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PubMed2000

Methadone-related fatalities in Hamburg 1990-1999: implications for quality standards in maintenance treatment?

Drug-related fatal poisonings were analysed in Hamburg from 1990 to 30th June 1999 with special attention to the role of methadone. The first methadone-related fatalities were observed in Hamburg three years after methadone maintenance treatment (MMT) was introduced in 1990. Meanwhile more than half of all fatal poisonings among drug addicts are monovalent or polydrug intoxications with evidence for methadone. From January 1997 until June 1999 methadone was the predominant cause of death in about 39% of all drug-related fatal poisonings while the proportion of mixed heroin/methadone intoxications was about 10%. The rising problem of methadone-related fatalities goes with a decline of monovalent heroin intoxications which decreased in the last 9 years from 60% to 11%. Sixty-five per cent of those who died of fatal methadone-related poisonings had no history of MMT (60% of those with methadone as predominant cause of death). Since take-home doses for up to 7 days are prescribed to the patient due to a change in the German Narcotics Act in 1998, the diversion of methadone into illegal markets may have been accelerated. This results in rising numbers of non-intentional methadone-related fatalities among addicts who have never been in MMT. The prerequisites for the prescription of take-home doses should be taken more serious. There is no doubt that MMT reduced the mortality rate among the great majority of patients in Hamburg but supreme efforts should be made to prevent or reduce fatal intoxications by methadone in the non-treatment group.

Analgesics, Opioid↗

PubMed2001

Blood carbon monoxide and hydrogen cyanide concentrations in the fatalities of fire and non-fire associated civil aviation accidents, 1991-1998.

Blood samples submitted to the Civil Aeromedical Institute (CAMI) from aviation accident fatalities are analyzed for carbon monoxide (CO), as carboxyhemoglobin (COHb), and hydrogen cyanide, as cyanide (CN(-)). These analyses are performed to establish possible exposure of victims to smoke from in-flight/post-crash fires or to CO from faulty exhaust/heating systems. The presence of both gases in blood would suggest that the victim was alive and inhaled smoke. If only COHb is elevated, the accident (or a death) could be the result of CO contamination of the interior. Information pertaining to blood levels of these gases in aviation fatalities, in relation to the associated accidents, is scattered or not available, particularly with regard to toxicity. Therefore, considering that COHb> or =10% and CN(-)> or =0.25 microg/ml are sufficient to produce some degree of toxicological effects, the necessary information was extracted from the CAMI database. Samples from 3857 fatalities of 2837 aviation accidents, occurring during 1991-1998, were received; 1012 accidents, encompassing 1571 (41%) fatalities, were fire associated, whereas 1820 accidents were non-fire related. The remaining five accidents were of unknown fire status. There were fewer fire related fatalities and associated accidents in the (COHb> or =10% and CN(-)> or =0.25 microg/ml) category than that in the (COHb<10% and CN(-)<0.25 microg/ml) category. No in-flight fire was documented in the former category, but in-flight fires were reported in 14 accidents (18 fatalities) in the latter category. No non-fire accident fatality was found wherein levels of both gases were determined to be at or above the stated levels. There were 15 non-fire accidents with 17 fatalities wherein only COHb (10-69%) was elevated. The present study suggests that aviation fire accidents/fatalities were fewer than aviation non-fire accidents/fatalities and confirms that aviation accidents related to in-flight fires and CO-contaminated interiors are rare.

Accidents, Aviation↗

PubMed2002

Trends in fatal coronary heart disease among people aged 25-74 years in Oita City, Japan, from 1987-1998.

Serum cholesterol has been increasing in recent years in Japan. There is concern that risk of coronary heart disease (CHD) may be increasing too, but there is little information on validated fatal CHD trends in the Japanese population. We identified 1,056 deaths from heart disease and other deaths possibly hiding CHD from death certificates of residents aged 25-74 years in Oita City, Japan in 1987-1988, 1992-1993, and 1997-1998 (mean population, 273,000 in 1997-1998). We validated 994 of them by medical record review and physician interviews, classifying them into definite fatal acute myocardial infarction (AMI) and possible fatal AMI or CHD death based on Monitoring Trends and Determinants in Cardiovascular Disease project's criteria. Sudden death was defined to estimate the number of CHD sudden deaths. In men, age-adjusted mortality rates due to validated fatal CHD remained quite stable over 10 years (25.3 per 100,000 [95% CI, 15.0-35.5] in 1987-1988 to 24.2 per 100,000 [95% CI, 16.1-32.3] in 1997-1998). When 50% or all sudden deaths were included as fatal CHD, the rates for men tended to decline. This was due to decreasing out-of-hospital deaths in connection with a declining CHD death rate among men aged 65-74 years, whereas in-hospital CHD deaths were level. In women, the rate of validated fatal CHD was highest in 1992-1993, but the 1997-1998 rate was similar to the 1987-1988 rate. We did not find that fatal CHD rates increased in Oita men and women from 1987-1998. Rather, out-of-hospital fatal CHD tended to decline in Oita men.

Adult↗

PubMed2000

Lessons for management of anaphylaxis from a study of fatal reactions.

BACKGROUND: The unpredictability of anaphylactic reactions and the need for immediate, often improvised treatment will make controlled trials impracticable; other means must therefore be used to determine optimal management. OBJECTIVES: This study aimed to investigate the circumstances leading to fatal anaphylaxis. METHODS: A register was established including all fatal anaphylactic reactions in the UK since 1992 that could be traced from the certified cause of death. Data obtained from other sources suggested that deaths certified as due to anaphylaxis underestimate the true incidence. Details of the previous medical history, the reaction and necropsy were sought for all cases. RESULTS: Approximately half the 20 fatal reactions recorded each year in the UK were iatrogenic, and a quarter each due to food or insect venom. All fatal reactions thought to have been due to food caused difficulty breathing that in 86% led to respiratory arrest; shock was more common in iatrogenic and venom reactions. The median time to respiratory or cardiac arrest was 30 min for foods, 15 min for venom and 5 min for iatrogenic reactions. Twenty-eight per cent of fatal cases were resuscitated but died 3 h-30 days later, mostly from hypoxic brain damage. Adrenaline (epinephrine) was used in treatment of 62% of fatal reactions but before arrest in only 14%. CONCLUSIONS: Immediate recognition of anaphylaxis, early use of adrenaline, inhaled beta agonists and other measures are crucial for successful treatment. Nevertheless, a few reactions will be fatal whatever treatment is given; optimal management of anaphylaxis is therefore avoidance of the cause whenever this is possible. Predictable cross-reactivity between the cause of the fatal reaction and that of previous reactions had been overlooked. Adrenaline overdose caused at least three deaths and must be avoided. Kit for self-treatment had proved unhelpful for a variety of reasons; its success depends on selection of appropriate medication, ease of use and good training.

Adolescent↗

PubMed1992

Fatal familial insomnia, a prion disease with a mutation at codon 178 of the prion protein gene.

BACKGROUND: We previously described two members of a family affected by an apparently genetically determined fatal disease characterized clinically by progressive insomnia, dysautonomia, and motor signs and characterized pathologically by severe atrophy of the anterior ventral and mediodorsal thalamic nuclei. Five other family members who died of this disease, which we termed "fatal familial insomnia," had broader neuropathologic changes suggesting that fatal familial insomnia could be a prion disease. METHODS: We used antibodies to prion protein (PrP) to perform dot and Western blot analyses, with and without proteinase K, on brain tissue obtained at autopsy from two patients with fatal familial insomnia, three patients with sporadic Creutzfeldt-Jakob disease, and six control subjects. The coding region of the PrP gene was amplified and sequenced in the samples from the two patients with fatal familial insomnia. Restriction-enzyme analysis was carried out with amplified PrP DNA from 33 members of the kindred. RESULTS: Protease-resistant PrP was found in both patients with fatal familial insomnia, but the size and number of protease-resistant fragments differed from those in Creutzfeldt-Jakob disease. In the family with fatal familial insomnia, all 4 affected members and 11 of the 29 unaffected members had a point mutation in PrP codon 178 that results in the substitution of asparagine for aspartic acid and elimination of the Tth111 I restriction site. Linkage analysis showed a close relation between the point mutation and the disease (maximal lod score, 3.4 when theta was zero). CONCLUSIONS: Fatal familial insomnia is a prion disease with a mutation in codon 178 of the PrP gene, but the disease phenotype seems to differ from that of previously described kindreds with the same point mutation.

Adolescent↗

PubMed1994

Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma.

BACKGROUND: Many deaths from attacks of asthma may be preventable. However, the difficulty in preventing fatal attacks is that not all the pathophysiologic risk factors have been identified. METHODS: To examine whether dyspnea and chemosensitivity to hypoxia and hypercapnia are factors in fatal asthma attacks, we studied 11 patients with asthma who had had near-fatal attacks, 11 patients with asthma who had not had near-fatal attacks, and 16 normal subjects. Their respiratory responses to hypoxia and hypercapnia, determined by the standard rebreathing technique while the patients were in remission, were assessed in terms of the slopes of ventilation and airway occlusion pressure as a function of the percentage of arterial oxygen saturation and end-tidal carbon dioxide tension, respectively. The perception of dyspnea was scored on the Borg scale during breathing through inspiratory resistances ranging from 0 to 30.9 cm of water per liter per second. RESULTS: The mean (+/- SD) hypoxic ventilatory response (0.14 +/- 0.12 liter per minute per percent of arterial oxygen saturation) and airway occlusion pressure (0.05 +/- 0.05 cm of water per percent of arterial oxygen saturation) were significantly lower in the patients with near-fatal asthma than in the normal subjects (0.60 +/- 0.35, P < 0.001, and 0.16 +/- 0.08, P < 0.001, respectively) and the patients with asthma who had not had near-fatal attacks (0.46 +/- 0.29, P = 0.003, and 0.15 +/- 0.09, P = 0.004). The Borg score was also significantly lower in the patients with near-fatal asthma than in the normal subjects, and their lower hypoxic response was coupled with a blunted perception of dyspnea. CONCLUSIONS: Reduced chemosensitivity to hypoxia and blunted perception of dyspnea may predispose patients to fatal asthma attacks.

Adult↗

PubMed2001

Fatalities due to anaphylactic reactions to foods.

Fatal anaphylactic reactions to foods are continuing to occur, and better characterization might lead to better prevention. The objective of this report is to document the ongoing deaths and characterize these fatalities. We analyzed 32 fatal cases reported to a national registry, which was established by the American Academy of Allergy, Asthma, and Immunology, with the assistance of the Food Allergy and Anaphylaxis Network, and for which adequate data could be collected. Data were collected from multiple sources including a structured questionnaire, which was used to determine the cause of death and associated factors. The 32 individuals could be divided into 2 groups. Group 1 had sufficient data to identify peanut as the responsible food in 14 (67%) and tree nuts in 7 (33%) of cases. In group 2 subjects, 6 (55%) of the fatalities were probably due to peanut, 3 (27%) to tree nuts, and the other 2 cases were probably due to milk and fish (1 [9%] each). The sexes were equally affected; most victims were adolescents or young adults, and all but 1 subject were known to have food allergy before the fatal event. In those subjects for whom data were available, all but 1 was known to have asthma, and most of these individuals did not have epinephrine available at the time of their fatal reaction. Fatalities due to ingestion of allergenic foods in susceptible individuals remain a major health problem. In this series, peanuts and tree nuts accounted for more than 90% of the fatalities. Improved education of the profession, allergic individuals, and the public will be necessary to stop these tragedies.

Adolescent↗

PubMed2005

Relationships of frontal offset crash test results to real-world driver fatality rates.

In a study of the relationship between Insurance Institute for Highway Safety frontal offset crash test ratings and real-world fatality rates, there was a clear trend for better-rated vehicles to have lower driver fatality risk, although the correlation was not uniform across all vehicle groups or statistically significant in all cases. For all types of crashes combined, fatality rates per registered vehicle were generally lower for vehicles rated good than for vehicles rated poor, but rates for acceptable and marginal vehicles were not always within this range. A more precise examination of fatality risk was accomplished by comparing driver outcomes in fatal two-vehicle crashes. When a rated vehicle collided with a nonrated vehicle, the fatality risk for the rated vehicle driver was highest for poorly rated vehicles, then progressively smaller for vehicles with marginal, acceptable, or good ratings. For two-vehicle crashes of similar vehicles rated good and poor, the odds of driver fatality was 34 percent lower for the good vehicle than for the poor vehicle, but this estimate was not statistically significant. Finally, in head-on crashes of rated vehicles, the estimated odds of driver fatality was approximately 74 percent lower for the good vehicle than for the poor vehicle, with confidence limits ranging from 28 to 91 percent.

Accidents, Traffic↗

PubMed2002

Fatal crashes among older drivers: decomposition of rates into contributing factors.

This study selected US drivers aged 55 years or older who were involved in fatal crashes in 1990 and 1995 and explored factors that influenced their fatal crash involvement rate. The fatal crash involvement rate (risk of being involved in a fatal crash) can be thought of as the product of the crash fatality rate (risk of dying given a crash), the crash incidence density (risk of crash), and the exposure prevalence (amount of driving). Fatal crash involvement rates increased with age. The relative contributions of the crash incidence densities and exposure prevalences were greater than that of the crash fatality rates. The decomposition methodology was shown to be a useful method for investigating the potential benefit of crash prevention interventions aimed at different components of the fatal crash involvement rate.

Accidents, Traffic↗

PubMed2001

Potential risks and prevention, Part 1: Fatal adverse drug events.

Potential risk factors for and the preventability of fatal adverse drug events (ADEs) were studied. Case reports of ADEs published in Clin-Alert during 1976-95 were the source of information on fatal ADEs, Patient, drug, and event variables were identified, and the causality, predictability, and preventability of each case were assessed. Data were entered into a relational database for analysis. The data indicated 447 cases involving a fatal ADE. Ten percent of the fatal ADEs were assessed as definite, 46% as probable, and 44% as possible. Fatal-ADE frequency increased with age. Forty-five percent of the patients were 40-69 years of age, and 40% were healthy. Central-nervous-system agents, antineoplastics, antimicrobials, and cardiovascular agents accounted for 69% of the deaths. Only 33% of patients received more than the usual dosage. Many of the suspected drugs could have been monitored with blood level tests but were not, and baseline testing of critical blood count and liver and renal function was often not performed. The most common causes of death were hepatitis, hepatic failure, cardiopulmonary arrest, overdose, and agranulocytosis. ADE types were distributed as adverse drug reactions (58%), allergic reactions (19%), medication errors (17%), and drug interactions (6%). Sixty-eight percent of the fatal ADEs were judged to have been preventable; of these, a pharmacist could have prevented 57%. Litigation was reported for 14% of the fatal-ADE cases; judgments and settlements averaged $1.1 million. A review of published case reports of ADEs for 1976-95 yielded information on possible risk factors for fatal ADEs and on which events may have been preventable.

Adverse Drug Reaction Reporting Systems↗

PubMed1998

Acute myocardial infarction case fatality, incidence and mortality rates in a population registry in Gerona, Spain, 1990-1992. REGICOR Investigators.

BACKGROUND: Community-based registries provide the best approach to assessing the impact of myocardial infarction (MI) in a population. The objective of the present study was to determine MI mortality, incidence, attack rate and 28-day case fatality in the province of Gerona, Spain from 1990 to 1992. METHODS: Standardized methods were used to find, register and classify MI cases in that population (509628 inhabitants) as definite, possible and insufficient-data MI. RESULTS: Of the 1456 cases fulfilling eligibility criteria, 850 (58.4%) were classified as definite MI, 162 (11.1%) as fatal possible MI, 232 (15.9%) as no MI and 160 (11.0%) as fatal insufficient data. The 1990-1992 age-standardized incidence rates (first MI cases only) for definite and fatal possible MI were 140.8 per 100000 men and 20.4 per 100000 women, all aged 35-64 years; attack rates (first and recurrent MI cases) were 182.9 and 24.5, and mortality rates 46.4 and 5.8, respectively. Case fatality at 28 days was 27.4% and 19.9% in men and women, respectively, but women died later over that period. With respect to men, the age-adjusted risk among women of dying within 28 days post-MI was 1.26 (95% confidence interval [CI]: 0.94-1.69). CONCLUSIONS: Myocardial infarction, incidence, mortality rates and case fatality in Gerona are among the lowest in the world. Age-adjusted case fatality within 28 days is only marginally higher in women than in men, but fatal cases occur later within this period in women.

Adult↗

PubMed1999

A registry-based case-control study of risk factors for the development of multiple non-fatal injuries on the job.

Using compensation records of Taiwan, we conducted a case-control study nested within a cohort of 77,846 active workers who experienced at least one incidence of non-fatal work-related injury between 1994 and 1996 in order to explore factors associated with risk of sustaining multiple non-fatal injuries in the workplace. Cases (n = 2,616) were workers with more than three incidences of non-fatal injury during the study period and controls (n = 3,974) were randomly sampled from workers who experienced only one incidence of non-fatal injury during the same period. Compared with construction workers, workers employed in mining and quarrying (OR = 2.7), manufacturing (OR = 1.2), commerce (OR = 1.6), transport, storage and communication (OR = 1.3) and social, personal and community service (OR = 1.4) were all at significantly elevated risk of multiple non-fatal injuries. Both age and wage showed a significant dose-response effect on the risk of developing multiple non-fatal injuries. The preliminary analysis suggests that workers in certain industries are at significantly elevated risks of multiple work-related non-fatal injuries, in particular those in the mining and quarry industries. Additionally, further preventive measures should be aimed at protecting older workers from such injuries and further studies would help provide more specific interpretations on the positive association between higher wage earning and risk of multiple non-fatal injuries.

Accidents, Occupational↗

PubMed1995

Driver fatalities in 1985-1993 cars with airbags.

OBJECTIVE: Analyses were conducted to estimate the effectiveness of airbags in reducing driver fatalities in motor vehicle crashes. DESIGN: Airbag effectiveness was estimated by (1) comparing driver fatalities in frontal crashes with driver fatalities in nonfrontal crashes for cars with airbags and manual belts and cars with manual belts only, and (2) by comparing driver fatal crash rates per 10,000 registered vehicles for cars with airbags and manual belts and cars with manual belts only. MATERIALS AND METHODS: Fatal Accident Reporting System data for 1985-1993 model year cars were compared. MEASUREMENTS AND MAIN RESULTS: The two methods yielded similar results. In the analysis based on location of damage, driver fatalities in airbag equipped cars were reduced by 24 percent in frontal crashes relative to comparable cars with manual belts only and by 16 percent in all crashes. In the analyses based on vehicle registration data, fatality rates for frontal crashes were reduced by 23 percent for cars with airbags and manual belts compared with the same cars equipped with manual belts only and by 16 percent for all crashes. CONCLUSIONS: Various estimates of airbag effectiveness are beginning to yield consistent results. These analyses confirm that driver airbags are reducing fatalities in the frontal crashes for which they are designed.

Accidents, Traffic↗

PubMed1996

Fatal motor vehicle crashes: variations of crash characteristics within rural regions of different population densities.

OBJECTIVE: While it is known that motor vehicle crash (MVC) fatality rates are inversely related to population density, there has been no description of which crash variables are related to population density. The purpose of this study was to describe crash characteristics of fatal MVCs and to determine which crash characteristics are related to population density. DESIGN: This is a retrospective review of fatal accident reporting system (FARS) records. They represent four different population density regions over a 5-year period in a four-state midwest region. RESULTS: There were 10,932 people in 6,318 vehicles who were involved in 4,970 fatalities. Occupant fatality rates per 100,000 persons were inversely related to population density. The variables related to lower population density were more light and heavy truck types, more frequent alcohol use and higher levels of intoxication, more frequent crashes that are noncollisions on less heavily traveled roads, more frequent crashes on gravel surface types, more frequent occupant ejection, and delayed medical care. CONCLUSION: Rural areas are not homogenous in terms of fatal MVC crash characteristics. By analyzing fatal MVC crash characteristics in regions with different population densities, many crash variables were found to be related to population density. By understanding which characteristics about fatal MVCs are related to population densities, different interventions could be targeted to different rural populations.

Accidents, Traffic↗

PubMed1996

Machinery-related occupational fatalities in the United States, 1980 to 1989.

The National Traumatic Occupational Fatalities surveillance system identified machinery-related incidents as the second leading cause of traumatic occupational fatalities in the United States between 1980 and 1989. These incidents resulted in 8,505 civilian worker deaths and an average annual fatality rate of .80 per 100,000 workers. Workers aged 65 years and older had 5.8 times the fatality rate of workers aged 16 to 64 years (4.06 vs. 70). The highest industry-specific rate was noted in agriculture, forestry, and fishing (7.47). Tractors and other agricultural machinery were associated with nearly 9 of every 10 fatal machinery-related incidents involving workers aged 65 or older. Although numerous studies of agricultural machinery-related fatalities are found in the literature, detailed analyses of machinery-related fatalities in the construction industry as well as analyses of work situations and risk factors associated with fatal injuries are needed.

Accidents, Occupational↗

PubMed2004

Anaphylaxis: can we tell who is at risk of a fatal reaction?

PURPOSE OF REVIEW: Anaphylaxis is frightening and patients commonly fear their next reaction will be fatal. This review looks at the characteristics of fatal reactions to find if a fatal recurrence is predictable. RECENT FINDINGS: Most publications on fatal anaphylaxis are case reports that do not help predict risks. Most epidemiological studies focus on non-fatal reactions. The UK fatal anaphylaxis register demonstrates that over two-thirds of those dying from sting reactions and over four-fifths dying from drug anaphylaxis had no previous indication of their allergy, whereas those dying from food allergy had usually had previous reactions but these were typically not severe. Recent reports of anaphylaxis epidemiology based on diagnostic coding or attendance for treatment may be biased by differences in health service resource utilization according to the cause and course of the reaction. SUMMARY: Most fatal anaphylactic reactions are unpredictable. The appropriate management after recovery from a severe reaction may be protective against a fatal recurrence. An accurate identification of the cause and effective avoidance is a crucial part of this management, together with effective treatment of asthma for those with food allergy, immunotherapy for sting allergy, the avoidance of drugs that potentiate anaphylaxis, and effective training in self-treatment.

Age Factors↗

PubMed2004

The epidemiology of serious and fatal injury in San Diego County over an 11-year period.

BACKGROUND: Analysis of the mechanism and severity of injury over time may permit a more focused planning of acute care and trauma prevention programs. METHODS: A retrospective, population-based study examining severe traumatic injury in a single county was undertaken. Three overlapping data sets were used to form a composite injury data set. RESULTS: There were 55,664 patients included in the study. A total of 40,897 (73.5%) patients survived and 14,767 (26.5%) died. Of those patients who died, 8,910 (60.3%) died in the field and were not transported to a trauma center. There was an increase in the mean age of all trauma victims (3 years) and an increase of 5 years in fatally injured patients. The mean Injury Severity Score decreased from 14.7 to 11.6 (p < 0.01); however, Injury Severity Score for fatal patients remained constant (39.7). The overall injury rate remained unchanged (195 per 10(5)), whereas the fatal injury rate decreased by 22% (45.9 per 10(5)) over the 11-year study period. The leading cause of injury was motor vehicle crash, followed by assault. The leading cause of fatal injury was suicide, followed by homicide. CONCLUSION: A combination of three independent injury data sources generated a composite data set of serious and fatal injury. This regional injury analysis was the most comprehensive overview of injury in our region. Important observations included the following: there has been no change in the overall incidence of severe injury within our county; the incidence of fatal traumatic injury has significantly decreased; the leading causes of nonfatal injury do not correlate with the rank order of fatal injury; intentional injury was the leading cause of injury deaths; and scene fatalities represent a poorly studied group of patients who may benefit from primary prevention and injury control research.

Accidents, Traffic↗

PubMed1999

Fire fatalities in older people.

OBJECTIVE: To compare the epidemiology of fire-related fatalities among older, middle-aged, and young people. DESIGN: Retrospective case series. SETTING: Alabama, 1992-1997. PARTICIPANTS: All persons fatally injured in fire-related incidents in the state of Alabama from 1992 to 1997. MEASUREMENTS: The State Fire Marshal's Office provided both demographic and autopsy information about the victim. In addition, information regarding the nature and circumstances of the fire was also obtained. RESULTS: Between 1992 and 1997, there were 674 fire-related deaths in the state of Alabama. The fire-related fatality rate was highest among older persons. The fatality rate was particularly high among older black people. The rate of fatal fires caused by heating devices was higher (15.0%) among older people compared with their young and middle-aged counterparts (6.3% and 4.5%, respectively). Fatalities among older people were least likely (26.0%) to occur if smoke detectors were present, compared with deaths among young and middle-aged persons (38.3% and 33.5%, respectively). There were fewer smoke detectors present in the fatal fires of older rural black adults and white adults (0.0% and 29.0%, respectively) compared with their urban counterparts (25.0% and 47.0%, respectively). Alcohol was not a factor in fatal fires involving older adults (29.0%) compared with those involving the young (52.0%) and middle-aged adults (73.9%). CONCLUSIONS: With the growth of the percentage of older people in the population, the problem of fire-related deaths in this age group is likely to increase. Interventions focused on this age group are necessary for the state of Alabama to meet the National Health Objectives for the year 2000.

Accidents↗