Role of alcohol in unnatural deaths: a study of all deaths in Sweden.
BACKGROUND
Most previous research has concentrated on the role of alcohol in one type of unnatural death in a selected population, but the present objective was to investigate the role of alcohol in all unnatural deaths (autopsied and not autopsied).


METHODS
All cases of unnatural death from 1992 through 1996 in Sweden were analyzed (n = 23,132). Death was attributed at least in part to alcohol if the deceased was a "known alcoholic"; if the underlying or contributing cause of death was alcohol-related; if the deceased had an alcohol-related inpatient diagnosis during the 3-year period prior to death; or if the deceased tested positive for blood alcohol.


RESULTS
Just over 28% of the unnatural deaths could be associated with alcohol; the association with alcohol was more than twice as common in deaths of males (35%) as in females (16%). When only autopsied cases or only blood-tested cases were taken as the denominators, 38% and 44%, respectively, of the deaths were associated with alcohol. Alcohol involvement also was twice as common in intentional deaths (36%) as in unintentional deaths (18%). The intoxication group (78%) had the highest fraction of deaths that could be associated with alcohol, followed by the undetermined group (62%), homicide (49%), fire (41%), suicide (35%), asphyxia (29%), traffic (18%) and fall (9%) groups. In the 20- to 59-year age group, alcohol involvement was found in 51% of the males and 35% of the females (47% for males and females combined).


CONCLUSIONS
The present estimates are conservative; alcohol involvement in unnatural deaths probably is even higher, up to 44% of the total. The present estimation is an important step in policy-making to lower the number of alcohol-related deaths in Sweden.
Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, Sweden.
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Sjögren
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Eriksson
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Ahlm
D000059:Accidents / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000097:blood / Q000401:mortality*; D000435:Alcoholic Intoxication / Q000097:blood / Q000401:mortality*; D000704:Analysis of Variance; D001334:Automobile Driving / Q000706:statistics & numerical data*; D002423:Cause of Death; D016009:Chi-Square Distribution; D003645:Death, Sudden / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology