The impact of the COVID-19 pandemic on suicide rates in Hungary: an interrupted time-series analysis.

BACKGROUND: From 2010 to 2019, suicide mortality fell steadily and substantially in Hungary: the declining trend remained stable, and the suicide rate decreased by more than one-third which was remarkable even from an international perspective. However, despite the declining trend, regional inequalities have always characterised the distribution of suicide mortality in Hungary. Following these favourable trends, COVID-19 appeared in Hungary on the 4th of March 2020 which might lead to an increase in suicides. We aimed to investigate this hypothesis in Hungary by gender, age, educational attainment, and region, as well. METHODS: To test whether the pandemic changed the declining trend of Hungarian suicide rates, the observed number of suicides during March-December 2020 (pre-vaccination period) was compared with the expected numbers (without the appearance of COVID-19). An interrupted time-series analysis was conducted by negative binomial regression using monthly data from January 2010 to February 2020 (pre-pandemic period). RESULTS: Suicide mortality increased significantly compared to the trend during the pre-pandemic period: overall (by 16.7%), among males (18.5%), in the age group 35-49 years (32.8%), and among vocational school graduates (26.1%). Additionally, significant growths in suicide rates were detected in the two regions (Central Hungary and Central Transdanubia) with the lowest COVID mortality rates (by 27.3% and 22.2%, respectively). CONCLUSIONS: Our study revealed reversed trend in suicide mortality during the pre-vaccination period compared to the pre-pandemic period in Hungary. There were significant differences in the pattern of suicide rates by gender, age group, educational attainment, and region during the pre-vaccination period in Hungary, which might be attributed to the socio-economic effects of the COVID-19 pandemic. These findings could prove useful in preventive strategies as the identification of groups at higher risk may be important for suicide prevention; however, further investigations are needed to explore the reasons.

Patterns of suicide deaths in Hungary between 1995 and 2017.

Hungary has had one of the highest suicide mortality rates in the world for decades. Investigating seasonality of suicide deaths is essential as its findings could be key elements in the prevention. In our study we have analyzed the seasonal effect in suicide mortality in relation to possible risk factors in Hungary during 1995-2017. Data on the numbers of suicide deaths were obtained from a published online database. Negative binomial regression was employed to investigate the effect of possible risk factors and seasonal and annual trends in suicide rates. The seasonal effect was further investigated, adding a significant risk factor from the "initial" negative binomial regression. The suicide risk was significantly (p < 0.001) higher in men than in women (incidence rate ratio: 3.48), and it increased with age and decreased with education level. Marriage was a protective factor against suicide. Annual suicide mortality declined significantly (p < 0.001 for trend) from 36.7 (95% confidence interval: 35.5-37.9) to 16.5 (15.7-17.3) per 100,000 persons per year during the study period. Significant seasonality was found in suicide rates with a peak in late June. Similar peaks were observed at each level of each risk factor. There were differences in peaks by suicide method. The peak of non-violent suicides was in early June; suicides committed by violent methods peaked half a month later. This study suggests that there was a significant seasonal effect on suicide deaths between 1995 and 2017, which remained significant even in the presence of each risk factor. To our knowledge, this has been the first study to investigate the seasonal pattern so extensively in Hungary. Our findings confirm that the environmental effects are involved in the etiology of suicide mortality.

Seasonal variation in childhood mortality.

Aim: This ecological study was carried out to determine the cyclic trends in the rate of perinatal and infant mortality and among children aged under 15 years who died in traffic accidents or from drowning, respiratory disease or cancer.Methods: Monthly data on the numbers of live births, perinatal and infant deaths, and deaths from respiratory disease, cancer, traffic accidents, accidental drowning, and submersion in children aged under 15 years were obtained from the Hungarian nationwide population register. The data were aggregated over the study period and cyclic trends were investigated using the Walter-Elwood and negative binomial regression methods.Results: Significant double-peak (May and November) trends were found in mortality rates for perinatal and infant deaths, respectively. Additionally, significant (p-value < .001) seasonal variation in monthly mortality rates for deaths from respiratory diseases was observed with a peak in February, and a significant single peak was observed in mortality rates in July in both deaths from traffic accidents and drowning among children aged 0-14 years. However, there was no seasonal variation in monthly mortality rates for deaths from childhood cancer.Conclusions: Since cyclic trends in mortality suggest some effect of environmental factors in etiology, we might speculate that perinatal mortality may have been related to respiratory infections. A significant single peak was observed in mortality rates in July in both deaths from traffic accidents and drowning among children aged 0-14 years which could be related to environmental factors, such as temperature, air masses, and fronts. However, there was no seasonal variation in monthly mortality rates for deaths from childhood cancer. All of these novel findings could prove useful in preventive strategies, but further cohort studies are needed to investigate this hypothesis.What is knownSeasonality in infant mortality is known.What is newA significant cyclic trend was found in infants' mortality, with a peak in deaths in winter during the post-perinatal period and double peaks in May and November during the perinatal period, which might be associated with respiratory syncytial virus infections.Winter-peak cyclic trends were observed in both preterm and low birthweight mortality.A significant cyclic trend was observed in mortality, with a peak in deaths from traffic accidents and drowning in July for children aged 0-14 years, but seasonal variation was not found in monthly deaths from childhood cancer.

Seasonal variation of mortality from external causes in Hungary between 1995 and 2014.

OBJECTIVE: To analyze trends in external mortality in Hungary between 1995 and 2014 by sex. METHODS: Data on the numbers of deaths due to external causes were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in external-cause mortality rates. Cyclic trends were investigated using the Walter-Elwood method. RESULTS: Suicide and accidents accounted for approximately 84% of the all-external-cause of deaths in Hungary. Annual suicide, unintentional falls and traffic accidents mortality declined significantly (p-value for annual trend: p < 0.001) from 30.5 (95% CI: 29.5-31.5) to 15.8 (15.1-16.5), from 31.2 (30.2-32.2) to 12.2 (11.7-12.8) and from 17.2 (16.4-18) to 5.4 (5-5.8) per 100 000 persons per year, respectively, during the study period. A significant declining trend in annual mortality was also found for assault, cold/heating-related accidents and accidents caused by electric current. However, the declining trend for drowning-related accidents was significant only for males. Significant winter-peak seasonality was found in the mortality rates from accidental falls, cold/heat-related accidents, other accidents caused by submersion/obstruction and other causes. Seasonal trends with a peak from June to July were observed in death rates from suicide/self-harm, accidental drowning/submersion and accidents caused by electric current. A significant seasonal variation with a peak in September was revealed in the mortality due to traffic accidents. CONCLUSIONS: This Hungarian study suggests that there was a significant seasonal effect on almost all kinds of deaths from external causes between 1995 and 2014. Environmental effects are involved in the aetiology of suicide and accidents.

Seasonal variation of cancer mortality in Hungary between 1984 and 2013.

Aims: Despite decreasing trends, Hungary is the leader in cancer mortality among European countries. We examined the seasonal variation of cancer mortality in Hungary between 1984 and 2013. Methods: Hungarian monthly cancer mortality and population data were used in the analysis. The Walter-Elwood method was used to determine seasonal variation in both mortality rates and proportionate mortality. Results: Significant winter-peak seasonality was found in all-cancer mortality. A similar seasonal trend with a peak from November to January was observed in death rates from colorectal, lung, female breast, prostate, bladder, brain, lymphoid and hematopoietic cancers. However, no more cyclical variation was identified in the mortality rates from other cancers. In addition, significant seasonal variation in proportionate mortality was shown for all cancer sites examined, with a peak in August or September. Conclusions: This study presents the seasonality pattern of different types of cancer mortality which might be related to environmental factors (e.g. infections).

Adverse perinatal outcome in teenage pregnancies: an analysis of a 5-year period in Southeastern Hungary.

OBJECTIVE: To determine the risks of adverse perinatal outcomes of teenage mothers. MATERIAL AND METHODS: A retrospective analysis was performed on teenage mothers (under 20 years of age) who delivered in the period of 2010-2014 at the Department of Obstetrics and Gynecology, University of Szeged (study group). All mothers who delivered in Hungary during the same period were studied as a control group. The following parameters were analyzed: demographic data of the mothers, maternal complications, perinatal outcome and congenital malformations of the newborns. The binominal test, Student's t-test and Poisson's regression were applied using STATA 9.0 (StataCorp, College Station, TX, USA) statistical software (p < .05 was considered to be statistically significant). RESULTS: During this 5-year period, 12,845 births were recorded at the Department, of these 274 (2.1%) were teenage pregnancies with 275 newborns. The offsprings of teenage mothers had significantly lower mean birth weight (3110.2 ± 564.03 g versus 3247 g), higher rate of congenital malformations (8.0 versus 5.0%) and higher admission to neonatal intensive care unit (12.4 versus 8.0%) than the infants in the control group. CONCLUSIONS: Younger maternal age was significantly associated with lower mean birth weight, higher risk of congenital malformations, and increased admission rate to neonatal intensive care unit.

Annual and seasonal trends in mortality rates from cardiovascular diseases in Hungary between 1984 and 2013.

OBJECTIVES: The aim of this study was to investigate annual and seasonal trends in mortality rates from cardiovascular diseases in Hungary between 1984 and 2013. METHODS: Annual and monthly mortality and population data were obtained from the Hungarian Central Statistical Office. The annual mortality data by gender and age were available for the following disease classifications of the circulatory system: all cardiovascular diseases, all diseases of the heart, hypertension, coronary heart disease, and cerebrovascular diseases. Six age groups were defined for both sexes. Negative binomial regression was carried out to analyse annual trends in age-standardized mortality rates. The Walter-Elwood method was used to identify seasonal variation using monthly numbers of deaths. RESULTS: Significant decreases in annual mortality rates for all cardiovascular diseases were found, but not for hypertension. Age-standardized death rates were higher for men for all causes, except for hypertension. The greatest sex difference in the average risk of death was observed in the middle-aged groups. The greatest percentage decrease in death rates during the study period was seen for both sexes in the under 35 age group. The lowest percentage change was observed among people aged over 75. Significant seasonality was found in monthly death rates from all causes, with a peak in February. CONCLUSIONS: In spite of a decreasing trend in the annual mortality rates for cardiovascular diseases, the Hungarian mortality rate is still high. Moreover, this study demonstrated a significant winter peak in mortality from cardiovascular diseases over a thirty-year period.

Trends in Gastrointestinal Cancer Mortality Rate in Hungary.

The aim of this study was to investigate the annual death trends for gastrointestinal cancer in Hungary between 1963 and 2012. Data on the numbers of cancer deaths were obtained from the published nationwide population register. Numbers of deaths from esophageal, gastric and colorectal cancer were available during the study period. However, the mortality data for hepatic, pancreatic and gallbladder cancer have been published only since 1979. Joinpoint regression was applied to investigate the annual trends in the rates of cancer mortality. The annual mortality rates of gastric and gallbladder cancer decreased throughout the study period. Furthermore, declines in mortality from esophageal and hepatic cancers have been observed since 1998 and 1995, respectively. However, the rates of colorectal and pancreatic cancer mortality have been increasing in the past few years. Nevertheless, the mortality rates of colorectal and pancreatic cancers have increased in males aged 40-59 years during the study period. Moreover, significantly higher risks of gastrointestinal cancer-related deaths have been observed in males as compared with females except for death related to cancer of the gallbladder. The presented data suggest that the Hungarian mortality rates are particularly high. The detection of gastrointestinal cancers at an early stage would significantly improves the outcome of these malignancies.

Trends in mortality rates in female genital organs and breast cancers in Hungary between 1979 and 2013.

OBJECTIVE: This study investigated annual and seasonal trends in deaths for cancers of the female genital organs and breast in Hungary between 1979 and 2013. STUDY DESIGN: Data on the numbers of cancer deaths were obtained from the published nationwide population register. Joinpoint regression was applied to investigate the yearly trends in cancer mortality rates. Cyclic trends were investigated using logistic regression, Edwards' and Walter-Elwood methods. RESULTS: The majority of deaths from cancers of the female genital organs and breast occurred in winter but using the observed numbers of deaths a significant seasonal pattern was only revealed for deaths from breast cancer with a peak in January and a nadir in July. However, seasonality in the proportion of deaths from female genital organs and breast cancers out of deaths from all causes detected a different peak and nadir. The proportion of female genital organs and breast cancer deaths out of deaths from all causes was higher around the end of summer and significant seasonal variation with a peak in August and nadir in February was revealed. CONCLUSION: This Hungarian study suggests that there was a significant seasonal effect on female genital organs and breast cancer mortality. Both seasonal patterns are interesting and informative to potentiate prevention. Our findings suggest that infectious diseases may increase the risk of the mortality among the immune deficient patents.

Trends in infant mortality rates in Hungary between 1963 and 2012.

AIM: This study investigated annual and seasonal death trends for infants of <1 year of age in Hungary between 1963 and 2012 and analysed commonly accepted risk factors. METHODS: Data on the numbers of live births and infant deaths were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in rates and also the effect of possible risk factors - low birthweight, maternal education and sex - on infant mortality. Cyclic trends were investigated using logistic regression. RESULTS: Annual infant mortality declined significantly (p < 0.001) from 42.9 to 4.9 per 1000 live births per year during the study period and significantly increased (p < 0.001) in the low birthweight group and lower maternal education groups. A significant (p < 0.001) cyclic trend in mortality was revealed, with a peak in deaths in late February for all infants and a double peak, in May and November, in the group of cases who died during the early neonatal period. CONCLUSION: This Hungarian study suggests that there was a significant seasonal effect on neonatal and infant mortality at the end of winter between 1963 and 2012. We speculate that this may have been related to respiratory infections.

Risk factors and trends in the rate of stillbirth in Hungary between 1971 and 2010.

OBJECTIVE: Possible risk factors and trends in the rate of stillbirth in Hungary between 1971 and 2010. METHODS: Annual data of fetal birth weight, fetal gender, maternal age and marital status of the mother categories were available for both live and stillborn cases and were analyzed using negative binomial regression. A p value less than 0.05 was considered significant. RESULTS: Male gender significantly increased risk of stillbirth (relative risk (RR):1.08; p < 0.001). The risk of stillbirth was also significantly associated with the maternal age (RR: 2.01 in the group older than 35 years, relative to younger mothers; p < 0.001), and the marital status (RR: 1.24 among the babies of an extramarital partnership; p < 0.001), this holding true for both fetal genders. However, a low birth weight ( < 2500 g) increased the risk of stillbirth more than 18-fold (RR: 18.47; p < 0.001) and there was a markedly higher risk of low birth weight in boys than in girls. Further, a strong negative correlation (r = -0.88) was detected between the real income per person of the overall population and the rate of stillbirth. CONCLUSIONS: These findings support the known risk factors of stillbirth and gender-specific analyses given an estimation of the risk of stillbirth in both boys and girls.