Prevalence of alcohol‐related pathologies at autopsy: E stonian F orensic S tudy of A lcohol and P remature D eath
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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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This under-reporting of alcoholic liver cirrhosis has persisted in later studies.
“This under‐reporting of alcoholic liver cirrhosis has persisted in later studies 294, 295, 296; this seems to be the case for all disease categories fully attributable to alcohol use 296, 297 including, but not limited to, the disclosure of alcohol use disorders.”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [296]
This under-reporting seems to be the case for all disease categories fully attributable to alcohol use including, but not limited to, the disclosure of alcohol use disorders.
“this seems to be the case for all disease categories fully attributable to alcohol use 296, 297 including, but not limited to, the disclosure of alcohol use disorders.”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [296]
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- Authors
- Tuusov, J., Lang, K., Väli, M., Pärna, K., Tõnisson, M., Ringmets, I., McKee, M., Helander, A., & Leon, D. A.
- Affiliations
- University of Tartu (EE)
- Tartu University Hospital (EE)
- London School of Hygiene & Tropical Medicine (GB)
- Karolinska Institutet (SE)
- Corresponding author
- Tuusov, Jana
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2014-08-28
- Volume
- 109
- Issue
- 12
- Pages
- 2018-2026
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC4241049
- OpenAlex
- W1587067571
- Cited by
- 20
- References
- 27
- Citations by year
- 2025: 3 · 2024: 2 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 1 · 2015: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Addiction (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Wellcome Trust (078557)
- Estonian Science Foundation (8847)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- alcohol-related mortality, premature mortality, alcohol biomarkers, alcoholic liver disease, alcohol-related heart disease, underlying cause of death, cause of death classification, alcohol consumption, Estonia
- MeSH terms
- Adult, Autopsy, Cause of Death, Cross-Sectional Studies, Estonia, Humans, Male, Middle Aged, Statistics as Topic, Biomarkers, Alcohol-Related Disorders, Mortality, Premature
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