Perspectives in Disease Prevention and Health Promotion Alcohol and Violent Death -- Erie County, New York, 1973-1983

Since 1973, Erie County, New York, has evaluated blood samples for the presence of alcohol and drugs in all medical-examiner-investigated deaths.* Recently, the files of the Erie County Medical Examiner's Office were examined specifically for blood-alcohol concentrations (BAC) of persons 15 years of age or older who died within 8 hours of injury during 1973-1983.

Erie County, located in the western part of New York, has a population of approximately 800,000 persons 15 years of age or older; the main city in this metropolitan area is Buffalo. A total of 3,293 deaths from unintentional and intentional injuries among persons in this age group was recorded during this period.** The largest proportion of deaths (34%) was traffic-related, followed by miscellaneous injuries (27%), suicides (20%), and homicides (19%).

Fifty-three percent of Erie County's population 15 years of age or older is female; 91% is white, and 9% is black (1). However, approximately 73% (59.0/100,000 population) of the victims were men, compared with 27% (20.1/100,000) women. The percentages of men and women who were intoxicated (0.1 g% BAC or higher) at time of death were 35% and 22%, respectively. Approximately 81% (34.7/100,000) of victims were white, compared with 19% (77.6/100,000) for blacks. The percentage of black victims who were intoxicated at time of death was 41%, compared with 29% for white victims.

For the 1,127 traffic-related fatalities, the percentage of persons killed who were drivers was 55%, compared with 20% who were passengers. Twenty-three percent were pedestrians, and 2% were bicyclists. Over 38% of all these traffic-fatality victims were legally intoxicated at time of death. Forty-four percent of drivers were legally intoxicated at time of death, compared with 33% of passengers, 30% of pedestrians, and 23% of bicyclists.

Among the 875 fatalities caused by miscellaneous unintentional injuries, 29% of the victims were legally intoxicated at time of death. Most of these deaths were caused by falls (6%) and drownings (4%). Twenty-one percent of fall victims and 26% of drowning victims were legally intoxicated at time of death.

Of the 655 suicide victims, 22% were intoxicated at time of death. The most common methods of suicide were gunshots (29%), drug and/or alcohol overdoses (23%), carbon monoxide poisoning (19%), and hanging (14%). The percentages of victims who were intoxicated were 28%, 17%, 28%, and 23%, respectively.

There were 623 homicide victims, approximately 32% of whom were intoxicated at time of death. The most common methods of homicide involved guns (49%), knives (30%), and personal weapons (i.e., hands or feet) (20%). The percentages of victims who were intoxicated were 44%, 36%, and 17%, respectively. Reported by E Abel, PhD, P Zeidenberg, MD, S Regan, Research Institute on Alcoholism, Office of Alcoholism and Substance Abuse, New York Div of Alcoholism and Alcohol Abuse, J Uko, MD, TA Rejent, Erie County Medical Examiner's Officer, Buffalo, New York; Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, Violence Epidemiology Br, Office of the Director, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Unintentional injuries are the leading cause of premature loss of life among Americans, and homicides and suicides are fourth (2). The presence of alcohol in victims of homicides, suicides, and unintentional injuries has been described previously (3-8). Studies have indicated that medical-examiner data are good sources of information for epidemiologic surveillance of alcohol in these victims (4). Several studies have compared victims of traumatic-injury death to victims of death from other causes and found that alcohol is more frequently present among victims of traumatic-injury deaths (3,5), suggesting that alcohol consumption may be a risk factor for violent and traumatic-injury deaths. To determine the relative risk for traumatic-injury deaths given the ingestion of alcohol, it will be necessary to collect data on traumatic-injury deaths among persons who do and do not consume alcohol.

These data from Erie County show somewhat lower proportions of alcohol involvement than previous reports of motor-vehicle fatalities (3,4,9), nonmotor-vehicle fatalities (4,10) and homicides (3,4,7,8). This may result from differences in drinking patterns between Erie County and other localities previously studied, differences from study to study in the BAC considered to be positive, or differences in the maximum acceptable time lapse between injury and death. However, the proportion of suicide victims in Erie County with positive BACs is similar to that in previous reports (3,4,8).

References

1. U.S. Department of Commerce, Bureau of the Census. Census tracts, Buffalo, N.Y. - SMSA 1980 Census. Washington, D.C.: U.S. Government Printing Office, 1983.

2. U.S. Department of Commerce, Bureau of Census. Statistical abstracts of the United States, 1982-1983. Washington, D.C.: U.S. Government Printing Office, 1983.

3. Adelson L. The pathology of homicide: a vade mecum for pathologist, prosecutor and defense counsel. Springfield, Illinois: Charles C. Thomas, 1974:883-918.

4. CDC. Alcohol and fatal injuries--Fulton County, Georgia, 1982. MMWR 1983;32:573-6.

5. Waller JA. Nonhighway injury fatalities. I. The roles of alcohol and problem drinking, drugs and medical impairment. J Chronic Dis 1972;25:33-45.

6. Haberman PW, Baden MM. Alcohol, other drugs, and violent death. New York: Oxford University Press, 1978.

7. Goodwin DW. Alcohol in suicide and homicide. Q J Stud Alcohol 1973;34:144-56.

8. Lester D. Alcohol and suicide and homicide. J Stud Alcohol 1980;41:1220-3.

9. Wold D. Annual Report--1981. NCME News 1982; Vol.3:6.

10. CDC. Alcohol as a risk factor for injuries--United States. MMWR 1983;32:61-2. *Deaths believed caused by homicide, suicide, or unintentional injuries occurring in the county. **Data were incomplete for 13 cases; therefore, totals for each of the four categories add to only 3,280.

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