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Extremely high sex disparities in adult premature mortality in Estonia 1995–2014: Is a stricter alcohol and tobacco policy needed? Health Policy 2023. [DOI: 10.1016/j.healthpol.2023.104723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Plis SS, Veselkina OV, Klevno VA, Vlassov VV. Mortality in Cases of Acute Alcohol Intoxication in Children: A 10-Year Retrospective Study of the Moscow Region, Russia. Am J Forensic Med Pathol 2022; 43:231-235. [PMID: 35679160 DOI: 10.1097/paf.0000000000000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Russia suffers from high alcohol-related mortality. Most forensic autopsies in Russia include blood alcohol tests, but a systematic analysis of these data has never been conducted for children's deaths. METHODS We performed an analysis of juvenile mortality using autopsy reports from the Moscow Region Bureau of Forensic Medical Examination from January 1, 2009, to December 31, 2018. RESULTS Despite a decrease in incidence ( Rs = -0.661), the number of cases of alcohol intoxication in minors was still high. The mean age of children in our study was 14.77 years (95% confidence interval [CI], 14.31-15.23). Death was predominantly among boys (72%) and those with higher blood alcohol concentrations (mean difference [MD], 0.295; 95% CI MD , 0.012-0.58). The number of cases of unnatural death increased with age ( Rs = 0.746, P = 0.001). Accidents were the most predominant cause of death, followed by suicide, homicide, and natural causes. Fatal alcohol intoxication was observed at an average blood alcohol concentration of 3.58 g/L (95% CI, 1.46-5.7), without any specific signs on autopsy. Even a strong smell of alcohol is an unreliable sign in the clinic. CONCLUSION A systematic study of alcohol in forensic autopsy shows that the number of children who die with alcohol intoxication is high. Teenagers are the predominant age group experiencing alcohol intoxication. In our opinion, an alcohol blood test should be performed in all suspicious cases, especially in teenagers.
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Affiliation(s)
- Semyon S Plis
- From the Department of Forensic Medicine, Moscow Regional Research and Clinical Institute ("MONIKI")
| | | | - Vladimir A Klevno
- From the Department of Forensic Medicine, Moscow Regional Research and Clinical Institute ("MONIKI")
| | - Vasiliy V Vlassov
- Department of Health Care Management and Economics, National Research University Higher School of Economics, Moscow, Russia
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Comments on "Evaluation and review of ways to differentiate sources of ethanol in post-mortem blood". Int J Legal Med 2021; 135:1477-1479. [PMID: 33611668 DOI: 10.1007/s00414-021-02529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
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Rahu K, Rahu M, Zeeb H. Sex disparities in premature adult mortality in Estonia 1995-2016: a national register-based study. BMJ Open 2019; 9:e026210. [PMID: 31315857 PMCID: PMC6661706 DOI: 10.1136/bmjopen-2018-026210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To quantify sex disparities in cause-specific premature adult mortality in Estonia, to determine the causes of death with the largest differences, to provide insight into related behaviours and to offer some guidance to public health policy-makers based on the results of the study. DESIGN A national register-based study. SETTING Estonia. DATA Individual records of deaths at ages 20-69 years in 1995-2016 from the Estonian causes of death register; data on tobacco smoking and alcohol consumption in the adult population in 1996-2016 from the biennial postal survey of health behaviour. MAIN OUTCOME MEASURES Overall and cause-specific age-standardised mortality rates, average annual percentage changes in mortality, and cause-specific men-to-women mortality rate ratios were calculated. In addition, the age-standardised prevalence proportions of tobacco smoking and alcohol consumption and men-to-women prevalence rate ratios were determined. RESULTS Overall premature adult mortality decreased considerably during 1995-2016, but no reduction was observed with respect to the large relative sex disparities. In circulatory disease mortality, the disparities widened significantly over time. Extremely high mortality rate ratios were observed for cancer of the upper aerodigestive tract and for lung cancer. There was a stable, more than fivefold male excess mortality from external causes. A fourfold male disadvantage was evident for alcohol poisoning, mental disorders due to alcohol and alcohol-related degeneration of the nervous system as a group. The prevalence of tobacco smoking and harmful alcohol consumption among men exceeded that among women by factors of two and six, respectively. CONCLUSIONS Even though premature adult mortality has markedly decreased over time, there has been no success in diminishing the large sex differences in the mortality patterns, mostly associated with smoking and excessive alcohol consumption, both more prevalent among men. Estonia needs a comprehensive and consistent alcohol policy while maintaining and further developing antitobacco measures.
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Affiliation(s)
- Kaja Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Mati Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Lepik D, Tõnisson M, Kuudeberg A, Väli M. Glycated haemoglobin (HbA 1c) for postmortem diagnosis of diabetes. Forensic Sci Res 2018; 3:170-177. [PMID: 30483666 PMCID: PMC6197130 DOI: 10.1080/20961790.2018.1452354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/12/2018] [Indexed: 11/24/2022] Open
Abstract
The study was conducted at the Estonian Forensic Science Institute in 2008–2014 as continuous part of our previous study of alcohol and premature death in Estonian men. Autopsy data from 504 cases of male deaths (ages 19–79) were collected and blood and urine samples for glycated haemoglobin (HbA1c), liver enzymes and alcohol concentration were analysed. The aim of our research was to find undiagnosed diabetes and diabetes risk cases postmortem on the basis of increased values of HbA1c. HbA1c was within the reference value 4.8%–5.9% (29–42 mmol/mol), in 88.1% (n = 444) of cases, below reference value in 2.4% (n = 12), in the risk group of diabetes, HbA1c 6.0%–6.4% (42–46 mmol/mol) was within 5.8% (n = 29), and HbA1c result of ≥6.5% (48 mmol/mol) manifested in 3.8% (n = 19) of cases. The higher the age, the more cases with HbA1c value ≥6.0% (42 mmol/mol) occurred. In the group of external causes of death (n = 348), the HbA1c value of ≥6.5% (48 mmol/mol) HbA1c occurred in four cases. The HbA1c value was ≥6.5% (48 mmol/mol) in 78.9% of 156 cases when the cause of death was disease, of which 58% were cardiovascular diseases. The prevalence of diabetes and diabetes risk was found lower compared to population-based study, as majority of the deceased were young and middle-aged males and no females were included. In the case of poisoning with narcotic substances, HbA1c was within the reference range. A negative correlation occurred between alcohol intoxication and HbA1c value. A positive correlation between ALT and HbA1c was found – the higher stage of liver damage correlated with the higher HbA1c level.
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Affiliation(s)
- Delia Lepik
- Department of Pathological Anatomy and Forensic Medicine, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu,Estonia
| | - Mailis Tõnisson
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Southern Estonian Forensic Medical Examination Department, Estonian Forensic Science Institute, Tallinn, Estonia
| | - Anne Kuudeberg
- Department of Pathological Anatomy and Forensic Medicine, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu,Estonia
| | - Marika Väli
- Department of Pathological Anatomy and Forensic Medicine, Faculty of Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu,Estonia.,Management Board, Estonian Forensic Science Institute, Tallinn, Estonia
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Tuusov J, Lang K, Väli M, Pärna K, Tõnisson M, Ringmets I, McKee M, Helander A, Leon DA. Prevalence of alcohol-related pathologies at autopsy: Estonian Forensic Study of Alcohol and Premature Death. Addiction 2014; 109:2018-26. [PMID: 25066373 PMCID: PMC4241049 DOI: 10.1111/add.12695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/09/2014] [Accepted: 07/16/2014] [Indexed: 12/11/2022]
Abstract
AIMS 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. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study included 554 men aged 25-54 in Estonia undergoing forensic autopsy in 2008-09. MEASUREMENTS 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. FINDINGS 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. CONCLUSION 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.
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Affiliation(s)
- Jana Tuusov
- Institute of Pathological Anatomy and Forensic Medicine, University of TartuTartu, Estonia,Estonian Forensic Science InstituteTallinn, Estonia
| | - Katrin Lang
- Department of Public Health, University of TartuTartu, Estonia
| | - Marika Väli
- Institute of Pathological Anatomy and Forensic Medicine, University of TartuTartu, Estonia,Estonian Forensic Science InstituteTallinn, Estonia
| | - Kersti Pärna
- Department of Public Health, University of TartuTartu, Estonia
| | - Mailis Tõnisson
- Estonian Forensic Science InstituteTallinn, Estonia,Internal Medicine Clinic, University of TartuTartu, Estonia
| | - Inge Ringmets
- Department of Public Health, University of TartuTartu, Estonia
| | - Martin McKee
- London School of Hygiene and Tropical MedicineLondon, UK
| | - Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet and Karolinska University LaboratoryStockholm, Sweden
| | - David A Leon
- Internal Medicine Clinic, University of TartuTartu, Estonia,The Arctic University of NorwayTromsø, Norway
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Rehm J, Kailasapillai S, Larsen E, Rehm MX, Samokhvalov AV, Shield KD, Roerecke M, Lachenmeier DW. A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol. Addiction 2014; 109:880-93. [PMID: 24467748 DOI: 10.1111/add.12498] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/27/2013] [Accepted: 01/22/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Unrecorded alcohol constitutes about 30% of all alcohol consumed globally. The aims of this systematic review were to determine the epidemiology (occurrence, types, prevalence) of unrecorded alcohol consumption in different countries/regions, analyse the chemical composition of unrecorded alcohol and examine health outcomes caused by the consumption of unrecorded alcohol, based on either epidemiology or toxicology. METHODS A systematic search for, and qualitative analysis of, papers with empirical results on the different categories of unrecorded alcohol, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Unrecorded alcohol was widespread in all regions of the world. Artisanal fermented beverages and spirits were the most common categories of unrecorded alcohol globally, and were available on all continents. In India, industrially produced spirits (country spirits) were most prevalent. In Russia and countries of the former Soviet Union, surrogate alcohols complemented artisanal spirits. Cross-border shopping was the most prevalent method of obtaining unrecorded alcohol in parts of Europe. Ethanol was the most harmful ingredient of unrecorded alcohol, and health consequences due to other ingredients found in unrecorded alcohol were scarce. However, as unrecorded alcohol is usually the least expensive form of alcohol available in many countries, it may contribute to higher rates of chronic and irregular heavy drinking. CONCLUSIONS Very large amounts of alcohol are produced globally that go unrecorded. The primary harm from this kind of alcohol arises from the fact that it is typically much cheaper than licit alcohol.
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Affiliation(s)
- Jürgen Rehm
- Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Institute of Medical Sciences, University of Toronto (UofT), Toronto, Canada; Dalla Lana School of Public Health, UofT, Toronto, Canada; Dept. of Psychiatry, Faculty of Medicine, UofT, Toronto, Canada; PAHO/WHO Collaborating Centre for Mental Health & Addiction, Toronto, Canada; Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany
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Rainio J, Ahola S, Kangastupa P, Kultti J, Tuomi H, Karhunen PJ, Helander A, Niemelä O. Comparison of ethyl glucuronide and carbohydrate-deficient transferrin in different body fluids for post-mortem identification of alcohol use. Alcohol Alcohol 2013; 49:55-9. [PMID: 24154730 DOI: 10.1093/alcalc/agt159] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Alcohol abuse is a major risk factor for premature death. Confirming the role of alcohol consumption in cause-of-death investigations has, however, remained difficult, due to lack of reliable biomarkers. METHODS We compared ethyl glucuronide (EtG) and carbohydrate-deficient transferrin (CDT) assays from serum, urine, cerebrospinal fluid and vitreous humor in a forensic autopsy population with either a positive (n = 38) or negative (n = 22) history of alcohol abuse based on detailed medical and police records and forensic toxicological investigations. RESULTS A positive blood alcohol concentration (median 1.15‰, range 0-3.3‰) was found in 26/38 (68%) of the cases with a documented history of alcohol abuse. EtG concentrations (mean ± SD) in urine (339 ± 389 mg/l, P < 0.001), vitreous humor (4.2 ± 4.8 mg/l, P < 0.001), serum (6.9 ± 8.9 mg/l, P < 0.01) and cerebrospinal fluid (1.7 ± 2.7 mg/l, P < 0.01) were significantly higher among the cases with a positive history of alcohol use than those in the alcohol-history negative group, whereas in corresponding comparisons CDT was significantly different only in cerebrospinal fluid (4.3 ± 2.1 vs. 2.3 ± 0.6%, P < 0.05). The highest sensitivities (92%) in detecting ante-mortem alcohol use were obtained for urine and vitreous humor EtG assays. CONCLUSION Our data indicate that measurements of EtG in urine or vitreous humor show the highest diagnostic accuracies in post-mortem investigations of excessive alcohol consumption and can be recommended for routine applications.
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Affiliation(s)
- Juha Rainio
- Corresponding author: Seinäjoki Central Hospital, 60220 Seinäjoki, Finland.
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McKee M. Seven goals for public health training in the 21st century. Eur J Public Health 2012; 23:186-7. [DOI: 10.1093/eurpub/cks151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Murphy A, Roberts B, Stickley A, McKee M. Social Factors Associated with Alcohol Consumption in the Former Soviet Union: A Systematic Review. Alcohol Alcohol 2012; 47:711-8. [DOI: 10.1093/alcalc/ags077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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