Investigating blood alcohol concentrations in injury-related deaths before and during the covid-19 national lockdown in Western Cape, South Africa: a cross-sectional retrospective review

Master Thesis


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In South Africa, alcohol is a significant contributor to the burden of injury-related morbidity and mortality. Our understanding of its impact in injury-related mortality in the country is limited. The COVID-19 lockdown period in South Africa introduced restrictions that limited the legal access to the sale and on-site consumption of alcohol and presented a unique opportunity for examination of the impact of such restrictions on injury-related mortality. This study aimed to examine the relationship between blood alcohol concentrations (BAC) and injury-related deaths and to investigate the effect of the COVID-19 lockdown periods and alcohol restrictions on injury-related mortality and post-mortem BAC levels. A retrospective cross-sectional analysis of BACs in all injury-related death cases admitted to mortuaries in the Western Cape (WC) province between 1 January 2019 to 31 December 2020 (inclusive) was conducted. Descriptive and inferential statistics were performed using STATA 13 (StataCorp, TX, USA), to investigate BACs in injury deaths before and during the COVID19 lockdown periods in South Africa. A total of 16,027 injury-related cases were admitted to forensic mortuaries in the WC province in the study period out of a total of 21,797 cases, with significantly fewer cases admitted in 2020 during the first two COVID-19 lockdown periods compared to the same period in 2019 (p< 0.001). Samples were collected for BAC levels in 12,077 (75.4%) of injury-related cases and were most frequently requested in suspected homicide cases (85.2% of 8190). A positive BAC (≥0.01 g/100 mL) was found in 5,078 (42.2%) of the study sample. No significant difference was observed in the mean positive BAC between 2019 (0.18±0.1%) and 2020 (0.17±0.09%), except in the months of level 5 lockdown between April and May 2020, when there was a decrease in the mean positive BAC to 0.13g/dL in 2020 compared to 0.18g/dL for the same period in 2019. There was a 47.7% reduction in injury-related cases seen year on year in the WC during the period of level 5 lockdown and full alcohol restriction in 2020 compared to 2019 however trauma cases increased later in 2020 during full alcohol restrictions. The data presented in this study shows a decrease in injury-related deaths in the WC during the lockdown periods that coincided with alcohol bans and an increase following relaxation of restrictions on movement and alcohol sales. The data shows that the mean concentrations were similar between all periods of alcohol restriction compared to 2019, however, there were significantly fewer individuals with positive BACs in 2020 during complete alcohol sales restrictions than in 2019. This did, however, coincide with a smaller mortuary intake during the level 5 lockdown. The findings of fewer injury-related deaths and fewer positive BACs during lockdown periods coinciding with complete alcohol sales restrictions in 2020 should be taken into consideration to inform future decisions on alcohol control policy in the country.