Development of prevention strategies against bath-related deaths based on epidemiological surveys of inquest records in Kagoshima Prefecture

Abstract

Sudden death in the bathroom (bath-related death) occurs more frequently in Japan than in other countries. To clarify the epidemiological characteristics of bath-related deaths, we reviewed inquest records of deaths in Kagoshima Prefecture from 2006 to 2019. We identified 2689 cases of bath-related death. Of these cases, 90% were among people aged ≥ 65 years. The majority occurred in a home bathtub between 16:00 and 20:00. Most deaths (52.0%) occurred in winter (December–February), and there were extremely strong negative correlations with the environmental temperatures (maximum, minimum, and mean) on the day of death. We identified the environmental temperature during cold winter months that bath-related deaths are likely to occur in Kagoshima, although further investigation concerning the effects of other confounding factors is required. Forensic autopsies have only been performed in 29 cases and the cause of death was not diagnosed correctly in the majority of cases. Although autopsies are essential to elucidate the pathogenesis of the deaths, it is difficult to increase the rate of autopsies under the current Japanese death investigation system. Therefore, we suggest that the best way to prevent bath-related death is establishing an “Alert system” based on our results, and to have people refrain from bathing on dangerous days.

Unveiling Lethal Risks Lurking in Hot Tub Baths: A Review of Tragic Consequences

“…Between 2006 and 2019, Kagoshima Prefecture [2] reported 2,689 bath-related deaths. It was evident that the mortality rate of bath-related deaths increased with age.…”

“…Heat therapy, such as saunas or hot tub bathing, is a popular recreational activity worldwide [1]. It is characterized by the immersion of the body in high-temperature water, typically between 41°C and 45°C, a practice akin to the Japanese custom of hot-water bathing [2]. The growing popularity of hot tub bathing over the past two decades has also led to an alarming rise in bathing-related injuries and fatalities [3].…”

Recent trends in three major unintentional accidental deaths among older people in Japan: Stumbling falls, bathtub drowning and food choking

“…6 Nevertheless, sudden deaths during bathing are a major concern in Japan, particularly among older individuals in winter. 6,7 A recent report suggests that the primary cause of bathtub drowning might be linked to consciousness disturbances and lethargy due to heat illness during hot water immersion. 8 In terms of a unique cause of food choking deaths in Japan, the tradition of consuming hot and soft rice cakes (mochi), especially during the New Year's holiday, contributes significantly.…”

Bathing-Related Ischemic Stroke: Association between Stroke Subtype and Cerebral Small Vessel Disease

“…Given the dangerous environments of bathrooms, where it is often slippery and one is usually alone, with the potential risk of drowning, bathing-related ischemic stroke (BIS) can be fatal, even if its symptoms are mild. Indeed, bathing-related deaths account for approximately 8% to 9% of all sudden deaths in Japan, and a certain proportion of these deaths are caused by strokes 3,4) . Therefore, elucidating the physiological mechanisms of BIS and establishing a strategy for its prevention is much required.…”