusted for sociodemographic variables (adjusted OR 2.0, 95% CI 1.8 to 2.2). The association was more pronounced in women than in men (adjusted OR: 2.3, 95% CI 2.0 to 2.7 for women and 1.9, 95% CI 1.6 to 2.1 for men; test of sex difference: χ2=4.17, p=0.041) and in individuals aged 61–95 years than the younger group (adjusted OR: 2.2, 95% CI 2.0 to 2.5 for 61–95 year olds and 1.5, 95% CI 1.2 to 1.9

for 40–60 year olds; test of age difference: χ2=7.65, p=0.005; table 3). Table 2 Hospitalisation for COPD and associated OR for subsequent suicide Table 3 Hospitalised COPD and associated OR for subsequent suicide, stratified by gender and age group We also noted that the relative risk of suicide progressively increased with an increasing frequency of COPD hospitalisations and with shorter time distance since last COPD hospitalisation (table 3). Carfilzomib The adjusted OR for suicide increased from 1.8 (95% CI 1.6 to 2.0) in patients with 1–2 previous COPD hospitalisations to 3.7 (95% CI 2.5 to 5.4) in those with more than five COPD hospitalisations. At the same time, the adjusted OR for suicide declined from 8.3 (95% CI 6.0 to 11.5) in patients hospitalised for COPD within the past 30 days to 1.2 (95% CI 1.0 to 1.4) in patients hospitalised for COPD more than 3 years ago. The observed pattern of ORs associated with the frequency and the recency of COPD hospitalisations remained similar in analyses stratified by sex and age group as well as by psychiatric history (data not shown).