A retrospective study on solitary deaths (kodoku-shi) from the aspects of forensic and social medicine

Abstract

Abstract Background: Solitary death is a major social and medical problem. However, the situation of solitary death has not been investigated fully. Our purpose was to clarify the present situation of solitary death from the viewpoint of forensic medicine. Methods:A total of 3,000 forensic autopsies were performed at the Department of Forensic Medicine, Wakayama Medical University, from April 2003 to December 2018. We retrospectively reviewed the autopsy reports of all cases and selected cases of solitary death or presumed solitary death. Solitary death was defined as death in people living alone that occurred at home or on the premises of home. A total of 637 cases were selected as solitary death cases or presumed solitary death cases in accordance with the abovementioned definition. We investigated the tendency of solitary death in forensic autopsies, sex, age distribution, manner or cause of death, dementia cases, postmortem interval until finding (PMI-f), first finder, past medical histories, and economic conditions. Moreover, the regional characteristics in Wakayama Prefecture were also examined. Results:Solitary death predominantly occurred in men (471 males, 166 females). This tendency increased from the age of 40 years in men and 60 years in women. Among the cases, 349 and 199 were natural death and external death, respectively. Ischemic heart disease- and fire-related fatalities were most common in natural death and external death cases, respectively. Suicidal death was more frequent in women than in men. The PMI-f in female cases was significantly shorter than that in male cases (p<0.001). Kushimoto and Shingu, located in the southern part (Kinan region), had a high solitary death rate in forensic autopsy cases. However, focusing on the economic state, few cases were welfare recipients in solitary death cases in Kinan region (non-urban area), and 23 of 36 welfare recipients lived in Wakayama City, indicating that the economic state would contribute more to the occurrence of solitary death in Wakayama City (urban area). Conclusions:We identified several risk factors and regional characteristics for solitary death cases, and our observations could contribute to administrative welfare measures for the prevention of solitary deaths.