A retrospective study was conducted in order to determine the prevalence and concentration of alcohol in post-mortem blood samples sent for toxicological analysis in Cork City and County in 2003 and 2004. Post mortem reports of these deaths were reviewed for the presence or absence of alcohol at the time of autopsy, blood alcohol concentration (BAC) at time of death, age and sex of the decedents. Of samples sent for blood alcohol analysis (BAA), 38.4% were positive for alcohol. 



Significant differences were found between the proportions of alcohol positive cases by cause of death. Alcohol positive cases were significantly younger (44.3 ± 17.8 years) than alcohol negative cases (51.9 ± 19.4years) and fifty two percent of drivers were positive for alcohol at the time of death. 



Awareness of the harmful and potentially fatal effects of alcohol should continue to be raised within the community, so as to prevent future fatalities

Bellis, M

Bolster, MA

Doyle, CT

National Documentation Centre on Drug Use

13Original PaperIrish Medical JournalJanuary 2009  Volume 102 Number 1www.imj.ieIntroductionAll sudden, unexplained and unexpected deaths, in Cork City andCounty are referred to the Coroner’s service for post mortemexamination. A percentage of these deaths are alcohol related insome way. The Irish continue to be amongst the highestconsumers of alcohol in the world, ranking second in 2001 foralcohol consumption within the enlarged EU. In 2003, alcoholconsumption per adult was 13.5 litres of pure alcohol, and alcoholrelated problems cost Irish society in excess of €2.65 billion1. Astudy by Ramstedt and Hope2 in 2004 showed that adults inIreland had the highest level of binge drinking in comparison toadults in six other European countries (UK, Germany, Italy, France,Sweden, Finland). The overall finding was that adverseconsequences particularly related to single heavy drinkingoccasions were relatively common in Ireland. The aim of this studyis to determine the prevalence and concentration of alcohol in thevarious types of death presenting to the coroner’s service in Corkcity and county for the years 2003 and 2004. The reportedfrequency of cases with alcohol present in post-mortem samplesvaries from 20-50% in different studies3.MethodsAll medico-legal autopsies in Cork city and county are conductedat the City Morgue on the grounds of Cork University Hospital.This serves a population of 447 829 people4. From January 1st2003 to December 31st 2004, 1028 autopsies were conducted,and of these, 47% were sent for toxicology. Cases that were notsent for blood alcohol analysis were those in which the decedenthad a know disease or illness, those involving very small children,infants and badly decomposed bodies. Blood samples were takenin glass bottles (Greiner Bio-One), containing sodium fluoride andpotassium oxalate, which inhibit bacterial fermentation of thesample so as not to distort the true blood alcohol concentration(BAC). Samples were analysed for blood ethanol by means ofreverse phase gas chromatography (Pencin-Elmer Clarus 500).Blood alcohol concentrations are reported in mg%, where 1.0mg% is equivalent to 1 mg of alcohol per 100 mL of blood. InIreland, it is illegal to drive a motor vehicle with a BAC of 80 mg%or higher. Because alcohol is known to impair judgement at levelslower than the legal limit5 any presence of alcohol at time of deathwas considered a positive case.The data set was analysed according to age, sex, manner of death,and blood alcohol level. Manner of death describes thecircumstances of the victim at the time of death (i.e. road trafficaccident, drowning, fall, hanging and others) and will be referred toas cause of death for the purpose of this study. The studyexcludes those aged 12 years and younger.Complete details for all variables were obtained from post-mortemreports. Age was missing for six cases, which was adjusted for instatistical analysis. All cases examined in this study were ‘closed’as they had completed inquest proceedings. The study focused onthose deaths found positive for blood alcohol (BA), which werecompared to alcohol negative deaths where possible. Permissionto proceed was granted by the four Coroners for Cork. Data wasprocessed with SPSS version 12.1 for windows using standardstatistical methods.ResultsFour hundred and eighty two samples were sent to the StateLaboratory for the analysis of blood alcohol. Of these, 185(38.4%) were found positive, with concentrations ranging fromtrace amounts to 628 mg%, with a mean of 175.3 mg% ± 112.5mg%. Of all deaths involving alcohol, 76% were over the legal limitof 80 mg%. Twenty percent were below the legal limit, and fourpercent contained only trace amounts of alcohol. The greatestproportion of alcohol related deaths belonged to a BAC categoryof between 101-200 mg%. Twelve percent of alcohol relateddeaths had levels ≥300 mg%, which some studies quote as beinglethal3.Blood Alcohol Positive CasesAll cases sent for toxicology were classified according to cause ofdeath (Figure1), and the percentage of alcohol positive caseswithin each category was determined. The relationship betweencategories was found to be significant (c2 = 65.889, Cr = .37, P<.001). The average alcohol concentration by cause of death forpositive cases was also determined (Figure 1). A comparison ofmeans using a one-way ANOVA test found a significantrelationship between the various causes of death (F = 13.257, df=11, P< .001).RTA = road traffic accident. D&AOD = drug and alcohol overdose,AAINTOX = acute alcohol intoxication, GSW=gun shot wound,The Role of Alcohol in Deaths Presenting to the Coroner’sService in Cork City and CountyM Bellis, MA Bolster, CT DoyleCork City Morgue, Cork University Hospital, Wilton, CorkAbstractA retrospective study was conducted in order to determine the prevalence and concentration of alcohol in post-mortem bloodsamples sent for toxicological analysis in Cork City and County in 2003 and 2004. Post mortem reports of these deaths werereviewed for the presence or absence of alcohol at the time of autopsy, blood alcohol concentration (BAC) at time of death, age andsex of the decedents. Of samples sent for blood alcohol analysis (BAA), 38.4% were positive for alcohol. Significant differences werefound between the proportions of alcohol positive cases by cause of death. Alcohol positive cases were significantly younger (44.3 ±17.8 years) than alcohol negative cases (51.9 ± 19.4years) and fifty two percent of drivers were positive for alcohol at the time ofdeath. Awareness of the harmful and potentially fatal effects of alcohol should continue to be raised within the community, so as toprevent future fatalities.Figure 1 Percentage of cases found positive for blood alcoholclassified by cause of death, and mean BAC by causeof death.14 Original PaperIrish Medical JournalJanuary 2009  Volume 102 Number 1www.imj.ieASPVOMIT=aspiration of vomitus, OTHER= car exhaust carbonmonoxide poisoning, crush injury, undetermined/suddenunexpected death, hypothermia, choking, industrial accident,poisoning, suffocation, stabbing.AgeA statistically significant difference was found between the meanage of the BA positive decedents (44.3 years ± 17.8 years) andthose negative for BA at the time of death (51.9 years ± 19.4years) (t = 4.292, P< .001). Furthermore, when comparing meanages between causes of death for the positive and negativegroups, victims of deaths involving alcohol were younger for mostcauses of death (Figure 2). A one-way ANOVA for the comparisonof means found a significant relationship between the mean ageand cause of death (F =1.451, P < .05) in BA positive deaths.Alcohol positive and negative deaths were compared by agegroupings. A significant relationship was found to exist betweenthe presence or absence of BA at the time of death and agecategory (c2 = 23.969 P<.001). Those younger than 25 weremore often intoxicated than not and comprised the largestproportion of alcohol positive deaths by age group. The 46-55group had the highest average BAC (Table 1).GenderMales comprised 79.5% of the alcohol positive sample. The meanBAC in positive cases for females was 193.21 mg% ± 128.6mg% and 170.67 mg% ± 107.9 mg% for males. Women were onaverage five years older than men in alcohol positive cases (48.84± 17.5 years versus 43.12 ± 17.7 years respectively).Road Traffic Accidents (RTAs)Decedents involved in RTAs are listed in table 2. Forty percent ofall RTAs in this study involved alcohol (Fig. 1). All drivers positivefor alcohol were male with a mean age of 32.9 years (± 12 years),compared to BA negative cases, with an average age 45.2 (±24.5 years). Although not significant, this 12-year age differenceis substantial. Pedestrians were found to have the highest BAC(Table 2).DiscussionThe presence of drugs at time of death is a possible confoundingvariable in this study. Previous studies vary on their inclusion ofthese cases. Because the main aim here was to study theprevalence of alcohol in all deaths presenting to the coroner’sservice, all alcohol positive deaths were included regardless ofdrug status.There is clear evidence that driving skills deteriorate and the riskof becoming involved in a crash increases from a blood alcoholconcentration of 20mg per 100 ml6. A study looking at bloodalcohol levels of those dying in RTAs in Cavan, Monaghan andLouth in 2001 and 2002 found that 40% of those killed on theroad had alcohol present in their blood and that all driversdetected with alcohol in their blood were male7. These figuresclosely match the present material. Of all RTA victims, pedestriansin this study and in others have been found to have the highestBAC compared to drivers and passengers8. One of therecommendations set out by the Strategic Task Force on Alcoholin their second report in 2004 was to lower the Irish legal limit ofBAC to 50 mg%. Several EU countries have lowered their limitsfrom 80mg% to 50mg% in recent years with Sweden at thelowest limit of 20mg%, where only 22% of RTA deaths werefound positive for BA9.Alcohol related death, illness and injury is one of the largest publichealth issues facing Ireland today. Alcohol substantially increasesthe risk of an individual to die an unnatural and violent death10 asFigure 2 Mean age by cause of death for alcohol positive andalcohol negative deaths.Table 1 Prevalence of BA positive and negative deaths, main cause of death, by age category for Cork City andCounty 2003-2004.Age group ≤ 25 26-35 36-45 46-55 56-65 >65Alcohola Positive %(N)52.7% (39)44.4% (28)52.2% (35)30.8% (28)37.8% (28)24.3% (26)% of total PositiveDeaths 21.2 % 15.2% 19.0% 15.2% 15.2% 14.1%Average BAC mg% Positive cases150 %±80.8 %186 %±123.1 %186 %±116.9 %223 %±121.8 %155 %±115.5 %159 %±114.1 %Main COD in positivecases Hanging Hanging Natural Natural Natural NaturalAlcohola negative %(N)47.3% (35)55.6% (35)47.8% (32)62.9% (63)62.2% (46)75.5% (81)% of total NegativeDeaths 11.8% 11.8% 10.8% 21.2% 15.5% 27.3%Main COD innegative cases RTA Natural Natural Natural Natural Naturalac2 = 23.969 P<.00115Original PaperIrish Medical JournalJanuary 2009  Volume 102 Number 1www.imj.ieit blurs rational thinking and increases self-destructive behaviourand aggressiveness towards others11. It is debatable what BAC isnecessary before acute alcohol influence should be regarded as acontributory cause of death3. Factors such as size, time of lastmeal, and alcohol tolerance all play a role in how alcohol impairs aperson’s coordination, vision and thinking. It is important torecognize the relationship between alcohol and unexpecteddeaths, as these deaths are potentially preventable. Studies todetermine how the BAC of Irish deaths reflects on alcoholconsumption in the overall population compared to other EUcountries would create greater awareness of the problem ofalcohol related deaths on a national and European level.AcknowledgementsSpecial thanks to the staff of the Cork City Morgue. Thanks alsoto the four Coroners for Cork; Dr M Cullinane, Dr M Kennedy, Mr F O’Connell and Dr C Quigley for granting permission toproceed with this study.Correspondence: M BellisDepartment of Laboratory Medicine and Pathology, University ofToronto, CanadaEmail: maggiebellis@yahoo.comReferences1. Strategic Task Force on Alcohol. Second Report. Ireland: HealthPromotion Unit, Department of Health and Children; September 2004.2. Ramstedt M, Hope A. The Irish drinking culture – drinking anddrinking-related harm, a European comparison. [Online]. 2004. [cited2006 Jan 8]; [10 pages]. Available from: URL:http://www.healthpromotion.ie/uploaded_docs/Irish-Drinking-Culture.pdf.3. Nordrum I, Eide TJ, Jorgensen L. Alcohol in a series of medico-legallyautopsied deaths in northern Norway 1973-1992. Forensic Sci Int2000 May 15;110:127-137.4. Central Statistics Office Ireland. [Online]. 2002 [cited 2005 Dec 22];Available from: URL:http://www.cso.ie/census/.5. National Safety Council. Never ever drink and drive. [ Online]. 2005.[cited 2005 Dec 22]; Available from: URL:http://www.nsc.ie/RoadSafety/RoadSafetyIssues/DrinkDrivingLeaflet/.6. BBC News. Alcohol limits should be lower. [Online]. 2004 Apr 8 [cited22 Dec 2005]; Available from:URL:http://news.bbc.co.uk/1/hi/health/3611173.stm.7. Condon D. Young men risk driving drunk. [Online]. 2004 Nov 11 [cited22 Dec 2005]; Available from:URL:http://www.irishhealth.com/?level=4&id=6624.8. Hain JR, Ryan DM Spitz WU. Fatal accidents and blood ethanol levelsin adolescents and adults. Am J Forensic Med Pathol 1989Sep;10:187-192.9. Sjogren H, Eriksson A, Ahlm K. Alcohol and unnatural deaths inSweden: a medico-legal autopsy study. Alcohol Clin Exp Res 2000Jul;24:1050-1056.10. Loftus IA, Dada MA. A retrospective analysis of alcohol in medicolegalpost-mortems over a period of five years. Am J Forensic Med Pathol1992 Sep;12:248-252.11. Skibin L, Bilban M, Balazic J. Harmful alcohol use of those who died aviolent death (the extended region of Ljublijana 1995-1999). ForensicSci Int 2005 Jan 17;147:S49-52.Table 2 Mean blood alcohol concentration accordingto decedent situation in road traffic accidentsfor Cork City and County 2003-2004.RTA VictimAlcoholPositive NAlcoholNegativeN% PositiveforalcoholMeanBACmg%DRIVER/MOTORCYCLIST 14 13 52%172.2 ± 120.9PASSENGER 1 8 12.5% 192.0PEDESTRIAN 4 6 40% 217.5 ± 54.7BICYCLIST 0 1 0% –

The role of alcohol in deaths presenting to the Coroner’s Service in Cork city and county.

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