Prevalence of alcohol‐related pathologies at autopsy: E stonian F orensic S tudy of A lcohol and P remature D eath

Abstract

AimsAlcohol 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 ParticipantsCross-sectional study included 554 men aged 25–54 in Estonia undergoing forensic autopsy in 2008–09.MeasurementsPotentially 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.FindingsMost 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.ConclusionThe 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.

The relationship between different dimensions of alcohol use and the burden of disease—an update

“…In their seminal study in 12 cities in 10 countries, Puffer & Griffith 293 found that after triangulating data on death certificates with data from hospital records and interviews of attending physicians or family members, the number of deaths with alcoholic liver cirrhosis more than doubled, with the majority of new cases being recoded from categories of cirrhosis which do not mention alcohol. 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. As a consequence, in national CRAs based on death registries, estimations of alcohol‐attributable liver diseases should not be based on routine data from these registries, but estimated indirectly via measures which have no or less bias (such as attributable fractions of liver cirrhosis or liver disease in general).…”

Glycated haemoglobin (HbA1c) for postmortem diagnosis of diabetes

“…In a previous study of association of alcohol with the mortality of Estonian men aged 25–54 years, alcohol was found in blood in concentrations ≥ 0.2 mg/g in 55% cases of death [ 38 ]. Results of that study of men also showed evidence of alcohol-induced pathologies in 75% of cases, and 32% had pathologies in two or more organs [ 39 ]. Some types of alcohol-related purchases were associated with a lower prevalence of type 2 diabetes (T2D), and respondents who purchased the greatest volumes of wine or beer – but not liquor – were less likely to report being diagnosed with T2D in 2011–2012 than non-drinkers [ 40 ].…”

Quantifying the global contribution of alcohol consumption to cardiomyopathy

“…The first major limitation is related to ACM mortality data, which may be subject to coding errors. As persons with ACM are likely to have other end-organ damages, attribution of a person’s death to a single disease category without any autopsy can be quite challenging [ 46 ]; and then there is the attribution to alcohol as well (see next paragraph). In some former Soviet countries like Belarus [ 47 ], Kyrgyzstan [ 48 ], Russia [ 49 , 50 ], and Ukraine [ 51 ], autopsies are obligatory for many deceased people.…”

“…Most prominently, in a study in 12 cities in 10 countries, Puffer and Griffith [ 61 ] found that after triangulating data on death certificates with data from hospital records and interviews of attending physicians or family members, the number of deaths with alcoholic liver cirrhosis more than doubled, with the majority of new cases being detected under categories of cirrhosis that do not mention alcohol. This underreporting of alcoholic liver cirrhosis has persisted in later studies as well [ 46 , 62 – 64 ], and it seems to be the case for all disease categories fully attributable to alcohol use [ 46 , 65 ]. More specifically for ACM, one study estimated the amount of underestimation to be about 30% [ 64 ].…”