Hjelt Institute, Department of Forensic Medicine, 00014 University of Helsinki, Finland.
Forensic Sci Int. 2011 Oct 10;212(1-3):121-5. doi: 10.1016/j.forsciint.2011.05.029. Epub 2011 Jun 25.
In the present study we examined how consistently and completely the role of acute alcohol (ethanol) intake as a cause of death is reported on death certificates, how complete and specific the statistical recording of cause-of-death data on acute alcohol-induced deaths is, and how the information ultimately appears in the national mortality statistics. Data on all alcohol-positive deaths with blood alcohol concentration of ≥ 0.5‰ (g/kg) in Finland in 2005 (N = 2348) were reviewed. Overall, a concentration-dependent association was found between forensic-toxicologically determined blood alcohol concentrations and acute alcohol-specific cause-of-death diagnoses. Based on a medico-legal re-evaluation of death certificates, acute alcohol-specific causes were found to be underreported nationally at a rate of 8%. For accidental alcohol poisonings alone, the figure was about 1%. This underreporting was not corrected during recording of the cause-of-death data, though individual corrections and changes were observed. Especially, recording of multiple causes suffers from this underreporting of acute alcohol-specific causes. ICD-10 seems to do well in fulfilling the demands for a specific classification of uncomplicated alcohol poisoning. In combined alcohol-drug poisonings, however, ICD-10 shows a bias towards drugs over alcohol, even when alcohol has been specified and reported as the most toxic component by the medico-legal pathologist. Since the national statistics is based on the underlying causes, this state of affairs is likely to result in the underestimation of the role of acute alcohol intake as a cause of death. This observation of underreporting of acute alcohol-specific causes on death certificates should result in a harmonisation of education and principles and practices used in death certification. To increase the coverage and specificity of mortality statistics, based on the underlying causes of death, the coding of all components of alcohol-drug combinations and their classification according to the most important intoxicant or combination of intoxicants is recommended.
在本研究中，我们考察了在死亡证明中报告急性酒精（乙醇）摄入作为死因的一致性和完整性如何，死因数据的统计记录对急性酒精引起的死亡有多完整和具体，以及这些信息最终如何出现在国家死亡率统计数据中。审查了 2005 年芬兰所有血液酒精浓度≥0.5‰（g/kg）的酒精阳性死亡病例的数据（N=2348）。总体而言，在法医学毒理学确定的血液酒精浓度与急性酒精特异性死因诊断之间发现了浓度依赖性关联。基于对死亡证明的医学法律重新评估，发现全国范围内急性酒精特异性死因的报告率低，为 8%。仅对于意外酒精中毒，这一数字约为 1%。在死因数据记录过程中，并未纠正这种漏报，尽管观察到了个别更正和更改。特别是，多种死因的记录受到急性酒精特异性病因漏报的影响。ICD-10 在满足对单纯酒精中毒的特定分类要求方面表现良好。然而，在酒精和药物混合中毒的情况下，ICD-10 显示出对药物的偏见超过酒精，即使法医学病理学家已指定并报告酒精为最有毒成分。由于国家统计数据基于根本原因，这种情况很可能导致急性酒精摄入作为死因的作用被低估。这种在死亡证明上对急性酒精特异性病因漏报的观察结果应该导致在死亡证明方面的教育以及原则和实践的协调一致。为了提高死亡率统计数据的覆盖范围和特异性，建议对所有酒精和药物组合的成分进行编码，并根据最重要的中毒物质或中毒物质组合对其进行分类，以基于根本死因。
