Abstract
AimsAlcohol 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.Design, Setting and ParticipantsCross-sectional study included 554 men aged 25–54 in Estonia undergoing forensic autopsy in 2008–09.MeasurementsPotentially 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.FindingsMost 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.ConclusionThe 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.
Highlights
Alcohol can cause or be implicated in death in many ways, both through acute direct and indirect pathways [1], and as a result of chronic effects on organs such as the digestive and cardiovascular systems [2,3,4,5,6]
Given the range of alcohol-related pathologies, there is inevitably a loss of information and potential misclassification when assigning a single underlying cause of death. This poses a challenge, both for those certifying the cause of death and for epidemiologists and others attempting to interpret these data [15]. These issues are widely acknowledged, we have been unable to find any systematic quantification of the spectrum of alcohol-related pathologies found at autopsy, and how this relates to the statistical codes selected to capture the single underlying cause of death, even though this must be an issue in all countries
In this paper we address this gap, using the results of a forensic autopsy study conducted in Estonia in 2008–09
Summary
The majority of 554 men aged 25–54 undergoing forensic autopsy in Estonia in 2008–09 showed evidence of alcohol-related pathology. The recording of deaths by underlying cause failed to capture the scale and nature of alcohol-induced pathologies found. Keywords Alcohol drinking, alcohol-related pathologies, epidemiology, Estonia/forensic autopsy, ICD codes, postmortem alcohol biomarkers
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