Alcohol and unnatural deaths in Sweden: A medico-legal autopsy study

Objective: To investigate alcohol involvement in all types of unnatural dea ths in Sweden. Method: All cases of unnatural death that underwent medico-l egal autopsies (1992-1996) in Sweden were analyzed (N = 15,630; i.e., 68% o f all unnatural deaths). Alcohol was regarded as contributing to the death if: (1) there was any indication that the deceased was a "known alcoholic"; (2) the underlying or contributing causes of death were alcohol-related; ( 3) the deceased had alcohol-related inpatient diagnosis during a period of 3 years prior to death; or (4) the case tested positive for blood alcohol. Results: Thirty-nine percent of the blood-tested cases (n = 13,099) were po sitive for alcohol. Almost 40% of the unnatural deaths were associated with alcohol. Alcohol involvement was most common in the intoxication group (84 %), followed by the "undetermined" (65%), homicide (55%), fall (48%), fire (44%), asphyxia (41%), suicide (35%) and traffic (22%) groups. More than ha lf (52%) of the deaths in the age group 30-60 years, 35% of those aged 0-29 years and 25% of those aged 60 and over were associated with alcohol. Conc lusions: In Sweden, two of five unnatural deaths are associated with alcoho l; this is a conservative estimate. Alcohol-associated mortality varies con siderably between different groups of external causes of death, between men and women, and with age.