title: Prevalence of alcohol-related pathologies at autopsy: Estonian Forensic Study of Alcohol and Premature Death.
abstract: OBJECTIVE
  Alcohol can induce diverse serious pathologies, yet this complexity may be obscured when alcohol-related deaths are classified according to a single underlying cause. We sought to quantify this issue and its implications for analysing mortality data.
  
  
  METHODS
  Cross-sectional study included 554 men aged 25-54 in Estonia undergoing forensic autopsy in 2008-09.
  
  
  METHODS
  Potentially alcohol-related pathologies were identified following macroscopic and histological examination. Alcohol biomarkers levels were determined. For a subset (26%), drinking behaviour was provided by next-of-kin. The Estonian Statistics Office provided underlying cause of death.
  
  
  RESULTS
  Most deaths (75%) showed evidence of potentially alcohol-related pathologies, and 32% had pathologies in two or more organs. The liver was most commonly affected [60.5%, 95% confidence interval (CI) = 56.3-64.6] followed by the lungs (18.6%, 95% CI = 15.4-22.1), stomach (17.5%, 95% CI = 14.4-20.9), pancreas (14.1%, 95% CI = 11.3-17.3), heart (4.9%, 95% CI = 3.2-7.0) and oesophagus (1.4%, 95% CI = 0.6-2.8). Only a minority with liver pathology had a second pathology. The number of pathologies correlated with alcohol biomarkers (phosphatidylethanol, gamma-glytamyl transpeptidase in blood, ethylglucuronide, ethylsulphate in urine). Despite the high prevalence of liver pathology, few deaths had alcoholic liver disease specified as the underlying cause.
  
  
  CONCLUSIONS
  The majority of 554 men aged 25-54 undergoing forensic autopsy in Estonia in 2008-09 showed evidence of alcohol-related pathology. However, the recording of deaths by underlying cause failed to capture the scale and nature of alcohol-induced pathologies found.
authors: Institute of Pathological Anatomy and Forensic Medicine, University of Tartu, Tartu, Estonia; Estonian Forensic Science Institute, Tallinn, Estonia.
authors: Jana
authors: J
authors: Tuusov
authors: Katrin
authors: K
authors: Lang
authors: Marika
authors: M
authors: Väli
authors: Kersti
authors: K
authors: Pärna
authors: Mailis
authors: M
authors: Tõnisson
authors: Inge
authors: I
authors: Ringmets
authors: Martin
authors: M
authors: McKee
authors: Anders
authors: A
authors: Helander
authors: David A
authors: DA
authors: Leon
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000401:mortality* / Q000473:pathology*; D001344:Autopsy; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003430:Cross-Sectional Studies; D004957:Estonia; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D013223:Statistics as Topic
chemical_list: D015415:Biomarkers
keywords: Alcohol drinking; Estonia/forensic autopsy; ICD codes; alcohol-related pathologies; epidemiology; post-mortem alcohol biomarkers.