Sex differences in the association between hazardous alcohol consumption and suicide mortality: A population-based cohort study in South Korea

Abstract

Background: While the co-occurrence of hazardous alcohol consumption and mental health problems has been well documented, evidence on sex-specific associations between hazardous alcohol consumption and suicide mortality remains limited. This cohort study explored the relationship between hazardous alcohol consumption and suicide mortality among men and women. Methods: A nationally representative sample of 64,756 adults (27,726 males and 37,030 females) was followed until December 31, 2022, using data from a national death registry. Hazardous alcohol consumption was measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Participants were classified into non-alcohol use, low-risk alcohol consumption, and hazardous alcohol consumption groups. Deaths caused by intentional self-harm (ICD-10 codes X60-X84) were classified as suicide mortality. Sex-stratified Cox regression models were applied to compute hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During a median follow-up of 9.67 years, 190 suicidal deaths occurred. Higher AUDIT-C scores were positively associated with the risk of suicide mortality among women (HR: 1.15, 95% CI: 1.03-1.28) but not among men (HR: 1.02, 95% CI: 0.95-1.09). In analyses in which alcohol use status was categorized, hazardous alcohol consumption was not linked to suicide mortality among men (HR: 1.01, 95% CI: 0.57-1.79), whereas hazardous alcohol consumption had a 2.50-fold (95% CI: 1.18-5.32) higher risk for suicidal mortality among women, compared with non-alcohol use. Conclusions: Hazardous alcohol consumption was linked to an increased risk of suicide mortality, particularly among women. This study underscores the need for sex-specific approaches to suicide prevention, particularly targeting women who engage in hazardous alcohol consumption.