Relationship between betahydroxybutyrate (BHB) and acetone concentrations in postmortem blood and cause of death.

Unexpected death caused by diabetic or alcoholic ketoacidosis is easily overlooked due to the non-specific symptoms. Although the acid betahydroxybutyrate (BHB) is the most abundant ketone body formed in conditions with ketoacidosis, routine analysis in postmortem investigations often only includes the neutral ketone body acetone. This study aims to evaluate the usefulness of implementing routine BHB analysis in postmortem cases, by investigating the relationship between BHB and acetone concentrations in postmortem blood and the main cause of death. From our database of forensic autopsy cases examined from 2012 to 2015, there were 376 cases with BHB and/or acetone detected in postmortem blood that could be paired with data from the Norwegian Cause of Death Registry. Cases were categorized into three groups based on cause of death: "Diabetes-related" (n = 38), "Alcohol-related" (n = 35) and "Other" (n = 303). Analysis of BHB in blood was performed using UHPLC-MS/MS (limit of quantification (LOQ) 52 mg/L) and of acetone using HS-GC-FID (LOQ 87 mg/L). For the purpose of the study, the acetone method was also validated for a LOQ of 23 mg/L. The median BHB concentration was significantly higher in the group of diabetes-related deaths (671 mg/L, range 68-1311 mg/L) compared to the group of alcohol-related (304 mg/L, range 65-1555 mg/L, p <0.001) and other causes of deaths (113 mg/L, range 0-1402 mg/L, p <0.001). In seven deaths (1.9%), the BHB blood concentration was above the suggested pathological threshold of 250 mg/L, without detection of acetone in blood above 23 mg/L. In 15% of deaths by other causes than diabetes or alcohol, a pathologically significant BHB blood concentration was detected. Our results indicate that BHB is a more reliable marker of pathologically significant ketoacidosis than acetone, and we suggest that BHB should be routinely analyzed in postmortem investigations.

[Differences by sex and income level in mortality from causes directly related to alcohol in Navarre, 1993-2017]. / Diferencias por sexo y nivel de renta en la mortalidad por causas directamente relacionadas con el alcohol en Navarra, 1993-2017.

BACKGROUND: Alcohol consumption is a risk factor for many health problems. Mortality from causes of death wholly attributable to alcohol consumption by sex and income level was studied and trends in the 1993-2017 period were analyzed in Navarre (Spain). METHODS: Deaths due to alcohol-induced mental disorders, dependence and abuse, alcoholic cardiomyopathy, alcoholic cirrhosis and other alcoholic liver diseases, and accidental alcohol poisoning were selected through codes ICD-9 and ICD-10. Annual income that determines copayment level was used as an indicator of socioeconomic status. Mortality rates adjusted to the European standard population were calculated using the direct method and joinpoint regression was used to evaluate the temporal trend. RESULTS: A total of 441 deaths were recorded in the population aged 35-79 years. It highlights liver cirrhosis as the most common cause (77,5%). Death rates in men were ten and five times higher than in women in 1993-1997 and 2013-2017 periods, respectively. Compared to men with incomes above 18,000 €, mortality rates were five times higher in the population with incomes below 18,000 €. No statistically significant changes were observed in the trend of mortality rates throughout the period studied. CONCLUSIONS: Mortality by causes of death wholly attributable to alcohol has not decreased in Navarre in the last three decades, it is higher in men than in women and in the population with lower incomes.

Las cifras del abuso de alcohol en España: cerca de 420.000 muertes en el siglo actual / Alcohol abuse numbers in Spain: nearly 420.000 deaths in current century

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[Alcohol-associated mortality in Russia (based on the materials for the period from 2011 till 2016)]. / Alkogol'-assotsiirovannaia smertnost' v Rossii (po materialam 2011-2016 gg.).

The objective of the present study was to evaluate the frequency of alcoholic drunkenness documented during forensic medical expertises (investigations) of the corpses carried out in this country throughout the period from 2011 till 2016. The investigations were conducted with the use of medical statistics methods by calculating the fractional difference, dynamics, and rates of detection of the cases of alcoholic intoxication depending on the cause of death. The study has demonstrated the high frequency of the cases of alcoholic drunkenness revealed during forensic medical expertises (investigations) of the corpses that amounted to 30.5% [15, 16]. The total number of the corpses examined in 2016 was 8.6% higher than in 2011. The frequency of the documented cases of alcoholic drunkenness during the same period decreased by 19.7%. The frequency of the documented cases of alcoholic drunkenness in the cases of violent death was 2.8 times that in the cases of death from various diseases (52.8 and 19.0% respectively). The enhanced frequency of alcoholic drunkenness in relation to the number of the conducted forensic medical expertises was documented in the cases of death by drowning and from hypothermia whereas the lowest frequency of alcoholic intoxication was recorded for the corpses of the people who had died from malignant tumours and diseases of the nervous system. Various regions of Russia differed in terms of the frequency of alcoholic drunkenness recorded among the recently deceased people.

Mortality from diseases, conditions and injuries where alcohol is a necessary cause in the Americas, 2007-09.

AIMS: To describe mortality from diseases, conditions and injuries where alcohol was a necessary cause in selected countries in the Americas. DESIGN: A descriptive, population-based study. SETTING: The data come from 16 countries in North, Central and South America for the triennium 2007-09 (latest available data). PARTICIPANTS/CASES: A total of 238 367 deaths were analyzed. MEASUREMENTS: We calculated age-adjusted and age-specific mortality rates by sex and country using the Pan American Health Organization (PAHO) mortality database. FINDINGS: The annual average of deaths where alcohol was a necessary cause in the 16 countries was 79, 456 (men comprised 86% and women 14%). People aged 40-59 years represented 55% overall. Most deaths were due to liver diseases (63% overall) and neuropsychiatric disorders (32% overall). Overall age-adjusted rates/100,000 were higher in El Salvador (27.4), Guatemala (22.3), Nicaragua (21.3) and Mexico (17.8) and lower in Colombia (1.8), Argentina (4.0) and Canada (5.7). The age groups at the highest risk were 54-59 to 64-69 years in most countries. In Guatemala, El Salvador and Nicaragua the rates increased earlier, among those aged 30-49 years. Male rates were higher than female rates in all countries, but the male : female ratio varied widely. CONCLUSIONS: Diseases, conditions or injuries where alcohol is a necessary cause are an important cause of premature mortality in the Americas, especially among men. Some countries show high risk of dying from this group of causes.

Alcohol-attributable mortality and years of potential life lost in Chile in 2009.

AIMS: The aim of the study was to estimate mortality and years of potential life lost (YPLL) attributable to alcohol consumption in 2009 in Chile. METHODS: The population considered for this study included those 15 years and over. Exposure to alcohol in the population was estimated by triangulating the records of alcohol per capita consumption in Chile with information from the Eighth National Study of Drugs in the General Population (2008). The effect of alcohol consumption on each cause of death (relative risk) was extracted from previously published meta-analyses. With this information we estimated the alcohol-attributable fraction (AAF) and deaths and YPLL due to alcohol consumption. The confidence intervals for the AAF were estimated with Monte Carlo sampling using the estimated variances of the exposure prevalence and relative effect. RESULTS: The estimated total number of deaths attributable to alcohol consumption was 8753 (95% CI: 6257, 11,584) corresponding to 9.8% (95% CI: 7.01%, 12.98%) of all deaths in Chile in 2009. The total estimated YPLL attributable to alcohol were 195,475 (95% CI: 164,287, 227,726), corresponding to 21.5% (95% CI: 18.1%, 25.0%) of total YPLL for that year in Chile. CONCLUSION: Alcohol consumption is a major risk factor and accounts for nearly one of ten deaths in Chile. These results may be used to guide the design of public health policies and evaluations.

Opportunities for prevention of alcohol-related death in primary care: results from a population-based cross-sectional study.

The mortality rate from alcohol-related conditions has risen sharply in the United Kingdom and it is not known whether opportunities for preventive interventions could be improved. The purpose of our study was to identify opportunities to detect, assess, and manage alcohol problems in primary care according to evidence-based guidelines. We carried out a cross-sectional study on patients who died from alcohol-related conditions in the calendar year 2003 within National Health Service Greater Glasgow Health Board area, Scotland (population 920,000). We described patient characteristics and care recorded in health service records, comparing it with best evidence-based practice in Scottish Intercollegiate Guidelines Network and Health Technology Board for Scotland recommendations on the management of harmful drinking and alcohol dependence. 501 deaths occurred from an alcohol-related cause. The mean age at death was 57.5 years and 72% were male. The most common causes of death, recorded by the International Classification of Diseases, revision 10, excluding accidents, were alcoholic liver disease (290, 57.9%) and mental and behavioural disorders due to alcohol (70, 14.0%). Lifetime mean consultations at primary care general practitioner and hospital outpatient departments were 24 in males and 5 in females. All individuals who died from an alcohol-related cause had at least one biochemical or physical indicator suggestive of alcohol misuse. 21% (95% CI 13-33%) had no record of having been advised to abstain from alcohol and 23% (95% CI 15-35%) had received brief interventions. 58% (95% CI 46-70%) had been referred to specialist alcohol services but a third of them did not attend. The majority of patients (83%, 95% CI 72-90%) had no evidence of shared health service and social work care. We concluded that individuals who died from alcohol-related conditions were usually in contact with statutory and voluntary services but further efforts were required to use these opportunities to detect, assess, and manage serious alcohol problems according to evidence-based guidelines.

[Impact of alcohol use disorder on mortality: are there age and gender differences?]. / Impacto del trastorno por consumo de alcohol en la mortalidad: ¿hay diferencias según la edad y el sexo?

OBJECTIVES: To estimate excess mortality in patients with an alcohol use disorder and to calculate the population-based impact attributable to this disorder, with emphasis on differences according to gender and age. METHODS: We carried out a longitudinal study of a dynamic retrospective cohort in which 7,109 patients (76.5% men) aged 18-64 years who started medical day treatment between 1997 and 2006 were recruited. Deaths were monitored until the end of 2006 using a national mortality register. Standardized mortality ratios (SMR) by age and gender and population attributable risks (PAR) by age group were estimated. RESULTS: There were 557 deaths (83% were men). The total excess mortality was 8 times higher than in the general population aged 18-64 years, especially in the group aged 25-34 years old (SMR: 11.2 [95% CI: 7.8-16.0] in men and 24 [IC95%: 11.5-50.4] in women). Significant differences by gender were found in all the variables analyzed. In Barcelona, alcohol use disorder was estimated to cause 73 deaths per year, representing 3.3% of the total annual deaths in this city in persons aged 18-64 years. This percentage was substantially higher in the groups aged 25-34 years (PAR: 19.4% [95% CI: 19.2-19.6]) and 18-24 years (PAR: 11.1% [95% CI: 10.7-11.4]). CONCLUSIONS: Women and young men with an alcohol use disorder have a higher risk of early mortality. Early detection of problematic alcohol consumption and selective and well-indicated prevention programs should be improved.

Acidentes de trânsito e a frequência dos exames de alcoolemia com vítimas fatais na cidade do Rio de Janeiro / Traffic accidents with fatal victims and alcohol consumption in Rio de Janeiro City / Accidentes de tránsito y la frecuencia de los exámenes de alcoholemia con víctimas fatales en la ciudad del Rio de Janeiro

Estudo epidemiológico descritivo. O objetivo foi analisar os óbitos por acidentes de trânsito, registrados no Instituto Médico Legal (IML), na cidade do Rio de Janeiro, segundo a frequência de realização dos exames sobre os níveis de alcoolemia. Foram analisados 533 prontuários, no período de seis meses, que corresponderam a 12,3% do total de mortes registradas. Evidenciou-se que o exame de alcoolemia foi prioritariamente realizado nas vítimas que vieram de via pública e deram entrada no IML nas primeiras 12 horas após o acidente. A realização dos testes de alcoolemia teve significativa relação com o tempo decorrido entre o acidente e o óbito. Identificou-se, contudo, grande perda de oportunidade de realização do exame para um grande número de vítimas vindas diretamente de via pública nas primeiras 12 horas do acidente (50,1%), colaborando para uma subnotificação dos verdadeiros números de álcool no trânsito.

[Spectrum of hazardous alcohol use]. / A kockázatos alkoholfogyasztás spektruma.

We speak of hazardous drinking if the drinker runs the risk of developing drinking-related problems, while the diagnosis of alcohol abuse or alcohol dependency cannot yet be made based on formal criteria. Drinking involves a significant risk if it exceeds a certain quantity and frequency (even if the exact threshold values or their calculation methods are still debated); if it is associated with hazardous situations (sports, driving) and states (pregnancy, various cardiovascular diseases); if there is a high level of aggressivity in the drinker's personality traits and behaviour; if the drinker is a growing child or adolescent, a woman or an elderly person; if the "executive functioning" of the drinker is weak; if the external and internal stimuli related to drinking are conditioned to the effect of alcohol, and the drinker subsequently consumes the same quantity in an unaccustomed environment.

Mortalidade nos acidentes de trânsito na cidade do Rio de Janeiro relacionada ao uso e abuso de bebidas alcoólicas / Prevalence of alcoholemy in fatal victims of traffic accidents in the city of Rio de Janeiro

Os acidentes de trânsito representam relevante papel no conjunto das principais causas de morbimortalidade no mundo contemporâneo. O presente estudo teve como objetivo descrever, a mortalidade decorrente de acidentes de trânsito, registrados no IML, na cidade do Rio de Janeiro, e investigar a sua relação com a alcoolemia apresentada nas vítmas. O estudo foi epidemiológico, exploratório e descritivo...

The effects of smoking and drinking on cardiovascular disease and risk factors.

Research on how tobacco and alcohol use interact to influence risk for cardiovascular disease is limited. Alcohol consumption of three or more drinks per day and cigarette smoking share similar, and probably additive, effects on some forms of cardiovascular disease. There is relatively little evidence, however, that the effets are worse when smoking and drinking occur together than would be expected from their independent effects. In most cases, moderate drinking does not share these risks and even has opposite effects of cigarette smoking on some risk factors. Ongoing public health efforts to minimize tobacco use and harmful drinking should result in clear and important gains to the nation's cardiovascular well-being.

Trends in mortality attributable to current alcohol consumption in east and west Germany.

There is emerging awareness of alcohol as a cause of the persisting health divide between east and west Germany. This study quantifies the burden of alcohol attributable mortality in the two parts of Germany in the 1990s, taking account of both adverse and beneficial effects of alcohol. We used an epidemiological approach that applies cause-specific alcohol attributable fractions derived from published relative risks and data on the distribution of alcohol consumption in east and west Germany in 1990/1992 and 1998 to mortality data for the two regions in 1992 and 1997, thus producing an estimate of the number of alcohol attributable deaths 'caused' or 'prevented'. Including the cardio-protective effect of alcohol, there were about 1.4% more deaths among men aged 20+ in 1992 in Germany than would have been expected in a non-drinking population, while there were 0.1% fewer deaths among women. By 1997, this had increased to 1.8% excess male deaths and 0.1% excess female deaths. In 1997, alcohol 'caused' 9.0% of all deaths in east German men compared with 5.6% in the west (women east: 2.5%; women west: 2.2%). At the same time, alcohol 'prevented' 5.2% deaths in east German men compared with 4.3% in the west, while there were 2.9% and 2.0% fewer deaths in women. This resulted in a net excess of deaths due to alcohol, except east German women, where 0.3% deaths were estimated to have been averted by alcohol. Although by 1997 net deaths 'caused' by alcohol had increased in the west and declined in the east, the burden of mortality due to alcohol among men remained highest in the east whereas in women the order had reversed.Mortality attributable to alcohol contributes considerably to overall mortality and to the east-west gap in Germany. This study points to the need for comprehensive policies on alcohol in Germany to close the persisting east-west health gap.

Alcohol-related morbidity and mortality.

Alcohol use is related to a wide variety of negative health outcomes including morbidity, mortality, and disability. Research on alcohol-related morbidity and mortality takes into account the varying effects of overall alcohol consumption and drinking patterns. The results from this epidemiological research indicate that alcohol use increases the risk for many chronic health consequences (e.g., diseases) and acute consequences (e.g., traffic crashes), but a certain pattern of regular light-to-moderate drinking may have beneficial effects on coronary heart disease. Several issues are relevant to the methodology of studies of alcohol-related morbidity and mortality, including the measurement of both alcohol consumption and the outcomes studied as well as study design. Broad summary measures that reflect alcohol's possible effects on morbidity, mortality, and disability may be more useful than measures of any one outcome alone.

Characteristics of adult acute poisoning mortality in a large industrial-agrarian region of Bulgaria during socioeconomic transition and crisis (1990-1998).

The severe socioeconomic crisis in Bulgaria, accompanying the transition after the collapse of the totalitarian regime affected unfavorably the health status of the population, increasing the incidence of socially important diseases by making poverty, unemployment, emigration, alcoholism and drug addiction widespread. Systematic studies of acute poisoning suicide and poisoning mortality still lack. To analyze acute poisoning (AP) characteristics during this period in a large industrial-agricultural region of Bulgaria, we retrospectively examined 327 adult AP deaths in Plovdiv region 1990-1998. Males (73.1%) prevail in all age categories. As a caseload men predominate in "working age" categories, women in "pre/retirement age". Mortality rates tended to increase with age, more marked in men. The main cause of death from AP was alcohol intoxication in men (30.1%) and drugs in women (33.7%). Suicides prevailed over accidents (54.1% vs. 45.9%). Accidents were significantly higher in men, suicides in women; 57.5% received no medical aid for more men than women (61.9% vs. 45.5%). Untapped resource for decreasing AP mortality rates are patients who do not receive medical aid and die at home, although that is difficult to correct in a period of crisis.

Hospital morbidity of alcohol use disorders in the center of France.

BACKGROUND: The Auvergne region of central France has the third highest mortality rate in the country for alcohol-related disorders and the highest level of alcohol consumption among young people. METHODS: An exhaustive cross-sectional study of regional hospital morbidity related to alcohol was undertaken on a single day in May 1998, including 9,552 hospital beds. All inpatients age 16 and older in the Departments of Medicine, Surgery, Obstetrics and Gynecology, Psychiatry, and Medium-Stay Services were studied. The aim was to define alcohol-related behavior patterns (by using the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] criteria of abuse and dependence and the CAGE questionnaire) and to measure the proportion of nonsomatic alcohol-related care dispensed in hospital. RESULTS AND CONCLUSIONS: The prevalence of alcohol use disorders in all wards was 20%. Half of these patients were alcohol dependent, a quarter were diagnosed as alcohol abusers, and a quarter had an alcohol-related problem that was not identified during the stay. Alcohol use disorders were more common in male inpatients (34% vs. 8% in female inpatients) and in certain age groups. One male subject in two and one female subject in five between 34 and 45 years had an alcohol-related problem. Almost 25% of male inpatients studied between the ages of 16 and 20 years had an alcohol-related problem, but only half had been diagnosed previously. Hospital care for alcohol-related health problems was seriously inadequate. On average, 38% of patients diagnosed with an alcohol use disorder received relevant nonsomatic alcohol care, of which 13% were alcohol abusers and 50% were alcohol-dependent patients. SIGNIFICANCE: This exhaustive study demonstrates the degree of alcohol-related morbidity among hospitalized patients, which is particularly high in men, in the Auvergne region of France. The study emphasizes the lack of diagnosis, particularly for the young, and the apparent deficiencies in the hospital management of these patients.