Fatal Alcohol Poisoning Research Articles

The role of adenosine in alcohol-induced respiratory suppression

Alcohol-related poisoning is the foremost cause of death resulting from excessive acute alcohol consumption. Respiratory failure is crucial to the pathophysiology of fatal alcohol poisoning. Alcohol increases accumulation of extracellular adenosine. Adenosine suppresses breathing. The goal of this investigation was to test the hypothesis that adenosine signaling contributes to alcohol-induced respiratory suppression. In the first experiment, the breathing of mice was monitored following an injection of the non-selective adenosine receptor antagonist caffeine (40 mg/kg), alcohol (5 g/kg), or alcohol and caffeine combined. Caffeine reduced alcohol-induced respiratory suppression suggesting that adenosine contributes to the effects of alcohol on breathing. The second experiment utilized the same experimental design, but with the blood brain barrier impermeant non-selective adenosine receptor antagonist 8-sulfophenyltheophylline (8-SPT, 60 mg/kg) instead of caffeine. 8-SPT did not reduce alcohol-induced respiratory suppression suggesting that adenosine is contributing to alcohol-induced respiratory suppression in the central nervous system. The third and fourth experiments used the same experimental design as the first, but with the selective A1 receptor antagonist DPCPX (1 mg/kg) and the selective A2A receptor antagonist istradefylline (3.3 mg/kg). Istradefylline, but not DPCPX, reduced alcohol-induced respiratory suppression indicating an A2A receptor mediated effect. In the fifth experiment, alcohol-induced respiratory suppression was evaluated in Adk+/- mice which have impaired adenosine metabolism. Alcohol-induced respiratory suppression was exacerbated in Adk+/- mice. These findings indicate that adenosinergic signaling contributes to alcohol-induced respiratory suppression. Improving our understanding of how alcohol affects breathing may lead to better treatment strategies and better outcomes for patients with severe alcohol poisoning.

Significant decrease in the rate of fatal alcohol poisonings in Finland validated by blood alcohol concentration statistics

BackgroundAlcohol may cause death directly by acute poisoning, as well as induce illnesses or accidents that lead to death. Our research question was whether the current decreasing trend in acute fatal alcohol poisonings in Finland is a real phenomenon or an artefact caused by possible changes in the process of determining the cause of death. MethodsAll cases in the national post-mortem toxicology database in which the underlying cause of death was acute alcohol poisoning in 1987–2018 were investigated in terms of blood alcohol concentration (BAC), age and gender. The number of acute alcohol poisonings was compared to the number of deaths from alcohol induced illness in the post-mortem toxicology database. ResultsA total of 12 126 acute alcohol poisoning cases were retrieved. Between 2004 and 2017 the number of acute alcohol poisonings decreased 60.1 %. At the same time the number of alcohol induced illnesses in the study material remained stable or decreased marginally.The median BAC in all acute alcohol poisonings was 3.2 g/kg. The annual median BAC values showed a small but significant decrease over the study period. The proportion of women in acute alcohol poisonings increased significantly over the study period, from 17.1%–22.3%. Women were on average 2.5 years older than men. ConclusionsOn grounds of the BAC statistics and supporting evidence, we conclude that the significant decrease in the number of fatal alcohol poisonings is true and likely reflects changes in the overall consumption of alcohol.

ALCOHOL RELATED PROBLEMS IN RUSSIA AND BELARUS: A COMPARATIVE ANALYSIS OF TRENDS

Goal: in present article comparative analysis of trends in alcohol-related problems rates (violent mortality, fatal alcohol poisonings, alcoholic psychoses), alcohol sales per capita, socioeconomic parameters in Russia and Belarus in soviet (1970-1991) and post-soviet (1992-2015) periods were analyzed.
 Materials and methods. As indicators of alcohol problems were used the mortality rate from external causes, the mortality rate from acute alcohol poisoning and the incidence of alcoholic psychoses. As an integral indicator characterizing the health status of the population was used the indicator of life expectancy at birth.
 Results: the results of correlation analysis suggest that alcohol sales is a statistically significant associated with alcohol-related problems rates in both countries during the Soviet period. However, there was no relationship between this variables during the post-Soviet period. The outcomes of this study indicate that psychosocial distress and macroeconomy were important determinants of fluctuations in alcohol-related problems rates in both countries. In the context of alcohol policy this mean that decrease in economic and physical availability of alcohol should be considered as a main priority.

Fatal Alcohol Poisonings and Poisonings by Other Toxic Substances in Russia

Background: It is widely believed that one of the negative consequences of Gorbachev’s anti-alcohol campaign in Russia in the mid-1980s was the dramatic growth in the number of deaths from poisonings by non-beverage alcohol surrogates. Objective: This paper aims to clarify this important issue by analyzing the trends in fatal alcohol poisonings and poisonings by other toxic substances in Russia between 1956 and 2005. Methods: To examine the relation between fatal alcohol poisonings and poisonings by other toxic substances trends across the study period a time series analysis was performed using the statistical package “Statistica 12. StatSoft”. Results: The alcohol poisonings mortality rates for both sexes dropped sharply between 1984 and 1988. Substantial reduction was also recorded in the number of deaths from poisonings by other toxic substances in the mid-1980s. According to the results of time-series analysis there was a positive and statistically significant association between fatal poisonings by alcohol and poisonings by other toxic substances at the population level. Conclusion: The official statistical data do not support the claims that the Gorbachev’s anti-alcohol campaign contributed to the dramatic growth in fatal poisonings by non-beverage alcohol surrogates.

Assessing data on mortality from external causes: Case study of the Republic of Bashkortostan

The article addresses the poor quality of mortality statistics due to external causes, as figures are understated in Russia and its federal subjects. The actual death rates for homicides, suicides, and alcohol poisonings in the Republic of Bashkortostan have been reviewed based on the suggested models. According to models 1–3, on average, homicide mortality is estimated to be 1.6 times higher for males and 1.4 times higher for females compared to the officially reported data; suicide mortality rates are 1.2 times higher for both genders, while fatal accidental poisonings by alcohol are 1.8 times higher among males and 2.1 times higher among females. Model 4 predicts the gain in homicide mortality to be 3.8 and 3.2 times that for males and females, respectively, and the increase in suicide mortality to be 1.4 times higher for males and 2 times higher for females. Last but not least, mortality from fatal alcohol poisoning is predicted to be 3.0 times and 5.9 times higher than the officially reported rates. The mortality rate from the all so-called external causes is expected to increase by 1.2 times among males and by 1.4 times among females, mainly due to the increase in mortality levels in working-age groups (15–60).

Fatal Alcohol Poisonings and Gender Gap in Life Expectancy in Russia

Fatal Alcohol Poisonings and Gender Gap in Life Expectancy in Russia

The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act

We examine the early effects of U.S. state Medicaid expansions under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization. We couple administrative data on admissions to specialty SUD treatment and prescriptions for medications used to treat SUDs in outpatient settings with a differences-in-differences design. We find no evidence that admissions to specialty treatment changed in expanding states relative to non-expending states. However, post expansion, Medicaid-reimbursed prescriptions for medications used to treat SUDs in outpatient settings increased by 33% in expanding states relative to non-expanding states. Among patients admitted to specialty SUD treatment, we find that in expanding states Medicaid insurance and use of Medicaid to pay for treatment increased by 58% and 57% following the expansion. In an extension to the main analyses we find no evidence that the expansions affected fatal alcohol poisonings or drug-related overdoses. Overall, our findings provide evidence on the early effects of the ACA on SUD treatment utilization with the newly-eligible Medicaid population.

Alcohol poisoning and epidemiological alcoholism parameters in Russia

A comparative analysis of trends in fatal alcohol poisonings and incidence of alcoholism and alcoholic psychoses was carried out. The results of distributed lags analysis suggest positive relationship between trends in fatal alcohol poisonings and incidence of alcoholic psychoses. The relationship between trends in fatal alcohol poisonings and incidence of alcoholism was also positive but statistically not significant. These findings suggest that alcoholic psychoses incidence rate is more reliable indicator of alcohol-related problems than alcoholism incidence rate.

Fatal Alcohol Poisonings and Traffic Accidents in Russia

IntroductionRoad traffic injuries are the eight leading cause of death globally, and the leading cause of death for children and young adults [1,2]. According to prognosis, the worldwide road traffic injuries rank among the causes of death will climb to the fifth place by 2030, resulting in an estimated 2.4 million fatalities each year [2]. It is estimated that in the European Union 1.3 million road traffic accidents occur each year, resulting in 1.7 million injuries and over 40 000 deaths annually [3]. The direct and indirect costs of these accidents sums up to 160 billion euro, equal to 2% of the gross national product of the EU [2].Alcohol has been identified as one of the most significant risk factors for road traffic crashes in many developed and developing countries of the world [4]. At the individual level, there is dose-response relationship between alcohol consumption and fatal road traffic accidents, with risk of death increas-. ing non-linearly with increasing alcohol consumption [3]. Zador estimated that each 0.02 increase in a driver's BAC nearly doubled the risk of fatal crash [5]. It has been also estimated that the likelihood of being a fatally injured driver was at least 9 times greater at BACs of 0.05 to 0.09% than at zero BAC [4].Several studies report the positive association between alcohol consumption and traffic fatalities at the aggregate level. Skog evaluated the effects of changes in aggregate alcohol consumption on fatal motor vehicle traffic accidents in 14 western European countries after 1950 [6]. For male traffic accidents, significant relationships were uncovered in central and southern Europe, but not in northern Europe. Among females the effect was significant only in central Europe [6]. A more recent time series analysis based on Belarusian data for the period from 1970 to 1999 reported a close link between vodka sales per capita and road traffic fatality rates [7].Russia has one of the world's highest road traffic fatality rates due to drunk driving, poor road conditions, an outdated vehicle fleet [8,9]. Each year, approximately 30 000 Russians die in road accidents - about the same as in the European Union [2]. Road safety has attracted attention at the top levels of Russian politics, receiving mention in Putin's 2006 Annual Address to the Federal Assembly and serves as the centerpiece of a national speech by Medvedev in August 2009 [9].There is common believe that high level of alcohol consumption in conjunction with binge drinking pattern is a major determinant of high violent mortality rates in Russia [7,10-12]. Over the past 10 years, almost 40 000 Russians have died in road accidents caused by drunk drivers [9]. A large retrospective case-control study in three Russian industrial cities found dose-response association between alcohol consumption and mortality from road accidents: drinking of three or more bottles of vodka per week was strongly associated with deaths from road accidents both among men (RR= 4.20; CI: 3.31-5.34) and women (RR= 4.48; CI: 3.385.96) [13]. Although drunk driving officially accounts for 7,2% of all road traffic crashes at the national level, its proportion increases to one-fifth in some federal regions [9]. Furthermore, the most recent individual-level estimates suggest that 46.1% of all deaths from road accidents (47.7% and 41.0% of deaths among men and women respectively) were attributable to alcohol consumption [14].In line with this evidence we assume that a combination of higher level of alcohol consumption per capita and binge drinking of vodka results in a close association between alcohol and mortality from road accidents in Russia. To test this hypothesis trends in mortality from road accidents and fatal alcohol poisoning rates from 1970 to 2013 in Russia were analyzed employing time-series analysis.Material and methodsDataThe data on sex-specific road traffic fatality and fatal alcohol poisoning rates per 1 000 000 of the population were taken from the Russian vital statistics registration system. …

Forecasting of fatal alcohol poisonings rate in Russia

This article tests the possibility of forecasting of fatal alcohol poisonings rate in Russia using the analysis of time series from 1956 to 2013. The results from present study support the hypothesis that a change in the affordability of alcohol was the key determinant of dramatic fluctuations in the fatal alcohol poisonings rate in Russia during the last decades. Most visible effect of measures on restriction of alcohol’s availability was during antialcohol campaign 1985-1988 and following the adoption of new antialcohol initiatives in 2005. This study highlighted the limitations associated with forecasting of fatal alcohol poisonings rate using extrapolation of time series. Adoption of new antialcohol initiatives in 2005 appeared as an intervention witch effected the trends in fatal alcohol poisonings rate. This suggests that different kinds of social interventions hamper reliable forecasting of fatal alcohol poisonings rate.

Fatal poisonings in Finland during the years 2004–2009

Fatal alcohol and drug poisonings in Finland during the years 2004-2009 were studied. Cases were divided into those that occurred outside the hospitals (the majority of cases) and those that occurred within the hospitals (the minority of cases). Differences and similarities between the two groups were analysed. The postmortem toxicological investigation of all sudden and unexpected deaths in Finland is centralised at the Department of Forensic Medicine, University of Helsinki. We examined each fatal poisoning separately and verified the cause and place of death as well as the age and sex of the deceased. Fatal poisonings, including suicides, have remained unchanged for many years from the same high level, that is, about 1200 cases annually (22/100,000 inhabitants). The number of patients dying in hospitals due to poisoning has also remained stable (55-70 patients/year). However, the toxic agents involved in such poisonings have changed and deaths due to opioids are now being more numerous. The number of fatal unintentional drug poisonings rose significantly from 191 to 341 (3-6/100,000 inhabitants, p < 0.001) during the study years, and the difference between poisonings caused by drugs or alcohol also changed significantly (p < 0.001). Diminishing substantially, the number of all fatal poisonings will be challenging because of the high percentage of suicides. However, a reduction in unintentional drug overdoses, which are presently on the rise, should be possible.

P03-468 - Suicide and fatal alcohol poisoning among rural and urban population of Belarus

BackgroundIn most countries suicide rates are generally higher in rural than in urban areas. In many countries there has been a disproportionate increase in rural suicide contributing to greater rural/urban gradient. A wide range of factors, including social isolation, material deprivation and unfavorable changes in the demographic structure, have been cited as possible reasons for comparatively higher suicide rates in rural community. Given that alcohol abuse is a major risk factor for autoagressive behavior, we assume that alcohol may be the reason behind rural/urban gradient in suicide.AimThe aim of this study was to examine the suicide and fatal alcohol poisoning rates (as a proxy for binge drinking) among rural and urban population of Belarus.MethodUsing country age-adjusted, gender-specific mortality data between 1990 and 2005, we estimated rural/urban differentials in suicide and fatal alcohol poisoning rates over time. Results: Significant rural/urban gradient in suicide and fatal alcohol poisoning rates was found. The gradient increased consistently, suggesting widening rural/urban differentials across the period. The results of the correlation analysis indicate the presence of close association between the two variables for rural man and women.ConclusionThe increase rural/urban gradient in suicide observed in this study might to some degree reflect differentials changes over time in the alcohol-related problems rate for rural and urban population.

Suicide and fatal alcohol poisoning in Russia, 1956–2005

Background: The association between alcohol and suicide is well documented. The role of binge drinking patterns in the alcohol–suicide relationship is a very important issue today. The solid body of research and empirical evidence suggests that hazardous patterns of alcohol consumption (binge drinking) lead to a quicker and deeper intoxication, increasing the propensity for alcohol-related suicide.Purpose: To estimate the aggregate level effect of binge drinking on the suicide rate in the ‘wet’ Russian drinking culture.Method: Trends in age-adjusted, sex-specific suicide and fatal alcohol-poisoning rate (as a proxy for binge drinking) from 1956 to 2005 in Russia were analysed employing an ARIMA analysis in order to assess bivariate relationship between the two time series.Results: The results of the time-series analysis indicates the presence of a statistically significant association between the two time series at zero lag for male (r = 0.79; SE = 0.14), and for female (r = 0.58; SE = 0.14).Conclusion: The present study replicates previous findings from other settings that suggest positive association between alcohol and suicide at aggregate level. Support is thus provided for the hypothesis that suicide and alcohol are closely connected in cultures where intoxication-oriented drinking patterns prevail and these results add to the growing body of evidence that alcohol played a crucial role in the fluctuation in suicide mortality rate in Russia during the last decades.

All‐cause mortality and fatal alcohol poisoning in Belarus, 1970–2005

Although alcohol appears to be an important contributor to the burden of disease in the countries of eastern Europe, little systematic research has been undertaken on its impact on mortality in the former Soviet republic of Belarus. There may be a number of factors underlying the particularly negative effect of alcohol on mortality in Belarus, including the pattern of drinking and use of surrogates. A solid body of research and empirical evidence suggests that hazardous patterns of alcohol consumption (binge drinking) lead to quicker and deeper intoxication, increasing the propensity for alcohol-related mortality. To estimate the aggregate level effect of binge drinking on the all-cause mortality rate, trends in the all-cause mortality and fatal alcohol poisoning rates (as a proxy for binge drinking) in Belarus from 1970 to 2005 were analysed employing AutoRegressive Integrated Moving Average (ARIMA) time-series analysis in order to assess a bivariate relationship between the two time-series. The results of time-series analysis suggest a close relationship between all-cause mortality and fatal alcohol poisoning rates at the population level. This study supports the hypothesis that alcohol and all-cause mortality are connected closely in countries where the drinking culture is characterised by heavy drinking episodes and adds to the growing body of evidence that a substantial proportion of total mortality in Belarus is due to acute effects of binge drinking.

ALCOHOL AND DEATH-RATE FROM PANCREATITIS: POPULATION LEVEL OF INTERCONNECTION

In present work we focused on comparative analysis trends of mortality due to pancreatitis and fatal alcohol poisoning in Russia in 1965-2005. ARIMA time series analysis suggests a positive association between pancreatitis mortality rate and fatal alcohol poisoning rate for male (r = 0,74; SE = 0,14), and female (r = 0,50; SE = 0,14) at zero lag. According to outcomes of present study the intoxication-oriented pattern of alcohol consumption is a risk factor for mortality due to pancreatitis for male, as well as for female.

Intoxicación etílica y mortalidad por úlcera duodenal en Rusia, 1965-2005

Peptic ulcer disease is a common clinical problem. Binge drinking has been shown to increase the risk of ulcer at the individual level. To estimate the aggregate level effect of binge drinking on duodenum ulcer mortality rate. Trends in age-adjusted, sex-specific fatal alcohol poisoning and duodenum ulcer mortality rates in Russia from 1965 to 2005 were analyzed employing an ARIMA analysis in order to asses a bivariate relationship between the two time series. Time series analysis indicate the presence of statistically significant association between the two series for male (r = 0.51; SE = 0.16). The association between the two time series for female is also positive, however, statistically not significant (r = 0.25; SE = 0.14). This paper present new epidemiological evidence of aggregate level relationship between alcohol and duodenum ulcer mortality rate. The outcome of this study also supports the hypothesis that binge drinking of strong spirits is a risk factor of ulcer at the individual level.

Suicide and fatal alcohol poisoning in Belarus between 1970 and 2005

Suicide and fatal alcohol poisoning in Belarus between 1970 and 2005

Evaluation of Certifier Practices Regarding Alcohol-Related Deaths

Alcohol can contribute to various manners of death by acute intoxication that places a person at risk for fatal injury, acute fatal alcohol poisoning, or the various fatal complications of chronic abuse with or without superimposed acute intoxication. The reporting of alcohol use on the death certificate may vary with office policy or procedure, certifier judgment, and the timing of information received during investigation. To determine the number of deaths including mention of alcohol use in the investigative case file, the number of death certificates on which alcohol use is reported, the number of discrepancies between the 2, and the possible reasons for observed discrepancies. Retrospective case review of all deaths where alcohol use was mentioned in the investigative case file and/or on the death certificate for deaths investigated by the Fulton County Medical Examiner in Atlanta, Georgia, during a 1-year period between January 1, 2004, and December 31, 2004. Percentage of deaths with alcohol use reported on the death certificate, tabulation of where and how alcohol use is reported on the death certificate, and tabulation of the differences between the investigative case file and death certificate regarding alcohol's possible role in causing death. Among the 1324 deaths certified by the office, 105 (8%) had alcohol use reported on the death certificate. The majority (67%) of these cases were natural deaths. Sixty-nine (5%) deaths had mention of alcohol use in the investigative case notes but did not include it on the death certificate. Twenty-five (2%) deaths had mention of alcohol on the death certificate but did not have mention of it in the investigative case file based on our search criteria. However, subsequent review of additional case follow-up information disclosed a history of alcohol use or acute intoxication in each case. The data show that more natural deaths are considered to be directly caused by alcohol than other manners of death. For the unnatural manners of death (excluding acute alcohol poisoning), alcohol use is often viewed by medical examiners as an incidental, associated finding or risk factor surrounding the circumstances of death rather than being an actual cause of death. In such cases, alcohol use is often omitted from the death certificate. For deaths directly caused by alcohol, the proportion of cases involving possible underreporting or overreporting of alcohol involvement was relatively small and usually involved the omission of chronic alcohol use from the death certificate. Researchers need to be aware of potential limitations of death certificate data for studying alcohol-related deaths.

Suicides and alcohol consumption in Russia, 1965–1999

Background: Abrupt changes in the alcohol consumption level and the suicide rate associated with the anti-alcohol campaign of 1985–1991 and the market reforms of 1992. Methods: Epidemiological investigation of total Russian suicide rate and per capita alcohol consumption utilizing the Box–Jenkins technique and regression analysis. Results: The decrease of per capita consumption from 14.2 to 10.5 l in 1985–1987 and the growth of this index after 1987 (14.6 l in 1994) saw a respective decline and increase of suicides per litre of alcohol: eight males and one female per 100,000 of the corresponding population (13 or 6% of male or female suicides and 12% total suicides). The maximum suicide rate was reached in 1994 (41.8 per 100,000 population, in 1981–1994 r=0.91). In 1984–1986 and 1991–1994 the distribution of suicides’ age was close to that of the age distribution from fatal alcohol poisoning. Changes in the level of BAC-positive suicides are closely correlated with changes in the alcohol consumption level ( r=0.98), whereas changes in the number of BAC-negative suicides were not related to changes in consumption. Conclusion: Alcohol consumption level plays a considerable role in the suicide rate, especially for male suicides. The rate of alcohol-related suicides is very high in Russia, owing to the very high alcohol consumption rate in the country.

Alcohol sales and fatal alcohol poisonings: a time-series analysis.

To discover whether the number of fatal alcohol peaks during festivities characterized by unrestrained drinking and relates to sales of alcoholic beverages. Time-series and cross-sectional. Fatal alcohol poisonings and retail alcohol sales in Finland in 1983-99. Fatal alcohol poisonings were found to peak during weekends and in the May Day, Midsummer Day and Christmas celebrations. Regression analysis of quarterly series lead to a model showing that 1% increase in the sales of spirits increases the number of fatal alcohol poisonings by 0.4%. At the population level, increases in the sales of spirits and periods of hard drinking seem to increase deaths from alcohol poisoning. The findings could be of use in efforts to decrease hard drinking.