Bath-related deaths in Kagoshima, the southwest part of Japan

Abstract

In Japan, sudden death in the bathroom (what we call 'bath-related death') has been reported to occur particularly in the elderly population in the winter. This investigation aimed to obtain a better understanding of the factors associated with bath-related deaths. For this purpose, a retrospective review of the inquest records in Kagoshima Prefecture, the southwest part of Japan, during 2006-2007 was performed. There were 338 cases of bath-related death, which corresponds to a crude mortality rate of 9.7 per 100,000 persons per year. The occurrence of bath-related death was similar to that of other prefectures in Japan, despite the warm environment in Kagoshima. The victims' ages ranged from 37 to 101 years (mean 76.6 years) and 88.8% of patients were over 65 years. The associated factors included winter season (56.2%) and a medical history of hypertension (37.3%). These demographic and circumstantial factors correlated with previous studies in Japan. These results suggest that the Japanese method of bathing, in addition to cold bathrooms in winter, contributes to the high rate of bath-related death in Japan. In addition, the mortality rate of people who lived alone was significantly higher than that of those who lived with their families. Most cases occurred in the home bathroom (84.9%) at the time when elderly people usually bathe (48.7%). Our results indicate that bath-related death occurs most often during the normal daily life of the aged. Protective activities of the Japanese government and society should aim to reduce the number of these tragic deaths in the bathroom. Further, no autopsies were performed on the cases in this study. Therefore, the rate of autopsies in bath-related death should be increased in order to accumulate data based on objective evidence.

Reduction in central blood pressure after bathing in hot water

“…In winter, there are 9.7 bath-related deaths per 100 000 people per year, with elderly individuals being at particular risk of such fatalities [1]. Excessive reductions in blood pressure (BP) might be a causative factor in cases of drowning in hot water; therefore, it is important to understand the extent to which central BP decreases after bathing in hot water to prevent individuals from drowning.…”

Characteristics of Sudden Bath-Related Death Investigated by Medical Examiners in Tokyo, Japan

“…Sudden death in a bathtub occurs relatively frequently in Japan, particularly among elderly people. 1 – 4 The annual mortality rate for fatal drowning in Japan is higher than in other developed countries, and this is mainly attributable to bath-related deaths among elderly people. 4 , 5 However, the actual number of deaths exceeds the official number of bath-related deaths because many bath-related deaths have been attributed to sudden natural causes such as ischemic heart disease on death certificates.…”

“…A previous study showed that bath-related deaths typically occur during the winter months. 1 – 4 It is believed that a rapid change in body temperature, attributable to large differences between the bath water temperature and the ambient temperature in the dressing room, is a critical factor that is capable of inducing sudden death, particularly in elderly people. 4 However, the precise mechanism of bath-related deaths is unknown, and preventive strategies have not been established because the majority of bath-related deaths do not lead to autopsy in the current Japanese death investigation system.…”

Bath‐related deaths: Preventive strategies and suggestions for general physicians

“…Unfortunately, many cases of sudden deaths during bathing have been reported to date 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. In most cases, death occurs in a bathtub, and victims are found unresponsive with their faces immersed or completely submerged under the water.…”