Risk of suicide in people living with HIV: A nationwide, retrospective population-based cohort study in South Korea

Introduction

There is a paucity of studies that compare suicide- and non-suicide-related deaths, with strict adjustments for people living with human immunodeficiency virus (HIV; PLWH) and those without HIV. We, therefore, aimed to determine whether the risk of suicide differs between these groups.

Methods

This study included all PLWH diagnosed with HIV in South Korea between 1 January 2017 and 31 December 2017. Individuals who had never been diagnosed with HIV were selected as controls using 1:10 stratified random sampling, considering age and sex. The heterogeneity of covariates between PLWH and controls was decreased by 1:5 propensity score matching. The endpoint of the study was death by suicide, with follow-up from 1 January 2018 to 31 December 2022. Death that was not ruled as a suicide was categorized as being due to other causes.

Results

After propensity score matching, 22,415 PLWH (mean age 45.9 years; 91% male) and 96,790 controls (mean age 45.8 years; 90.5% male) were included in the final analysis. Within 5 years, 104 (0.5%) of PLWH and 246 (0.3%) of controls died by suicide. Cox regression analysis revealed a 1.84-fold higher risk of suicide among PLWH compared with controls (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.46–2.31; p < 0.001). Moreover, 836 (3.7%) of 22,415 PLWH and 2882 (3.0%) of 96,790 controls died of other causes within 5 years. Cox regression analysis also revealed a 1.26-fold increase in the risk of mortality due to other causes among PLWH (HR: 1.26; 95% CI, 1.17–1.36; p < 0.001).

Conclusions

This analysis of a South Korean cohort found higher rates of death due to suicide and other causes among people living with and without HIV. The risk of death by suicide was higher than that of other causes among PLWH.