Natural disease and alcohol intoxication amongst drivers of motor vehicles in Singapore from 1989 to 1993: a study of 140 necropsies.
A 5-year retrospective study of 140 necropsies conducted on drivers of vehicles (excluding motorcyclists) involved in fatal motoring events, drawn from 1285 traffic deaths, showed a marked preponderance of males (95%) and of Chinese subjects (87.1%), with over half (53.6%) aged between 20 and 39 years. Approximately a third was free of morphological evidence of natural disease, while the remainder showed evidence of various combinations of ischaemic heart disease (64.3%), hypertensive heart disease (38.6%), chronic obstructive airways disease (25.7%), benign hypertensive nephrosclerosis (15%), cerebral atheroma (15%) and other conditions. While the majority succumbed to the effects or complications of severe trauma, 35 subjects (25%) died from natural (that is, non-traumatic) causes, with 17 or almost half of these having occurred as sudden deaths "at the wheel", not associated with any form of collision. The mean age of the former (traumatic deaths) was 35.3 years while that of the latter (natural deaths) was 55.2 years (P < 0.001). Notably, ischaemic heart disease was the predominant natural cause, accounting for 31 of all such cases, none of which resulted in death or injury to any passenger, pedestrian or another motorist. It was also the cause of death in 12 vocational drivers, corresponding to 0.9% of all traffic deaths during this period. Although 34 drivers (24.3%) had detectable blood ethanol levels at autopsy, of which 28 (20%) exceeded the current legal limit of 80 mg/100 ml, all of the cases where death was attributed to natural causes were free of ethanol. However, 15 subjects (10.7%) who had died from trauma but had significant underlying pathology, comprising 13 cases of ischaemic heart disease, had blood ethanol concentrations well above the legal limit. It is possible that, in at least some of the latter, alcohol consumption might have acutely aggravated the underlying pathology and combined to contribute to the occurrence of these fatal accidents.
Department of Forensic Medicine, Institute of Science and Forensic Medicine, Singapore.
G
G
Lau
D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000435:Alcoholic Intoxication / Q000453:epidemiology / Q000401:mortality*; D001334:Automobile Driving; D006259:Craniocerebral Trauma / Q000401:mortality; D003645:Death, Sudden; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000401:mortality; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology