Peter Krantz

Sudden cardiac death in 15-35-year olds in Sweden during 1992-99.

Abstract.  Wisten A, Forsberg H, Krantz P, Messner T (Sunderby Hospital, Luleå; National Board of Forensic Medicine, Lund; Kiruna District Hospital, Kiruna; and Umeå University Hospital, Umeå; Sweden). Sudden cardiac death in persons 15–35‐year old in Sweden, 1992–99. J Intern Med 2002; 252: 529–536.

ALCOHOL-RELATED DEATH: A MAJOR CONTRIBUTOR TO MORTALITY IN URBAN MIDDLE-AGED MEN

The role of alcohol abuse in mortality was studied in an unselected population of over 10,000 46-48-year-old men in Malmö, Sweden. During follow-up of 0-6 years (mean 3 years) 199 men died. In 61 men (30.7%) death was alcohol related. A theoretical calculation of excess deaths in men with an alcohol-positive history yielded 78 deaths (39.2%). In the official cause of death statistics 10 of the deaths had been assigned alcoholic aetiology (5.0%). These estimates indicate that alcohol was the commonest underlying factor in death in this sample of middle-aged men. The number of deaths with alcoholic aetiology in official cause of death statistics should be multiplied by a factor of six to eight to arrive at the true alcohol-related death rate.

Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970 - 2006

BackgroundFew longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.MethodsFollow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.ResultsOf 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.ConclusionsThe cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.

Causes of premature mortality in Swedish drug abusers: a prospective longitudinal study 1970-2006.

AIMS To evaluate premature mortality and causes of death from young adulthood to middle age in a cohort of drug users followed during almost four decades. DESIGN Follow-up study of a consecutive cohort of patients with drug abuse/dependence. METHODS A cohort of 561 drug abusers, admitted to a detoxification and short-term rehabilitation unit 1970-1978 was followed to December 31st, 2006. Standardized interviews and hospital records with toxicological analyses were used for demographic data, substance use and psychiatric diagnoses at admission. For Follow-up analyses, autopsy protocols including toxicology tests and death certificates were obtained for assessment of causes of death which were coded according to ICD-10. Age-group standardized mortality ratios were calculated independently for both sexes. RESULTS 204 persons (36.4%) were deceased by 2006. SMR was 5.94 for the cohort. Compared to an age- and gender-matched population, the risk of premature death was about eighteen times higher between the ages of 20-44 and about five times higher from 45 up to the age of 69. Of 120 (59%) drug-related deaths, 43 were opiate overdoses, and 3 were overdose from amphetamine. A total of 53 (26%) persons died violent deaths: 39 suicides, of which 25 were drug-related, 3 homicides and 12 accidents. The Swedish national causes of death register underestimated drug-related death by 37% and suicide by 85% compared to the results from this study. CONCLUSIONS The cohort of drug abusers had an increased risk of premature often drug-related and violent death well into middle age, and to a great extent the drug addicts died from the same drug they had abused when they were first admitted for treatment. The underestimation of drug-related death and suicide in some national death cause registers could be reduced if the doctor routinely records ICD codes when issuing death certificates and autopsy protocols.

Phosphatidylethanol in post-mortem blood as a marker of previous heavy drinking

Abstract Phosphatidylethanol (PEth) is an ethanol-phospholipid adduct, formed via non-oxidative metabolism of ethanol. PEth was measured in femoral blood from 85 consecutive forensic autopsies and was detected in 35 of the cases at concentrations ranging from 0.8 to 22.0 μmol/l. Of the PEth positive cases, 12 did not have significant levels of ethanol in the blood. Two cases (both suicides involving hanging) had detectable ethanol, but no PEth present in the blood. We conclude that measurements of PEth provide indications of previous alcohol abuse in cases where this may not otherwise be evident.

Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis

Objectives.  To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992–99.

Alzheimer changes are common in aged drivers killed in single car crashes and at intersections

With increasing age, diseases affecting the cognitive functions are more frequent. These diseases may increase the risk for fatal car crashes. We analyzed the frequency of neuropathological alterations characteristic of Alzheimers disease (i.e. neuritic and diffuse plaques, and neurofibrillary tangles) in two association areas of the brain, parietal and frontal cerebral cortex, from 98 fatally injured aged drivers. In the age groups of 65-75 and over 75 years of age, 50% and 72% of the drivers, respectively, had neuritic plaques in either parietal and/or frontal cortex. In 14% of all killed drivers the number of neuritic plaques reached the Consortium to Establish a Registry for Alzheimers Disease (CERAD) age-related histologic score C, which indicates the diagnosis of Alzheimers disease (AD), and an additional 33% had score B, which suggests the diagnosis of AD. Neuropathological AD changes were most common in the brains of drivers killed in single vehicle crashes, followed by multivehicle crashes at intersections and least common in multivehicle crashes elsewhere, but the differences did not reach statistical significance. In a great majority (80-85%) of cases the killed aged driver was the guilty party of the crash. The results imply, that incipient AD may contribute to fatal crashes of aged drivers, and therefore the forensic autopsy of these victims should include neuropathological examination.

OCCURRENCE OF BARBITURATE, BENZODIAZEPINE, MEPROBAMATE, METHAQUALONE AND PHENOTHIAZINE IN CAR OCCUPANTS KILLED IN TRAFFIC ACCIDENTS IN THE SOUTH OF SWEDEN

An investigation of the following psychoactive drugs: barbiturate, benzodiazepine, meprobamate, methaqualone and phenothiazine, was performed on all automobile occupants killed in accidents in southern Sweden during 1977 and 1978. Of 122 drivers and 55 passengers analysed, low concentrations of these drugs were found in nine drivers and in five passengers. Thus, 7.3% of the drivers were driving under the influence of drugs and, of these, two drivers (1.6% of all analysed drivers) were also inebriated. Twenty-three per cent of the drivers were inebriated only. According to the circumstances in the accidents and the number of drivers whose analyses proved positive, drug influence seldom seems to be the cause of fatal traffic accidents.

DIFFERENCES BETWEEN SINGLE- AND MULTIPLE-AUTOMOBILE FATAL ACCIDENTS

This communication discusses probable similarities and differences between single-vehicle and multiple-vehicle accidents. The investigation is based upon all fatal automobile accidents in the whole of Sweden [1975]. It is shown that single-vehicle accidents are more common on weekends and late in the day. Collisions between vehicles occurred often during bad weather conditions. Single-vehicle accidents happened more often on roads with lower speed limits than did collisions between vehicles. In single-vehicle accidents the drivers were markedly younger, more often drunken, and showed severe signs of social deviance. These features of the drivers in single-vehicle accidents significantly differed from drivers involved in collisions between vehicles even when results were corrected with regard to the fact that there are always two drivers involved in collisions between vehicles, and thus 50% of the drivers in these accidents supposedly represent what could be called average drivers. The use of seat belts and possession of drivers licenses were much lower in single-vehicle accidents. The question of psychopathic states in drivers involved in single-vehicle accidents is raised.

TRENDS IN PREVALENCE OF FATAL SURGICAL DISEASES AT FORENSIC AUTOPSY

Background:  In 1992, there were major changes in Swedish law of the deceased, which had led to a dramatic decrease in autopsy rates. The aim of this study was to investigate the prevalence of fatal or potential fatal surgical diseases within a Swedish forensic autopsy cohort, before and after this change in legislation.