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Recent heavy alcohol consumption at death certified as ischaemic heart disease: correcting mortality data from Kaunas
Ricardas Radisauskas1, Remigijus Prochorskas, Vilius Grabauskas
1Department of Environmental and Occupational Medicine, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 4, LT- 50009 Kaunas, Lithuania. ricaradi@itc.kmu.lt
Insights
Many deaths attributed to ischaemic heart disease (IHD) in Lithuania were actually caused by alcohol toxicity. This misclassification significantly impacts official IHD mortality statistics, particularly in younger adults.
Area of Science:
- Public Health
- Cardiology
- Toxicology
Background:
- Official mortality statistics in Lithuania may misrepresent the true burden of ischaemic heart disease (IHD).
- Alcohol consumption is a significant public health concern with potential to influence cause-of-death reporting.
Purpose of the Study:
- To determine the proportion of deaths initially attributed to IHD that were actually caused by alcohol.
- To assess the impact of alcohol-related deaths on official IHD mortality statistics in Lithuania.
Main Methods:
- Analysis of 3061 deaths from IHD in Kaunas, Lithuania (ages 25-64, 1993-2007).
- Verification of underlying causes of death using international standards.
- Examination of post-mortem blood and urine alcohol concentrations in 1498 out-of-hospital sudden deaths.
Main Results:
- 8.7% of IHD deaths were reclassified as alcohol-related; 12.9% as other diseases.
- Alcohol was detected in 50.3% of autopsied out-of-hospital deaths; 18.0% had blood alcohol concentrations ≥3.5%.
- Alcohol presence was higher during winter months and weekends.
Conclusions:
- A substantial proportion of alcohol-attributable deaths are misclassified as IHD in Lithuania, affecting nearly 10% of registered deaths (ages 25-64).
- High rates of positive alcohol tests suggest underestimation of alcohol's role in out-of-hospital IHD deaths.
- Similar misclassification issues may exist in countries with high alcohol consumption and binge drinking.
Aims:
To assess the proportion of deaths assigned to ischaemic heart disease (IHD) which in fact were caused by the toxic effects of alcohol, and how this may affect the official statistics of mortality from IHD in Lithuania.
Methods:
Using the IHD register in Kaunas, Lithuania, and verifying underlying causes of death using standard international methodology, 3061 cases were found in Kaunas city who had died from IHD at age 25-64 during 1993-2007. Out-of-hospital sudden deaths accounted for 2467 cases (81%), including 1498 where forensic autopsy was conducted and post-mortem concentration of alcohol in blood and urine was available.
Results:
In total, 78.4% of all initial IHD diagnoses were verified, while in 8.7% of deaths the underlying cause of death was corrected into an alcohol-related cause and in 12.9% to other diseases. Alcohol was found in about half (50.3%) of out-of-hospital death cases subjected to autopsy. In 18.0% of cases, the alcohol concentration was 3.5% or higher. Alcohol was more likely to be present in winter months and at weekends.
Conclusion:
A significant number of alcohol-attributable deaths in Lithuania were misclassified as coronary deaths, accounting for almost one-tenth of officially registered deaths from IHD in ages 25-64. A high prevalence of positive post-mortem blood or urine alcohol tests suggests that the proportion of alcohol-related deaths among out-of-hospital IHD deaths may be actually even higher. A similar situation may be present in some other countries where high levels of alcohol consumption and binge drinking patterns are observed.
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