期刊论文详细信息
BMC Public Health
Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs – a retrospective study, 1992–2009
Ulf Björnstig2  Britt-Inger Saveman1  Kristin Ahlm3 
[1] Department of Nursing, Umeå University, Umeå, SE 901 87, Sweden;Division of Surgery/KBC, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, SE 901 87, Sweden;Section of Forensic Medicine, Department of Community Medicine and Rehabilitation, Umeå University, POB 7616, Umeå, SE 907 12, Sweden
关键词: Suicide;    Pharmaceutical drugs;    Illicit drugs;    Drowning;    Alcohol;   
Others  :  1162463
DOI  :  10.1186/1471-2458-13-216
 received in 2012-07-17, accepted in 2013-03-05,  发布年份 2013
PDF
【 摘 要 】

Background

Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.

Methods

During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.

Results

During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (≤18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688 /4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.

Conclusion

Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.

【 授权许可】

   
2013 Ahlm et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150413065353135.pdf 397KB PDF download
Figure 2. 36KB Image download
Figure 1. 34KB Image download
【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】
  • [1]World Health Organization (WHO): Violence and Injury Prevention and Disability. 2004. http://www.who.int/mediacentre/factsheets/fs347/en/index.html webcite Accessed February 9th, 2013
  • [2]Peden MM, McGee K: The epidemiology of drowning worldwide. Inj Control Saf Promot 2003, 10:195-199.
  • [3]Hyder AA, Borse NN, Blum L, Khan R, El Arifeen S, Baqui AH: Childhood drowning in low- and middle-income countries: Urgent need for intervention trials. J Paediatr Child Health 2008, 44:221-227. Review
  • [4]Irwin CC, Irwin RL, Ryan TD, Drayer J: Urban minority youth swimming (in) ability in the United States and associated demographic characteristics: toward a drowning prevention plan. Inj Prev 2009, 15:234-239.
  • [5]Lunetta P, Smith GS, Penttilä A, Sajantila A: Unintentional drowning in Finland 1970–2000: a population-based study. Int J Epidemiol 2004, 33:1053-1063.
  • [6]The National Board of Health and Welfare: Cause of deaths. Swedish Statistics. 2007. http://www.socialstyrelsen.se/ webcite Accessed February 9th, 2013
  • [7]Wintemute GJ, Kraus JF, Teret SP, Wright MA: The epidemiology of drowning in adulthood: implications for prevention. Am J Prev Med 1988, 4:343-348.
  • [8]Stjernbrandt A, Öström M, Eriksson A, Björnstig U: Land motor vehicle-related drownings in Sweden. Traffic Inj Prev 2008, 9:539-543.
  • [9]Byard RW, Houldsworth G, James RA, Gilbert JD: Characteristic features of suicidal drownings: a 20-year study. Am J Forensic Med Pathol 2001, 22:134-138.
  • [10]Jansson B, Ahmed N: Epilepsy and injury mortality in Sweden-the importance of changes in coding practice. Seizure 2002, 11:361-370.
  • [11]Bell GS, Gaitatzis A, Bell CL, Johnson AL, Sander JW: Drowning in people with epilepsy: how great is the risk? Neurology 2008, 71:578-582.
  • [12]Lunetta P, Penttilä A, Sarna S: Water traffic accidents, drowning and alcohol in Finland, 1969–1995. Int J Epidemiol 1998, 27:1038-1043.
  • [13]Franklin RC, Scarr JP, Pearn JH: Reducing drowning deaths: the continued challenge of immersion fatalities in Australia. Med J Aust 2010, 192:123-126.
  • [14]World Health Organization (WHO): Manual of International Classification of Diseases. Geneva: Injuries and Causes of Deaths (ICD9); 1977.
  • [15]Jones AW, Schuberth J: Computer-aided headspace gas chromatography applied to blood-alcohol analyses: importance of online process control. J Forensic Sci 1989, 34:1116-1127.
  • [16]Druid H, Holmberg P: A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci 1997, 42:79-87.
  • [17]World Health Organization (WHO): Anatomical Therapeutic Chemical (ATC) Classification System. 2013. http://www.whocc.no/atc_ddd_publications/guidelines/ webcite Accessed February 9th, 2013
  • [18]Kugelberg FC, Jones AW: Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic Sci Int 2007, 165:10-29. Review
  • [19]Swedish Transport Agency, statistics. (in Swedish) 2013. 2013. http://www.transportstyrelsen.se/sv/Press/Statistik/Vag/Olycksstatistik/Olycksstatistik-vag/arsdata-fran-1950/ webcite Accessed March 2013.
  • [20]Mitchell RJ, Williamsson AM, Olivier J: Estimates of drowning morbidity and mortality adjusted for exposure to risk. Inj Prev 2010, 16:261-266.
  • [21]Steensberg J: Epidemiology of accidental drowning in Denmark 1989–1993. Accid Anal Prev 1998, 30:755-762.
  • [22]Nasrullah M, Muazzam S: Drowning mortality in the United States, 1999–2006. J Community Health 2011, 36:69-75.
  • [23]Howland J, Hingson R, Mangione TW, Bell N, Bak S: Why are most drowning victims men? Sex differences in Aquatic skill behaviors. Am J Public Health 1996, 86:93-96.
  • [24]Melinder KA, Andersson R: Differences in injury mortality between the Nordic countries-with special reference to differences in coding practices. J Soc Med 1998, 26:190-197.
  • [25]Bowman SM, Aitken ME, Robbins JM, Baker SP: Trends in US pediatric drowning hospitalizations, 1993–2008. Pediatrics 2012, 129:275-281.
  • [26]Lindholms P, Steensberg J: Epidemiology of unintentional drowning and near-drowning in Denmark in 1995. Inj Prev 2000, 6:29-31.
  • [27]Suresh Kumar Shetty B, Shetty M: Epidemiology of drowning in Mangalore, a coastal Taluk of South India. J Forensic Leg Med 2007, 14:410-415.
  • [28]Håkanson L: How many lakes are there in Sweden? Phys Geogr 1994, 76:203-205.
  • [29]Wirthwein DP, Barnard JJ, Prahlow JA: Suicide by drowning: a 20-year review. J Forensic Sci 2002, 47:131-136.
  • [30]Sarma K, Kola S: Firearms, hanging, and drowning suicides in the Republic of Ireland. Crisis 2010, 31:69-75.
  • [31]Corcoran P, Reulbach U, Perry IJ, Arensman E: Suicide and deliberate self harm in older Irish adults. Int Psychogeriatr 2010, 22:1327-1336.
  • [32]Ingoldsby H, Callagy G: Alcohol and unnatural deaths in the West of Ireland: a 5-year review. J Clin Pathol 2010, 63:900-903.
  • [33]Stemberga V, Bralic M, Coklo M, Cuculic D, Bosnar A: Suicidal drowning in Southwestern Croatia: a 25-year review. Am J Forensic Med Pathol 2010, 31:52-54.
  • [34]WHO: World Suicide Prevention Day. 2004. http://www.who.int/mediacentre/news/releases/2004/pr61/en/ webcite Accessed February 9th, 2013
  • [35]Qin P, Agerbo E, Westergård-Nielsen N, Eriksson T, Mortensen PB: Gender differences in risk factors for suicide in Denmark. Br J Psychiatry 2000, 177:546-540.
  • [36]Salib E: Trends in suicide by drowning in the elderly in England and wales 1979–2001. Int J Geriatric Psychiatry 2004, 19:175-181.
  • [37]Denning DG, Conwell Y, King D, Cox C: Method choice, intent, and gender in completed suicide. Suicide Life Threat Behav 2000, 30:282-828.
  • [38]Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Långström N: Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort stud. BMJ 2010, 13:341-c3222. http://www.Bmj.com/content/341/bmj.c3222 webcite Accessed March 2013
  • [39]Putkonen H, Amon S, Eronen M, Klier CM, Almiron MP, Cederwall JY, Weizmann-Henelius G: Gender differences in filicide offense characteristics-a comprehensive register-based study of child murder in two European countries. Child Abuse Negl 2011, 35:319-328.
  • [40]Browne ML, Lewis-Michl EL, Stark AD: Watercraft-related drownings among New York State residents, 1988–1994. Public Health Rep 2003, 118:459-463.
  • [41]Warner M, Smith GS, Langley JD: Drowning and alcohol in New Zealand: what do the coroner’s files tell us? Aust N Z J Public Health 2000, 24:387-390.
  • [42]Smith GS, Keyl PM, Hadley JA, Bartley CL, Foss RD, Tolbert WG, McKnight J: Drinking and recreational boating fatalities: a population-based case–control study. JAMA 2001, 286:2974-2980.
  • [43]Meister KA, Whelan EM, Kava R: The health effects of moderate alcohol intake in humans: an epidemiologic review. Crit Rev Clin Lab Sci 2000, 37:261-296.
  • [44]Evans L: Traffic Safety, Alcohol. Bloomfield, Michigan; Science Serving Society Printed in United States of America. 2006, 237-269.
  • [45]Howland J, Smith GS, Mangione T, Hingson R, DeJong W, Bell N: Missing the boat on drinking and boating. JAMA 1993, 270:91-92.
  • [46]Cummings P, Quan L: Trends in unintentional drowning: the role of alcohol and medical care. JAMA 1999, 281:2198-2202.
  • [47]Ohberg A, Lonnqvist J: Suicides hidden among undetermined deaths. Acta Psychiatr Scand 1998, 98:214-218.
  • [48]Taylor C, Cooper J, Appleby L: Is suicide risk taken seriously in heavy drinkers who harm themselves? Acta Psychiatr Scand 1999, 100:309-311.
  • [49]O’Hanlon JF: Ten ways for physicians to minimize the risk of patients causing traffic accidents while under influence of prescribed psychoactive medication. Primary Care Psychiatr 1995, 1:77-85.
  • [50]Engeland A, Skurveit S, Mørland J: Risk of road traffic accidents associated with the prescription of drugs: a registry-based cohort study. Ann Epidemiol 2007, 17:597-602.
  • [51]Mørland J: Driving under the influence of non-alcohol drugs. Forensic Sci 2000, 12:80-105. Review
  • [52]Hindmarch I, Kerr JS, Sherwood N: The effects of alcohol and other drugs on psychomotor performance and cognitive function. Alcohol Alcohol 1991, 26:71-79.
  • [53]Quan L, Cummings P: Characteristics of drowning by different age groups. Inj Prev 2003, 9:163-168.
  • [54]Suominen P, Baillie C, Korpela R, Rautanen S, Ranta S, Olkkola KT: Impact of age, submersion time and water temperature on outcome in near-drowning. Resuscitation 2002, 52:247-254.
  • [55]Driscoll TR, Harrison JA, Steenkamp M: Review of the role of alcohol in drowning associated with recreational aquatic activity. Inj Prev 2004, 10:107-113.
  • [56]Wintemute GJ, Teret SP, Kraus JF, Wright M: Alcohol and drowning: an analysis of contributing factors and a discussion of criteria for case selection. Accid Anal Prev 1990, 22:291-296.
  文献评价指标  
  下载次数:53次 浏览次数:20次