Alcoholism is known to be greatly underdiagnosed in death certificates, a fact that biases in estimates of alcohol-related mortality. An autopsy series of 1658 cases (920 with natural cause of death and 738 nonnatural) was reviewed to evaluate the extent of this bias, and also to see how well different sources of information served as indicators of alcoholism when alcohol-related disease diagnosed at autopsy was considered as a gold standard. A stepwise logistic regression model adjusted by age and sex showed police reports of individual's alcohol usage and blood alcohol concentration (BAC) of > 2.9/1000 at autopsy to be the two most significant predictors of chronic alcohol abuse (p 2.9/1000), due to its high specificity, as particularly suggestive of chronic heavy drinking. However, it is wise to use these parameters only as an aid in decision-making, not as sole indicators of alcoholism. Deaths associated with chronic heavy drinking were frequent, 50.5% of the total series (male 56.4%, female 37.1%). For all but one age-group (male 45-64 years), however, death certificates mentioned alcohol-related diseases in less than half of these cases. Especially evident underdiagnosis was found for female and males 65 years and older. These results indicate that alcoholism is frequent in such a highly selected population as a series of forensic autopsies and suggest that estimates of prevalence of alcoholism based only on review of death certificates are to be considered with great caution.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Seasonal variation in suicides has been shown in many countries. We assessed the seasonality and the variation with latitude in suicides and homicides, and the impact of alcohol on the seasonality in suicides. METHODS: Official computerized registers on causes of death in all Greenland during 1968-2002 were used. Sales data on beer from one of the major food store chains for July 2005-June 2006 were examined. Seasonal variation was assessed by Rayleigh's test for circular distributions. RESULTS: There were a total of 1351 suicides and 308 homicides. The suicides rate varied from 4.2/100 000 person-years in 1971 to 128.4/100 000 person-years in 1987. The homicide rate varied from 2.1/100000 person-years in 1969-1970 to 34.8/100 000 person-years in 1988. Out of the 1351 suicides, 80.5% were committed by men and 19.5% by women. Median age was 25 years (n = 1351; Range 11-84 years). Violent methods of suicide were used in 95% of all cases (n = 1286). Out of the 308 homicide victims, 61% were men and 39% were women, and 13% were killed in multiple homicide events.There was a significant seasonal variation with peaks in June and troughs in the winter in all suicide cases (n = 1351, r = 0.07; Z = 7.58, p
Approximately 9% of the homicides in Finland are committed by adolescents under 20 years of age. The purpose of this study was to investigate the offence and offender characteristics in homicidal adolescents. Forensic psychiatric evaluation statements of adolescent offenders accused of a homicide during 1990-2001 were reviewed retrospectively (n=57). In 38% of the cases, there were multiple offenders. In 58% of the cases, the victim was an acquaintance, in 25% a stranger, in 12% a family member and in 5% of the cases an (ex)intimate partner. Sixty-nine percent of the offenders were intoxicated and 21% under the influence of drugs at the time of the killing. The most frequent motives were an argument (25%) and a robbery (25%). Sixty-four percent of the offenders had developmental problems and 42% had a crime history. Approximately half were diagnosed as having a conduct or a personality disorder, but 32% of the offenders were considered not to suffer from a mental illness or substance abuse. For 63%, the level of intellectual functioning was average or above average. There were signs of more than one form of violence in 54% of the cases and 28% of the cases contained excessive violence. The use of multiple and excessive violence was significantly related to the offender age, multiple offenders, offender-victim relationship and substance abuse, but not related to having developmental problems, crime history or mental illness.
OBJECTIVE: To investigate alcohol involvement in all types of unnatural deaths in Sweden. METHOD: All cases of unnatural death that underwent medico-legal autopsies (1992-1996) in Sweden were analyzed (N = 15,630; i.e., 68% of all unnatural deaths). Alcohol was regarded as contributing to the death if: (1) there was any indication that the deceased was a "known alcoholic"; (2) the underlying or contributing causes of death were alcohol-related; (3) the deceased had alcohol-related inpatient diagnosis during a period of 3 years prior to death; or (4) the case tested positive for blood alcohol. RESULTS: Thirty-nine percent of the blood-tested cases (n = 13,099) were positive for alcohol. Almost 40% of the unnatural deaths were associated with alcohol. Alcohol involvement was most common in the intoxication group (84%), followed by the "undetermined" (65%), homicide (55%), fall (48%), fire (44%), asphyxia (41%), suicide (35%) and traffic (22%) groups. More than half (52%) of the deaths in the age group 30-60 years, 35% of those aged 0-29 years and 25% of those aged 60 and over were associated with alcohol. CONCLUSIONS: In Sweden, two of five unnatural deaths are associated with alcohol; this is a conservative estimate. Alcohol-associated mortality varies considerably between different groups of external causes of death, between men and women, and with age.
Research has shown a strong link between alcohol use and a variety of problems, including violence. Parker and colleagues have presented a selective disinhibition theory for the link between alcohol use and homicide (and other violence) that posits a causal relationship that is also influenced by other situational and contextual factors. This model is particularly well suited for aggregate-level investigations. In this study, we examine the impact of alcohol factors, including consumption measures and Alcoholics Anonymous (AA) membership rates, on homicide mortality rates in Ontario, and test predictions derived from the selective disinhibition model.
Time series analyses with ARIMA modeling were applied to total, male, and female homicide rates in Ontario between 1968 and 1991. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines.
For the total population and males, homicide rates were significantly and positively related to total alcohol consumption and to the consumption of beer and spirits. They were also negatively related to AA membership rates in the analyses involving spirits and wine and positively related to unemployment rates in the analyses involving beer, wine, and total alcohol. Among females, none of the measures were significant predictors of homicide mortality rates.
These data provide important support for the selective disinhibition model and confirm important relationships between per capita consumption measures and homicide mortality rates, especially among males, seen in other studies. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.
OBJECTIVE: This article tests whether different forms of community-level alcohol control significantly affect injury deaths in a population with extremely high injury mortality. METHOD: The 1981 Alaska local option law provides a natural experiment for studying how implementation of community level controls may be associated with changes in injury deaths, most of which are alcohol-related, among Alaska Natives living in small communities. The study compares population and community-specific death rates under different levels of alcohol control for the 97 communities that passed restrictions between 1980 and 1993 with the death rates in the same communities during periods when no restrictions were in place. RESULTS: Injury death rates were generally lower during periods when alcohol sales, importation or possession were restricted than when no restrictions were in place (wet). More restrictive controls (dry) significantly reduced homicides; less restrictive control options (damp) reduced suicides. Accident and homicide death rates fell, on average, by 74 and 66 per 100,000, respectively, for the 89 communities that banned sale and importation or possession. A control group of 61 small communities that did not change control status under the law showed no significant changes over time in accident or homicide death rates. CONCLUSIONS: The changes in accidental and homicide death rates are statistically significant, although these reduced rates remain 2.5 to 7 times national death rates. The isolated nature of Alaskan villages may explain why alcohol control has more effect in Alaska than has been found in studies of Native Americans living in other states.
It is well established that use of alcohol increases the risk of fatal injuries. The presence of blood alcohol in autopsied deaths is regularly encountered in medico-legal practices. The aim of this study was to investigate the prevalence and concentration of alcohol in 1539 medico-legal autopsies in two counties in northern Norway in the period 1973-1992, and the reporting of acute alcohol influence among these deaths to the official cause-of-death statistics. Blood alcohol concentration (BAC) >/=0.5 per thousand (50 mg/100 ml) was found in 47.6% (n=456) of violent deaths tested, and in 93% (n=426) of these the BAC was >/=1.0 per thousand. In 17.4% (n=55) of tested natural deaths the BAC was >/=0.5 per thousand. Acute alcohol-influenced violent deaths were under-reported to the cause-of-death statistics. Deaths by motor vehicle traffic accidents did not differ from other violent deaths in this respect. The under-reporting among violent deaths was 41% in cases with BAC >/=0. 5 per thousand and 37% where the BAC was >/=1.0 per thousand during the whole period. It is concluded that post-mortem BAC >/=0.5 per thousand, should be regarded as a possible contributory cause in all violent deaths, and reported accordingly.
To determine the prevalence and context of alcohol use in the deaths of children and youth reviewed by the BC Children's Commission.
In 489 case reviews of BC children and youth, we examined the role that alcohol may have had at the time of death or whether there was a history of alcohol use either by the deceased child or another person in the child's life.
Alcohol is most prevalent in the lives of 15-18 year olds. It is present at the time of death in two fifths of Motor Vehicle Incidents (MVI) and one third of suicides and drownings.
Alcohol has a profound presence in the lives and deaths of children reviewed by the Children's Commission. Enhancing deterrence laws and alcohol control policies, and increasing public awareness are warranted.