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Prevalence of alcohol‐related pathologies at autopsy: E stonian F orensic S tudy of A lcohol and P remature D eath
Author(s) -
Tuusov Jana,
Lang Katrin,
Väli Marika,
Pärna Kersti,
Tõnisson Mailis,
Ringmets Inge,
McKee Martin,
Helander Anders,
Leon David A.
Publication year - 2014
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12695
Subject(s) - autopsy , medicine , confidence interval , alcohol , alcoholic liver disease , urine , cause of death , pathology , gastroenterology , physiology , disease , biology , cirrhosis , biochemistry
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 E stonia 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. T he E stonian S tatistics O ffice 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 E stonia 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.