Alcohol and unnatural deaths in the West of Ireland: a 5-year review

Helen Ingoldsby; Grace Callagy

doi:10.1136/jcp.2010.078741

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Alcohol and unnatural deaths in the West of Ireland: a 5-year review

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Intervention to reduce mortality due to the alcohol-related road traffic collision
Masahito Hitosugi
Published on: 22 October 2010

Published on: 22 October 2010
Intervention to reduce mortality due to the alcohol-related road traffic collision
- Masahito Hitosugi, Associate Professor
- Other Contributors:
  Shogo Tokudome
Editor - The article "Alcohol and unnatural death in the West of Ireland: a 5-year review" emphasized the need for effective interventions to reduce mortality due to the alcohol-related road traffic collision (RTC)[1]. Recently in Ireland, allowable blood alcohol concentration (BAC) limit of drivers was decreased from 0.8mg/ml to 0.5mg/ml. According to Ingoldsby and Callagy concluded in their manuscript that legislative...
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Editor - The article "Alcohol and unnatural death in the West of Ireland: a 5-year review" emphasized the need for effective interventions to reduce mortality due to the alcohol-related road traffic collision (RTC)[1]. Recently in Ireland, allowable blood alcohol concentration (BAC) limit of drivers was decreased from 0.8mg/ml to 0.5mg/ml. According to Ingoldsby and Callagy concluded in their manuscript that legislative change might not be effective in reducing fatalities because the BACs in most of fatal drivers exceeded 0.8mg/ml[1]. However, the conclusion seems to be doubtful. In Japan, legal limit of BAC in drivers decreased and its effect have been scientifically validated by us. In 1970, the Japanese government introduced a law setting the maximum allowable breath alcohol concentration at 0.25mg/L (BAC of 0.5mg/ml). This law was revised in 1978 to increase penalties for drivers in violation of this law. We analyzed the BAC of drivers involved in fatal MVCs that occurred between 1986 and 2001[2]. Approximately 10.0 to 13.7% of offenders were drunk drivers with BAC levels of 0.5mg/ml or more. However, 3.8 to 6.1% of offenders were drunk drivers with BAC levels below the legal limit (between 0 and 0.5mg/ml). Furthermore, we determined the relative risks of fatal MVCs due to alcohol-impaired (BAC level greater than 0.25mg/L) driving in Japan[3]. The relative risk of fatality was 5.5 in 1986 and gradually increased to 8.0 by 2001 for alcohol-impaired driving of a four-wheeled vehicle. The increase in the relative risk indicates that a large number of deaths could be prevented if drivers refrained from drinking. In June 2002, the Japanese Government strengthened the Road Traffic Law and decreased the allowable breath alcohol concentration from 0.25 to 0.15 mg/L (BAC: from 0.5 to 0.3mg/ml). In 2002, the number of drunk driving collisions was markedly decreased from the previous year (25,440 to 20,328, a 20.1% decrease). Also, the number of fatal drunk driving collisions was 997 in 2002, a 16.3% decrease from the previous year. In 2002, 8,326 persons died in MVCs in Japan, the lowest number in the preceding 35 years and a 5.0% decrease from the previous year. These data reflected the deterrent effect of the revised law. With the strength of allowable BAC limit, the awareness in which drunk driving should be prohibited also improved, subsequently, the number of drunk driving might be decreased. Therefore, the effect of the revision of the law of drunk driving in Ireland should be accurately validated with the nationwide statistics of the accidents and fatalities by drunken-driving. We agree the proposal that interventions other than driving limit reduction should be considered to reduce mortality. In Japan, in addition to reduce the allowable BAC limit of drivers, stricter countermeasures for drunk driving also contributed to the decrease of alcohol related vehicle accidents and fatalities. The police responded by implementing the revised Traffic Law to include stricter regulations and penalties targeting drunk driving and any environments that enable drunk driving (enacted in 2007). Furthermore, the police force continues to promote strict regulations. When a person is arrested for drunk driving, an in-depth investigation is conducted not only on the driver but also on the other vehicle passengers and/or persons who provided the alcohol to the driver. It was decided that the revised Road Traffic Law would also promote the application of the penal code to fellow passengers who had enabled the drunk driving actions, or to persons who had provided alcohol to the driver. Recently, the number of traffic collisions caused by drunk driving has decreased as a result of the expansion and consolidation of two sets of penal codes, along with the revision of the Road Traffic Act and establishment of a new penal code. In 2008, there were 6,219 cases of drunk driving-related collisions, less than one-third of those in 2002[4]. We showed the effective measures to prevent alcohol-related traffic fatalities in Japan. We forensic pathologists have to not only determine the actual cause of death, but contribute to the primary prevention of unnatural deaths. Further effort might be needed for us to lesser the common alcohol- associated unnatural deaths.
References 1. Ingolsby H, Callagy G. Alcohol and unnatural deaths in the West of Ireland: a 5-year review. J clin Pathol 2010;63:900-903. 2. Hitosugi M, Maegawa M, Kido M, et al. Trends in fatal traffic accidents due to alcohol-impaired driving in Japan, relative to breath alcohol levels of drivers. Jpn J Occup Med Traumatol 2007;55:234-238, in Japanese with English abstract. 3. Hitosugi M, Sorimachi Y, Kurosu A, et al. Risk of death due to alcohol- impaired driving in Japan. Lancet 2003;361:1132. 4. Ministry of Land, Infrastructure, Transport and Tourism in Japan. White Papers on Ministry of Land, Infrastructure, Transport and Tourism, 2008. Ministry of Land, Infrastructure, Transport and Tourism in Japan, Tokyo, 2009, in Japanese.
Masahito Hitosugi, MD, PhD, Shogo Tokudome, MD, PhD, Department of Legal Medicine, Dokkyo Medical University School of Medicine Mibu, Tochigi 321-0293, Japan hitosugi@dokkyomed.ac.jp
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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