title: Characteristics of sudden bath-related death investigated by medical examiners in Tokyo, Japan.
abstract: BACKGROUND
  Sudden bath-related deaths occur frequently in Japan, particularly among elderly people. However, the precise mechanism of bath-related death remains uncertain, and effective prevention strategies have not been established.
  
  
  METHODS
  Cases of bath-related deaths (n = 3289) were selected from all cases handled by the Tokyo Medical Examiner's Office from 2009 to 2011 (N = 41 336). The ages and occurrence dates were examined, and major autopsy findings, including toxicological analysis, were evaluated for the autopsied cases (n = 550).
  
  
  RESULTS
  Most cases occurred in individuals older than 60 years of age during winter. Analysis of autopsy findings revealed water inhalation signs in many cases (n = 435, 79.1%). Circulatory system diseases constituted more than half of the pathological findings regarding factors that may have contributed significantly to death (n = 300, 54.5%), and cardiac lesions were the most common pathological finding (n = 250, 45.5%). However, approximately one-third of the cases exhibited no remarkable pathological findings (n = 198, 36.0%). A quarter of all cases involved blood ethanol levels that exceeded 0.5 mg/mL (n = 140).
  
  
  CONCLUSIONS
  The results suggested that drowning plays an important role in the final process of bath-related death. Circulatory system diseases may be the primary underlying pathology; however, there were variations in the medical histories and pathologies of cases of bath-related death. From a preventive perspective, family members should pay attention to elderly people with circulatory system diseases during bathing, particularly in winter. Additionally, the notion that ill or inebriated individuals should not take baths should be reinforced.
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo Metropolitan Government.
authors.forename: Hideto
authors.initials: H
authors.lastname: Suzuki
authors.forename: Wakako
authors.initials: W
authors.lastname: Hikiji
authors.forename: Takanobu
authors.initials: T
authors.lastname: Tanifuji
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Abe
authors.forename: Tatsushige
authors.initials: T
authors.lastname: Fukunaga
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D001344:Autopsy; D001494:Baths / Q000009:adverse effects*; D001775:Blood Circulation; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003334:Coroners and Medical Examiners; D003645:Death, Sudden / Q000453:epidemiology*; D004332:Drowning / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012621:Seasons; D014041:Tokyo / Q000453:epidemiology; D055815:Young Adult