A survey of teenager unnatural deaths in northern Sweden 1981–2000

doi:10.1016/j.aap.2004.09.002

Accident Analysis & Prevention

Volume 37, Issue 2, March 2005, Pages 253-258

https://doi.org/10.1016/j.aap.2004.09.002 Get rights and content

Abstract

Objective:

To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.

Setting:

The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.

Material and methods:

All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umeå, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.

Results:

Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.

Conclusions:

Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

Introduction

Teenagers are highly exposed to fatal and non-fatal injury events (Massie et al., 1995, Mao et al., 1997, Roberts et al., 1998, Cvijanovich et al., 2001, Everett et al., 2001, Johansson et al., 2001). Nearly 60% of all deaths in Sweden during 2000, among those aged 10–19 years, were caused by external causes (The National Board of Health and Welfare, 2003). Among persons aged 21 years and younger in the US, one quarter is non-fatally injured annually with the highest injury rates among those aged 15 through 19 years. The average cost of these injuries was estimated to US$ 17,000, including medical payments, estimated cost of lost future work and decreased quality of life (Danseco et al., 2000). Thus, apart from the devastating psychological trauma that each teenager injured or killed represents the economical potential of injury prevention is enormous.

Teenagers have a high proclivity for a risky behavior, exemplified by drinking and driving, speeding, neglecting seat belts, risk taking while driving and night time driving (Massie et al., 1995, Mao et al., 1997, Jelalian et al., 2000, Everett et al., 2001). Even peer pressure can induce such a risky behavior, e.g., a teenaged driver with teenaged passengers run a much higher risk of involvement in injury events resulting in seriously or fatally injured occupants than a teenaged driver without occupants of the same age (Preusser et al., 1998, Doherty et al., 1998, Cvijanovich et al., 2001).

Suicides are also of major concern, even though suicidal deaths among teenagers are infrequent events. Most research on teenager suicide has focused on sociological, psychological or psychiatric risk factors (cf. Lindqvist and Johansson, 2000). In addition, the use of Haddon's (Haddon, 1980) matrix to analyze suicides and to develop preventive measures has been suggested (Beskow et al., 1994).

The aim of this study was to survey the injury panorama of unnatural deaths among teenagers from a well-defined, sparsely populated geographic area in Sweden in order to provide a basis for preventive measures.

Section snippets

Material and methods

All unnatural deaths among teenagers (13 through 19 years of age) autopsied at the Department of Forensic Medicine in Umeå, National Board of Forensic Medicine, from 1981 through 2000 were examined. All cases were identified through the databases of the Department of Forensic Medicine, Umeå. The catchment area of the department comprises the four northernmost rural counties of Sweden (908,000 inhabitants including 81,441 teenagers, 1991). The region comprises 55% of the total area of Sweden and

General (n = 355)

Two hundred and forty-eight subjects (70%) died in unintentional injury events and 102 (29%) in intentional injury events (88 suicides, 14 homicides). Five cases (1%) were classified as undetermined manner of death. Two hundred and sixty-seven (75%) were boys and 88 were girls (25%) with a median age of 17 among boys and 16.5 among girls. The average annual incidence of teenage unnatural deaths during the 20-year period was 20/100,000 teenagers. The number of unintentional deaths decreased (p <

Discussion

Unintentional injuries declined during the study period while intentional injuries, mainly suicides, did not. This calls for a discussion of the possibility of allocating injury prevention interest and resources from unintentional injuries towards intentional ones (O’Carroll et al., 1994), unless new resources are made available.

We use here the term “unintentional injury event” instead of “accident”, which may be misleading if interpreted as a total and non-preventable surprise (Davis and

Acknowledgements

This study was supported by grants from Trygg-Hansa forskningsfond, Sweden. Thanks to Richard Lindström, MD, for help with coding of the material. Special thanks to P.-O. Bylund, R.N., Ph.D. and Ulf Björnstig, MD, Ph.D. for reading and commenting on the manuscript. Also thanks to Thomas Lekander, The Swedish National Road Administration, for providing statistics on licensed drivers.

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A survey of teenager unnatural deaths in northern Sweden 1981–2000

Abstract

Objective:

Setting:

Material and methods:

Results:

Conclusions:

Introduction

Section snippets

Material and methods

General (n = 355)

Discussion

Acknowledgements

J. Am. Acad. Child Adolesc. Psychiatry

Soc. Sci. Med.

Accid. Anal. Prev.

J. Adolesc. Health

Accid. Anal. Prev.

J. Adolesc. Health

Accid. Anal. Prev.

Accid. Anal. Prev.

J. Traffic Med.

Soc. Sci. Med.

Accid. Anal. Prev.

Accid. Anal. Prev.

Accid. Anal. Prev.

The presence and accessibility of firearms in the homes of adolescent suicides

JAMA

Vehicle-related fatalities among Swedish conscripts

Mil. Med.