Trends in Deaths Associated With Abuse of Volatile ... · 1971-1987 and each year to 1997, using GORs Table 5 Number of VSA deaths in each Region and Coun try: 2 4 1971-1987 and each

Department of Public Health Sciencesand the Toxicology Unit

Department of Cardiological Sciences

St George's Hospital Medical SchoolCranmer Terrace, London SW17 0RE

J.C. TaylorC.L. NormanJ.M. Bland

J.D. RamseyH.R. Anderson

June 1999

Report No. 12

Trends in Deaths Associated WithAbuse of Volatile Substances

1971 - 1997

St George's Hospital Medical School VSA Deaths 1971-1997

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Published by St George's Hospital Medical SchoolDepartment of Public Health SciencesCranmer TerraceTootingLONDON SW17 0RE

Telephone: 0181 725 5491

e.mail: [email protected]

This report is available on our WEB site where previous reports can be found:

http://www.sghms.ac.uk/depts/phs/vsamenu.htm

ISBN 1 8981 8317 1


1

TABLE OF CONTENTSPage

INTRODUCTION 3

ACKNOWLEDGEMENTS 5

KEY FINDINGS FOR 1997 6

COMMENTARY 7

BIBLIOGRAPHY 18

Figure 1 Flow chart of collection and dissemination of data 19

Table 1 Age distribution of deaths: 1971 - 1995, 1996 and 1997 20

Table 2 Sex distribution of VSA deaths: 1971 - 95, 1996 and 1997 21

Table 3 Number of deaths in age groups 10-14 and 15-19, 22all causes, RTAs and VSA: 1997

Table 4 Number of VSA deaths in each Region and Country: 231971-1987 and each year to 1997, using GORs

Table 5 Number of VSA deaths in each Region and Country: 241971-1987 and each year to 1997, using SSRs

Table 6 Standardised Mortality Ratios for each Region and Country, 25adjusted for age and sex: 1988 - 1997, using GORs

Table 7 Standardised Mortality Ratios for each Region and Country, 26adjusted for age and sex: 1988 - 1997, using SSRs

Table 8 Substances abused: 1971 - 87 and each year to 1997 27

Table 9 Primary substances abused: 1988 - 1997 28

Table 10 Product abused by substance: 1971 - 1997 29

Table 11 Product abused by substance: 1997 30

Table 12 Methods of administration of volatile substances: 311971 - 95, 1996 and 1997

Table 13 Methods of administration of volatile substances 32by substance:1971 - 95, 1996 and 1997

Table 14 Mechanism of death: 1971 - 87 and each year to 1997 33


2

Figure 2 Number of VSA deaths each year: 1971 - 1997 34

Figure 3 Monthly VSA deaths among children, showing effect of 351992 advertising campaign

Figure 4 Monthly VSA deaths among adults, showing effect of 361992 advertising campaign

Figure 5 Age distribution of deaths: 1971 - 1996 and 1997 37

Figure 6 Cumulative distribution of age at death, all ages: 381971 - 1996 and 1997

Figure 7 Age distribution of deaths, ages 9-14, 15-19 and 20+: 391971 - 1997

Figure 8 Quartiles of age distribution by year of death: 1983 - 1997 40

Figure 9 VSA deaths 1983 -1997, males and females, 41comparing children and adults

Figure 10 VSA mortality rates, ages 10 to 14 by sex: 1988 - 1997 42

Figure 11 VSA mortality rates, ages 15 to 19 by sex: 1988 - 1997 43

Figure 12 Map showing Standardised Mortality Ratios for each Region 44and Country, all ages: 1988 - 1997, using GORs

Figure 13 Map showing Standardised Mortality Ratios for each Region 45and Country, all ages: 1988 - 1997, using SSRs

Figure 14 Substances abused, all ages: 1988 - 1997 46

Figure 15 Principal mechanism of death, all ages: 1988 - 97 47

Figure 16 Place of death: percentages for 1997 48

Figure 17 Place where substance was abused: percentages for 1997 49

Figure 18 Place where substance was abused: males and females: 501990 - 1997

Figure 19 Place where substance was abused, by year: 1990 - 1997 51


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INTRODUCTION

This is the twelfth annual statistical summary of data on trends in deaths associated

with the deliberate inhalation of volatile substances. Data for 1997 are included here

for the first time together with updated information for earlier years, so Report 12

supersedes all previous reports. There is necessarily a delay of more than twelve

months between the end of a calendar year and publication of our annual report. This is

to allow time for details to become available from HM Coroners and from the Office for

National Statistics (ONS), and the General Register Offices for Scotland and Northern

Ireland.

Our data set includes deaths from 1971 onwards, and our methods of data collection

have been stable and systematic since 1983. For some analyses all cases have been

used. For examining some time trends, only the period of stable data collection has

been used, whilst for others only the most recent ten years have been included, as

appropriate. To examine recent trends 1997 has been compared with the preceding

nine years, 1988-1996.

Our information for England and Wales is provided from the following main sources:

HM Coroners to whom we write regularly, ONS, the Medical Toxicology Unit, and press

clippings agencies. For Scotland, information is supplied by the Crown Office and

General Register Office for Scotland. Details of Northern Ireland deaths are provided

by the State Pathologist’s Department, HM Coroner for Greater Belfast, the General

Register Office for Northern Ireland and the Lord Chancellor’s Department. The


4

Deputy Viscount in Jersey, HM Greffier in Guernsey, and the High Bailiff in the Isle of

Man supply information for their areas.

Data on all cause mortality and population estimates are supplied by ONS and the

General Register Offices for Scotland and Northern Ireland.

The criteria used for classifying deaths and details of how we collect the data may be

found in the publications listed on page 18. Figure 1 shows the flow of collection and

dissemination of data.


5

ACKNOWLEDGEMENTS

The register of Volatile Substance Abuse deaths is funded by the Department of

Health.

For England and Wales we wish to thank all HM Coroners who notify cases to us, the

ONS Health Statistics Division for providing death certificates, the Medical Toxicology

Unit (formerly the National Poisons Unit), the British Aerosol Manufacturers'

Association for giving us access to their press cuttings information, and the Health and

Safety Executive and the Railways Inspectorate for liaison over workplace deaths

where necessary.

For Scotland, we wish to thank the Crown Office for providing information on Scottish

deaths, and the General Register Office for Scotland for providing death certificates.

For Northern Ireland, we wish to thank the staff of the State Pathologist’s Department

for ascertainment, the General Register Office for Northern Ireland for death

certificates, HM Coroner for Greater Belfast and the Lord Chancellor's Department for

the supply of documents.

We wish to thank the Deputy Viscount in Jersey, and HM Greffier in Guernsey whose

assistance enables us to include information for the Channel Isles, and the High Bailiff

and Coroner of Inquests for the Isle of Man.


6

KEY FINDINGS FOR 1997

• There were 73 deaths associated with volatile substance abuse in 1997.

• Over the last ten years, there have been significant falls in the numbers of deathsassociated with aerosols and glues, whilst those associated with gas fuels haverisen. These are now associated with the majority of deaths.

• Concern over butane lighter refills is reinforced by the figures for 1997, when theywere associated with 56% of all VSA deaths, the highest percentage everrecorded.

• VSA deaths continue to be much more common among males than females,although the proportion of females among the deaths has risen in recent years,and rose again in 1997 to 23%.

• Death rates continue to be highest in the northern areas of the British Isles.

• Volatile substance abuse accounts for one in fifty of all deaths in ages 15-19(inclusive) in the United Kingdom.

• The average age at death has increased, with fewer deaths among persons under18 years of age.


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COMMENTARY

Mortality associated with the abuse of volatile substances (VSA) is related to many

factors, including the chemical nature of the substance itself, the product containing it,

the method of inhalation and the prevalence of abuse. We have been collecting data

on deaths in a systematic way since 1983. New information is added to our database

when it becomes available.

The purpose of this report is to monitor trends rather than to provide an exhaustive

commentary. More detailed analyses of some of the data, such as the substances

abused and toxicological aspects, are the subjects of separate papers.

GENERAL NOTE

When looking at trends and mortality rates in this report it should be remembered that

they will be subject to random variation when the numbers are small. When further

cases or additional data for previous years come to light they are added to the data set.

Occasionally, if later information on a death previously included puts it outside our

criteria, then that death is removed from the data set. Any important revisions are

noted in our reports.


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NOTE ON DELAYS IN ASCERTAINMENT

The ascertainment of cases suffered temporary interruptions from 1993 to 1998. In

England and Wales, these were due to the change in coding systems used by ONS.

The new system is now operating smoothly and all the VSA deaths missed during the

transition have now been notified. During this period, HM Coroners continued to notify

us, and ascertainment through press clippings was unchanged.

In Scotland, changes of staff at the Crown Office meant that notifications were

suspended for a short period. There are still difficulties in ascertaining deaths through

this route, although steps are being taken to try to remedy this. To retrieve missing

VSA deaths, a validation exercise was carried out with assistance from staff at the

General Register Office for Scotland. They extracted all death certificates with ICD

codes previously occurring on Scottish death entries for VSA. All these were then

investigated by the research team, and those which met our criteria have been

included in the data set.

Altogether, 15 cases occurring in England and Wales before 1997 have been added to

the data, with 7 cases for Scotland.


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TRENDS IN TOTAL DEATHS PER YEAR

The total number of deaths to the end of 1997 was 1691. During 1997 there were 73

deaths. Figure 2 gives the total number of deaths for each year. The variation

between years from 1988 to 1997 was greater than would be expected by chance1,

indicating that real changes in the frequency of VSA deaths have occurred over this

period.

During the period following the Department of Health's 1992 advertising campaign,

there is no evidence that the increases in 1995 and 1996 are greater than natural

variation would produce2.

TIME SERIES ANALYSIS

Reports 8 and 9 included analyses of the monthly number of deaths following the

Department of Health’s advertising campaign of February 1992 aimed at parents.

These showed a sharp drop in deaths among children following the campaign. To

ensure that no bias was caused by the earlier omission of the cases notified late, as

described above, this analysis has been repeated. It includes data for England, Wales

and Scotland, as only these areas received the full campaign. As Figure 3 shows,

following the campaign there was a sharp fall in deaths among children, which has

persisted. We estimate that the number of deaths in persons under 18 years of age

has fallen by 60% from that predicted by the previous trend3. Among adults (Figure 4)

there was a small fall, estimated to be 18%. This was not statistically significant 4.

Thus, the evidence is that there was a large and sudden fall in VSA deaths among

1 chi-squared = 88.09, 9 d.f., P<0.00012 chi-squared = 2.99, 5 d.f., P = 0.73 P<0.001 95% CI 43% to 72%4 P=0.2 (95% CI -13% to 40%)


10

children following the campaign, and that this reduction has persisted up to the end of

1997.

There have been other, smaller, campaigns since 1992, aimed either at parents or

young people, which may have reinforced the message of the national campaign.

AGE

VSA deaths comprise an important proportion of all deaths in young people, as death

from any cause in this group is rare. In 1997, there occurred the death of a child of

seven, the youngest ever recorded. Table 1 shows the age distribution of deaths, with

the highest numbers of deaths being aged 14 to 18. This group accounts for 53% of all

VSA deaths from 1971 to 1997. Changes in the age distribution are illustrated in

several ways. Figure 5 shows a shift in the distribution of deaths in 1997 towards

higher ages. Figure 6 shows the cumulative distribution of age at death for the same

years, again showing the higher age of deaths in 1997.

Figure 7 shows trends over time in the number of deaths by age group. This shows that

the fall in deaths since 1990 was predominantly among young people. Among adults

there was a levelling rather than a fall. Figure 8 shows the change in median age. It

also shows that the age at death has risen, particularly over the years 1992-4. This is

statistically significant5.

SEX

Table 2 shows the sex distribution of deaths associated with volatile substances.

Deaths are far more common amongst males than females. Over the past ten years

the majority (85%) of cases have been male. It should not be inferred from this that


11

VSA is much more common among males than females. Studies suggest that the

practice of VSA is more nearly equal between the sexes. For example, Chadwick et

al, 1991, reported 3.8% of boys and 4.0% of girls in a school sample had ever tried

VSA, and 0.6% of boys and 0.7% of girls had abused volatile substances 10 times or

more.

The proportion of females has risen again in 1997 to 23.3% and this increase is

statistically significant6. There appears to have been an increase in the proportion of

females over time, and this change appears to have been different for children and

adults.

Figure 9 shows the percentage of males and females among deaths under 18 and over

18, for each year since 1983, the period over which the data collection methods have

been stable. Statistical analysis showed that there was no significant rise in under 18s7,

but a significant rise among over 18s8. For all ages, there was a significant rise in the

proportion of females over time9, and weak evidence10 that there was an interaction

with age group, i.e. that the rate of change was different in adults than in children.

To take into account possible changes in the population at risk, Figures 10 and 11

show the mortality rates per million per year for the 10-14 and 15-19 age groups by

sex. In both age groups, the mortality rates for females are less than those for males,

particularly among 15-19 year olds. It should be noted that different scales have been

used for Figures 10 and 11.

5 t=5.3, P<0.001, linear regression6 chi-squared = 4.69, 1 d.f., P=0.3, comparing 1997 to the previous 9 years7 P=0.68 P=0.029 P=0.0210 P=0.1


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Table 3 compares the numbers of VSA deaths with those from all causes and those

from road traffic accidents (RTAs) at ages 10-19. In 1997, VSA accounted for 0.5% of

all deaths at ages 10-14 and 2.1% at ages 15-19. This compares with 18.0% and

25.5% of deaths associated with road traffic accidents, which are by far the most

frequent cause of death in these age groups.

REGIONAL VARIATION

Table 4 shows the numbers of deaths by country and region, using Government Office

Regions, which were adopted during 1996. To facilitate comparisons of statistics for

individual regions and countries over time, Table 5 gives the same information, but

using the old Standard Statistical Regions. Inspection of these tables suggests that

there has been little change in the distribution of deaths by region over time.

Comparing 1997 with the previous nine years, the difference between the distributions

by region is not significant11.

Table 6 and Figure 12 show the standardised mortality ratios (SMRs) by region and

country, using Government Office Regions, whilst Table 7 and Figure 13 give SMRs for

the Standard Statistical Regions we have used in previous reports.

SMRs are used to compare the regions taking account of any differences in the age

and sex distribution of the population. An SMR shows the ratio of the number of deaths

actually observed, to the number of deaths expected if the region were like the country

as a whole. This is expressed as a percentage, so the whole country would have SMR

= 100. Regions with an SMR greater than 100 have more deaths than would be

expected if the country were uniform, and regions with an SMR of less than 100 have


13

fewer deaths.

For Government Office Regions, the highest SMRs were for North East Region,

Scotland, and the Region of Yorkshire and the Humber. This regional structure

separates London from the rest of south east England. It is interesting that London's

SMR is below the national average, although not significantly. Using Standard

Statistical Regions the highest SMRs were in the Northern Region of England,

Scotland, and Yorkshire and Humberside. Thus there were more deaths than

expected in the north of Great Britain and in Northern Ireland, and fewer deaths than

expected in the south, particularly in East Anglia and the South West Region of

England.

SUBSTANCES ABUSED

We classify separately butane which is intended for fuel use and butane used as a

propellant in aerosols. Butane had replaced chlorofluorocarbons (CFCs) as a

propellant in 90% of domestic aerosols by the end of 1989 (British Aerosol

Manufacturers' Association). This change in the composition of aerosols is part of the

move away from substances causing destruction of the ozone layer and towards more

"environmentally friendly" products.

Most deaths were associated with only one substance. In 6.2% of cases, two or more

substances were involved. Table 8 and Figure 14 show the number of times deaths

were associated with each substance. Cases where there was more than one

substance used appear more than once in this table and graph. The primary substance

abused is shown in Table 9.

11 chi-squared = 10.26, 10 d.f, P = 0.4, omitting the Channel Isles and the Isle of Man


14

Over the period 1988 to 1997 there has been a significant change in the substance

abused12.

Inspection of Table 9 suggests that numbers of gas-fuel related deaths have not

changed much between 1988 and 1997, and year to year variation is not significant13.

The frequency of aerosol-related death has decreased considerably, and this is

statistically significant14. The frequency of glue-related death has also decreased,

though not as much as for aerosols, and this is also statistically significant15. As the

total number of deaths has fallen, butane now accounts for a much greater proportion

of deaths, although the absolute number of butane deaths shows no significant

change.

PRODUCTS ABUSED

Within the broad substance categories a wide variety of products has been abused.

Table 10 shows products abused by substance for 1971 to 1997 and gives types of

products linked to deaths showing them as percentages of substances used rather

than as percentages of the total number of deaths. Thus deaths can appear more than

once in this table.

Since 1971 gas cigarette lighter refills have been linked to 80.9% of fatal abuses of gas

fuel, and 30.7% of all substances fatally abused. Deodorants and antiperspirants were

12 chi-squared = 77.7, 27 d.f., P< 0.0001, fire extinguishers, others and not knowns combined (Thesignificance tests in this section ignore the fact that a few people appear more than once in Table 8,having abused more than one substance).13 chi-squared = 6.20, 9 d.f., P = 0.714 chi-squared = 98.89, 9 d.f., P < 0.000115 chi-squared = 21.66, 9 d.f., P = 0.01


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involved in 40.6% of fatal abuses of aerosols, and 7.4% of all substances. Pain relief

sprays were used in 19.1% of fatal abuses of aerosols, accounting for 3.5% of all fatal

abuses. 48.5% of the fatal abuses of glue since 1971, 8.3% of all fatal abuses, have

been associated with contact adhesives. Table 11 gives the same information for 1997

alone. Butane lighter fuel related deaths accounted for 56.2% of deaths, considerably

more than the long-term average of 30.7% shown in Table 10.

The terms "glue sniffing" and “solvent abuse”, which were commonly used in

connection with volatile substance abuse, have for some years been inadequate to

describe the problem, hence our adoption of the term “volatile substance abuse”. We

note that the World Health Organisation has also now adopted the term “volatile

substance”, but consider that their term “volatile substance use” is inaccurate since the

correct term for deliberate misuse is "abuse". Another term widely used is "inhalant

abuse".

METHOD OF ADMINISTRATION

Methods of administration of volatile substances are shown in Table 12. Table 13

gives this information by substance and shows that, where this is recorded, the

predominant method of abuse of fuel gases, (mainly butane lighter refills), is by

discharging them directly into the mouth. As expected, most glues had been abused

by inhalation of the fumes/vapours from plastic bags.

MECHANISM OF DEATH

We give priority to indirect mechanisms of death: plastic bag suffocation where the

deceased has been found with a plastic bag over the head, inhalation of gastric

contents, and trauma, which includes causes such as hanging and drowning. We only

record a death as due to direct toxic effects if none of these priorities can be applied.


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Table 14 and Figure 15 show the number of deaths due to each mechanism. Overall,

53.3% were due to direct toxic effects and this figure has not changed much over time.

The proportions of deaths attributable to suffocation by plastic bag and trauma have

fallen in recent years in line with the decline in the number of deaths associated with

glues.

PREVIOUS HISTORY OF SOLVENT ABUSE

There are obvious difficulties in distinguishing absolutely between the first occasion,

and, for example, the second or third occasion on which VSA has taken place. In

1997, for 46 cases (63%) there was evidence of a previous history of solvent abuse.

For the remaining 27 people (37%), there was no evidence of their having indulged in

VSA before. For some of these we have strong evidence that death occurred on the

occasion of first abuse. However, the absence of evidence should not lead to the

assumption that death occurred on the first occasion.

PLACE WHERE SUBSTANCE WAS ABUSED

Figure 16 shows the place of death. For 1997, equal numbers were recorded with

death having occurred in hospital or on arrival at hospital (38.4% of cases) and at home

(38.4%).

Figure 17 shows where substances were abused. In 1997 the most common place for

abuse remains the home (53.4%), and in 24.7% of the deaths the substance was

abused in a public place such as a park, shopping centre or the street. Comparing


17

1997 with previous years there was no significant change in place of abuse16.

Figure 18 shows the place of abuse by sex. There was a significant difference

between the sexes in the place of abuse17. Males are more likely to die as a result of

abuse in a public place or at work, and females at home or at the home of a friend.

Figure 19 shows the place where the substance was abused for 1990 to 1997. There

was a significant change over time18. This is explained by a decline in deaths

associated with abuse in a public place.

16 chi-squared = 4.41, 4 d.f, P = 0.4, combining "workplace" with "other"17 chi-squared = 17.37, 4 d.f., P = 0.002, combining school with institution and workplace with other18 chi-squared = 38.3, 21 d.f., P = 0.01


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BIBLIOGRAPHY

1. Anderson HR, Dick B, MacNair RS, Palmer JC, Ramsey JD. An investigation of 140deaths associated with volatile substance abuse in the United Kingdom 1971-81. HumToxicol 1982;1:207-221.

2. Anderson HR, MacNair RS, Ramsey JD. Deaths from the abuse of volatile substances:a national epidemiological study. Br Med J 1985;290:304-307.

3. Anderson HR, Bloor K, MacNair RS, Ramsey J. Recent trends in mortality associatedwith the abuse of volatile substances in the UK.Br Med J 1986;293:1472-1473.

4. Ramsey J, Anderson HR, Bloor K, Flanagan RJ. An introduction to the practice,prevalence and chemical toxicology of volatile substance abuse. Hum Toxicol1989;8:261-269.

5. Anderson HR. Increase in deaths from deliberate inhalation of fuel gases andpressurised aerosols. Br Med J 1990;301:41.

6. Chadwick O, Anderson HR, Bland JM, Ramsey J. Solvent abuse: a population-basedneuropsychological study. Springer-Verlag New York 1991

7. Flanagan RJ, Ruprah M, Meredith TJ, Ramsey JD. An introduction to the clinicaltoxicology of volatile substances. Drug Safety 1990;5(5):359-383.

8. Ramsey JD, Anderson, HR, Taylor J, Flanagan RJ. Volatile substance abuse (solventabuse). Proceedings of the International Symposium on Forensic Toxicology, June 15-19, 1992. US Department of Justice, Federal Bureau of Investigation.

9. Esmail A, Anderson HR, Ramsey JD, Taylor J, Pottier A. Controlling deaths fromvolatile substance abuse in under 18s: the effects of legislation. Br Med J1992;305:692.

10. NIDA Research Monograph 148. Epidemiology of Inhalant Abuse: An InternationalPerspective. 1995. National Institute of Drug Abuse. US Government Printing Office.

11. Advisory Council on the Misuse of Drugs. Volatile Substance Abuse. London HMSO1995.

12. Esmail A, Warburton B, Bland JM, Anderson HR, Ramsey J. Regional variations indeaths from volatile solvent abuse in Great Britain. Addiction 1997;92:1765-1771.

13. Bland JM, Taylor J: Deaths due to volatile substance misuse are greatlyunderestimated (letter). Br Med J 1998;316:146.

14. Taylor JC, Bland JM, Anderson HR: Authors overestimated number of teenagersdying from misusing volatile substances (letter). Br Med J 1998;316:312.


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Back to Contents Back to Commentary

Volatile Substance Abuse Deaths

Collection and Dissemination of Data

Press clippings agences

St George’s Hospital Medical SchoolDepartment of Public Health Sciences

Office for National StatisticsGeneral Register Office, ScotlandGeneral Register Office, N Ireland

HM CoronersCrown Office, ScotlandLord Chancellor’s Dept, NI

State Pathologist’s Dept, NIMedical Toxicology Unit

Departmentof Health

Regularpublished

reports

Articles inscientificjournals

Talks tointerested

groups

ISDD

Deputy Viscount, JerseyHM Greffier, GuernseyHigh Bailiff, Isle of Man

St George’s Hospital Medical School

VSAMORTALITY

MONITORING

Relevantcharities

ad hoc statisticspublications

& liaison

FIGURE 1


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TABLE 1

Age Distribution of Deaths1971-1995, 1996 and 1997

1971-1995 1996 1997 TOTAL CUMULATIVEAGE No. % No. % No. % No. No. %

7 0 0.0 0 0.0 1 1.4 1 1 0.19 1 0.1 0 0.0 0 0.0 1 2 0.1

10 4 0.3 0 0.0 0 0.0 4 6 0.411 6 0.4 0 0.0 0 0.0 6 12 0.712 23 1.5 0 0.0 0 0.0 23 35 2.113 56 3.6 3 3.8 3 4.1 62 97 5.714 158 10.3 8 10.1 0 0.0 166 263 15.615 228 14.8 10 12.7 4 5.5 242 505 29.916 217 14.1 5 6.3 13 17.8 235 740 43.817 167 10.9 9 11.4 7 9.6 183 923 54.618 129 8.4 3 3.8 5 6.8 137 1060 62.719 85 5.5 3 3.8 3 4.1 91 1151 68.1

20-24 238 15.5 9 11.4 15 20.5 262 1413 83.625-34 141 9.2 20 25.3 13 17.8 174 1587 93.835-44 39 2.5 6 7.6 5 6.8 50 1637 96.845-54 22 1.4 2 2.5 3 4.1 27 1664 98.455-64 20 1.3 1 1.3 1 1.4 22 1686 99.765-74 4 0.3 0 0.0 0 0.0 4 1690 99.9

75 & over 1 0.1 0 0.0 0 0.0 1 1691 100.0

TOTAL 1539 100.0 79 100.0 73 98.6 1691

St George's Hospital Medical School



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TABLE 2

Sex Distribution of Deaths1971-1995, 1996 and 1997

1971-1995 1996 1997 TOTALSEX No. % No. % No. % No. %

Male 1352 87.8 63 79.7 56 76.7 1471 87.0

Female 187 12.2 16 20.3 17 23.3 220 13.0

TOTAL 1539 100.0 79 100.0 73 100.0 1691 100.0




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TABLE 3

Numbers of deaths in age groups 10-14 and 15-19All causes, RTAs and VSA : 1997

England and Wales, Scotland and Northern Ireland

Ages 10-14 Ages 15-19% %

CAUSE OF DEATH No. of all cause No. of all causedeaths deaths

All causes Male 373 100.0 995 100.0 Female 242 100.0 459 100.0 TOTAL 615 100.0 1454 100.0

Road Traffic Accidents Male 66 17.7 280 28.1 Female 45 18.6 91 19.8 TOTAL 111 18.0 371 25.5

Volatile Substance Abuse Male 2 0.5 23 2.3 Female 1 0.4 8 1.7 TOTAL 3 0.5 31 2.1

Sources of data for deaths from all causes and from RTAs (ICD codes E810-E819): England and Wales: Office for National Statistics

Series DH2 - Mortality Statistics: Cause 1997 Scotland: General Register Office for Scotland

Report of the Registrar General for Scotland 1997 Northern Ireland: General Register Office for Northern Ireland

Report of the Registrar General for Northern Ireland 1997




23

TABLE 4

Number of VSA Deaths in Each Region and Country1971-1987 and each year to 1997

(using Government Office Regions)

REGION or YEARCOUNTRY 1971-1987 88 89 90 91 92 93 94 95 96 97 TOTAL

ENGLAND: North East 42 9 11 12 4 4 4 4 4 5 5 104 North West 92 23 14 18 13 15 8 9 7 9 14 222 Yorkshire and the Humber 59 8 12 18 16 9 8 7 5 11 11 164 East Midlands 27 13 12 9 9 5 7 3 9 5 4 103 West Midlands 68 9 12 19 8 3 8 6 9 3 4 149 East of England 45 9 7 7 7 6 4 6 1 4 11 107 London 98 20 11 19 10 10 8 10 8 6 6 206 South East 76 12 12 15 13 11 5 5 12 9 4 174 South West 39 4 4 12 9 7 3 3 6 5 5 97

TOTAL ENGLAND 546 107 95 129 89 70 55 53 61 57 64 1326

WALES 33 4 2 7 1 6 6 1 1 3 0 64SCOTLAND 114 21 12 12 21 7 9 9 8 14 5 232NORTHERN IRELAND 22 4 4 4 10 2 6 2 1 3 3 61CHANNEL ISLANDS 1 1 0 0 1 0 0 0 2 1 0 6ISLE OF MAN 0 0 0 0 1 1 2

TOTAL UK 716 137 113 152 122 85 76 65 73 79 73 1691St George's Hospital Medical School



24

TABLE 5

Number of VSA Deaths in Each Region and Country1971-1987 and each year to 1997

(using Standard Statistical Regions)

REGION or YEARCOUNTRY 1971-

198788 89 90 91 92 93 94 95 96 97 TOTAL

ENGLAND: North 46 11 12 14 4 5 5 6 5 5 5 118 North West 88 21 13 16 13 14 7 7 6 9 14 208 Yorkshire/Humb'rside 59 8 12 18 16 9 8 7 5 11 11 164 East Midlands 27 13 12 9 9 5 7 3 9 5 4 103 West Midlands 68 9 12 19 8 3 8 6 9 3 4 149 East Anglia 9 2 3 3 4 3 3 4 1 3 2 37 South East 210 39 27 38 26 24 14 17 20 16 19 450 South West 39 4 4 12 9 7 3 3 6 5 5 97

TOTAL ENGLAND 546 107 95 129 89 70 55 53 61 57 64 1326

WALES 33 4 2 7 1 6 6 1 1 3 0 64SCOTLAND 114 21 12 12 21 7 9 9 8 14 5 232NORTHERN IRELAND 22 4 4 4 10 2 6 2 1 3 3 61CHANNEL ISLANDS 1 1 0 0 1 0 0 0 2 1 0 6ISLE OF MAN 0 0 0 0 1 1 2

TOTAL UK 716 137 113 152 122 85 76 65 73 79 73 1691




25

TABLE 6

Standardised Mortality Ratios for each Region and Country 1988 - 1997

adjusted for age and sex(using Government Office Regions)

Deaths 95% confidenceREGION or COUNTRY Observed Expected SMR interval

ENGLAND: North East 62 43.0 144 108 to 180 North West 130 114.0 114 94 to 134 Yorkshire & the Humber 105 84.1 125 101 to 149 East Midlands 76 68.5 111 86 to 136 West Midlands 76 88.8 86 66 to 105 East of England 62 85.4 73 55 to 91 London 108 120.6 90 73 to 106 South East 98 128.5 76 61 to 91 South West 58 76.60 76 56 to 95

TOTAL ENGLAND 775 809.50

WALES 31 48.1 65 42 to 87SCOTLAND 118 86.6 136 112 to 161NORTHERN IRELAND 39 32.6 120 82 to 157

WHOLE OF UK* 100

Crude Mortality Rates Males Females Bothper million population per year 2.88 0.48 1.66

Sources of population data: England and Wales: Office for National Statistics Scotland: General Register Office for Scotland Northern Ireland: General Register Office for Northern Ireland

*Channel Isles and Isle of Man are not included




26

TABLE 7

Standardised Mortality Ratios for each Region and Country 1988 - 1997

adjusted for age and sex(using Standard Statistical Regions)

Deaths 95%confidence

REGION or COUNTRY Observed Expected SMR interval

ENGLAND: North 72 51.2 141 108 to 173 North West 120 106.8 112 92 to 132 Yorkshire/Humberside 105 84.1 125 101 to 149 East Midlands 76 68.5 111 86 to 136 West Midlands 76 88.8 86 66 to 105 East Anglia 28 34.4 81 51 to 112 South East 240 297.6 81 70 to 91 South West 58 76.6 76 56 to 95

TOTAL ENGLAND 775 808.00

WALES 31 48.1 65 42 to 87SCOTLAND 118 86.6 136 112 to 161NORTHERN IRELAND 39 32.6 120 82 to 157

WHOLE OF UK* 100

Crude Mortality Rates Males Females Bothper million population per year 2.88 0.48 1.66

Sources of population data: England and Wales: Office for National Statistics Scotland: General Register Office for Scotland Northern Ireland: General Register Office for Northern Ireland

*Channel Isles and Isle of Man are not includedSt George's Hospital Medical School



27

TABLE 8

Substances Abused1971 - 1987 and each year to 1997

(n=1790)

YEAR1971-87 88 89 90 91 92 93 94 95 96 97 TOTAL

GAS FUELS No. 218 58 57 63 49 48 44 46 48 48 51 730% 29.0 38.4 47.5 38.9 38.6 54.5 51.8 66.7 60.0 59.3 67.1

AEROSOLS No. 140 51 25 34 30 11 12 2 8 12 10 335% 18.6 33.8 20.8 21.0 23.6 12.5 14.1 2.9 10.0 14.8 13.2

GLUES No. 179 18 14 27 18 12 11 10 13 5 7 314% 23.8 11.9 11.7 16.7 14.2 13.6 12.9 14.5 16.3 6.2 9.2

FIRE EXT No. 22 1 4 16 6 5 1 0 1 0 0 56% 2.9 0.7 3.3 9.9 4.7 5.7 1.2 0.0 1.3 0.0 0.0

OTHER No. 186 22 19 21 23 12 17 11 10 16 8 345% 24.8 14.6 15.8 13.0 18.1 13.6 20.0 15.9 12.5 19.8 10.5

NOT KNOWN No. 6 1 1 1 1 0 0 0 0 0 0 10% 0.8 0.7 0.8 0.6 0.8 0.0 0.0 0.0 0.0 0.0 0.0

TOTAL No. 751 151 120 162 127 88 85 69 80 81 76 1790% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

NOTE: All substances are included in this table, so numbers of substances aregreater than numbers of deaths.




28

TABLE 9

Primary Substances Abused1988 to 1997

(n=975)

88 89 90 91 92 93 94 95 96 97 TOTAL

GAS FUELS No. 55 54 62 49 48 41 45 47 48 51 500% 40.1 47.8 40.8 40.2 56.5 53.9 69.2 64.4 60.8 69.9 51.3

AEROSOLS No. 46 24 31 27 11 11 2 5 11 8 176% 33.6 21.2 20.4 22.1 12.9 14.5 3.1 6.8 13.9 11.0 18.1

GLUES No. 15 12 23 16 10 10 8 13 5 6 118% 10.9 10.6 15.1 13.1 11.8 13.2 12.3 17.8 6.3 8.2 12.1

FIRE EXT No. 1 4 16 6 5 1 0 1 0 0 34% 0.7 3.5 10.5 4.9 5.9 1.3 0.0 1.4 0.0 0.0 3.5

OTHER No. 19 18 19 23 11 13 10 7 15 8 143% 13.9 15.9 12.5 18.9 12.9 17.1 15.4 9.6 19.0 11.0 14.7

NOT KNOWN No. 1 1 1 1 0 0 0 0 0 0 4% 0.7 0.9 0.7 0.8 0.0 0.0 0.0 0.0 0.0 0.0 0.4

TOTAL No. 137 113 152 122 85 76 65 73 79 73 975% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0




29

TABLE 10

Product Abused by Substance 1971 - 1997

PERCENTAGEof

% OF ALLSUBSTANCES

PRODUCT No. SUBSTANCE GROUP n=1790GAS FUELSLighter fuel refill canisters 549 80.9 30.7Domestic gas (bottled) 81 11.9 4.5Propane gas cylinder 15 2.2 0.8Acetylene 2 0.3 0.1Natural gas 1 0.1 0.1Unspecified butane 31 4.6 1.7TOTAL for GAS FUELS 679 100.0 37.9AEROSOLSDeodorant / Antiperspirant 132 40.6 7.4Pain relief spray 62 19.1 3.5Air freshener 37 11.4 2.1Hair spray 26 8.0 1.5Cleaning fluids 15 4.6 0.8Insect spray 7 2.2 0.4Paint spray 8 2.5 0.4Aerosol glue 3 0.9 0.2Other aerosols 35 10.8 2.0TOTAL for AEROSOLS 325 100.0 18.2GLUESContact adhesives 149 48.5 8.3Bicycle tyre repair glue 10 3.3 0.6Model glue 3 1.0 0.2Other glues 145 47.2 8.1TOTAL for GLUES 307 100.0 17.2OTHERTypewriter correction fluid 113 33.5 6.3Chloroform 24 7.1 1.3Dry cleaning fluids 20 5.9 1.1Petrol 28 8.3 1.6Plaster remover 17 5.0 0.9Domestic cleaning fluids 16 4.7 0.9Industrial solvents / degreasers 14 4.2 0.8Anaesthetic agents 20 5.9 1.1Carbon tetrachloride 11 3.3 0.6Paint thinners and strippers 11 3.3 0.6Alkyl nitrites 6 1.8 0.3Brake cleaner 3 0.9 0.2Ether 3 0.9 0.2Benzene 1 0.3 0.1Petroleum spirits (excl. petrol) 1 0.3 0.1Miscellaneous products 49 14.5 2.7TOTAL for OTHER 337 100.0 18.8Fire Extinguishers 56 100.0 3.1Substance not known 11 100.0 0.6




30

TABLE 11

Product Abused by Substance 1997PERCENTAGE % OF ALL

of SUBSTANCESPRODUCT No. SUBSTANCE GROUP n= 73GAS FUELSLighter fuel refill canisters 41 80.4 56.2Domestic gas (bottled) 5 9.8 6.8Propane gas cylinder 0 0.0 0.0Acetylene 0 0.0 0.0Natural gas 0 0.0 0.0Unspecified butane 5 9.8 6.8TOTAL for GAS FUELS 51 100.0 69.9AEROSOLSDeodorant / Antiperspirant 6 60.0 8.2Pain relief spray 0 0.0 0.0Air freshener 2 20.0 2.7Hair spray 1 10.0 1.4Cleaning fluids 0 0.0 0.0Paint spray 0 0.0 0.0Insect spray 0 0.0 0.0Aerosol glue 0 0.0 0.0Other aerosols 1 10.0 1.4TOTAL for AEROSOLS 10 100.0 13.7GLUESContact adhesives 4 57.1 5.5Bicycle tyre repair glue 0 0.0 0.0Model glue and plastic cement 0 0.0 0.0Other glues 3 42.9 4.1TOTAL for GLUES 7 100.0 9.6OTHERTypewriter correction fluid 0 0.0 0.0Chloroform 2 22.2 2.7Dry cleaning fluids 0 0.0 0.0Petrol 0 0.0 0.0Plaster remover 0 0.0 0.0Domestic cleaning fluids 0 0.0 0.0Industrial solvents / degreasers 1 11.1 1.4Anaesthetic agents 0 0.0 0.0Carbon tetrachloride 0 0.0 0.0Paint thinners and strippers 1 11.1 1.4Alkyl nitrites 0 0.0 0.0Brake cleaner 0 0.0 0.0Ether 0 0.0 0.0Benzene 0 0.0 0.0Petroleum spirits (excl. petrol) 0 0.0 0.0Miscellaneous products 5 55.6 6.8TOTAL for OTHER 9 100.0 12.3Fire Extinguishers 0 100.0 0.0Substance not known 0 0.0 0.0




31

TABLE 12

Methods of Administration of Volatile Substances1971-1995, 1996 and 1997

1971-1995 1996 1997 TOTALMETHOD No. % No. % No. % No. %

Directly into mouth 392 25.5 35 44.3 22 30.1 449 26.6Sniffed from container 99 6.4 7 8.9 2 2.7 108 6.4Sniffed from cloth or sleeve 172 11.2 4 5.1 4 5.5 180 10.6Sniffed from plastic bag 253 16.4 7 8.9 7 9.6 267 15.8Plastic bag over head 179 11.6 7 8.9 9 12.3 195 11.5Mask or padding over face 42 2.7 0 0.0 1 1.4 43 2.5Other 23 1.5 1 1.3 1 1.4 25 1.5Not known 379 24.6 18 22.8 27 37.0 424 25.1

TOTAL 1539 100.0 79 100.0 73 100.0 1691 100.0St George's Hospital Medical School



32

TABLE 13

Methods of Administering Volatile Substances by Substance1971-1995, 1996 and 1997

1971-1995 1996 1997 TOTALMETHOD No. % No. % No. % No. %

GAS FUELSDirectly into mouth 317 51.6 35 72.9 22 43.1 374 52.5Sniffed from container 16 2.6 2 4.2 1 2.0 19 2.7Sniffed from cloth or sleeve 11 1.8 0 0.0 0 0.0 11 1.5Sniffed from plastic bag 34 5.5 1 2.1 0 0.0 35 4.9Plastic bag over head 71 11.6 2 4.2 7 13.7 80 11.2Mask or padding over face 12 2.0 0 0.0 1 2.0 13 1.8Other 10 1.6 1 2.1 0 0.0 11 1.5Not known 143 23.3 7 14.6 20 39.2 170 23.8TOTAL for GAS FUELS 614 100.0 48 100.0 51 100.0 713 100.0

AEROSOLSDirectly into mouth 42 14.7 0 0.0 0 0.0 42 13.8Sniffed from container 10 3.5 0 0.0 0 0.0 10 3.3Sniffed from cloth or sleeve 65 22.7 3 27.3 4 50.0 72 23.6Sniffed from plastic bag 54 18.9 2 18.2 3 37.5 59 19.3Plastic bag over head 31 10.8 2 18.2 0 0.0 33 10.8Mask or padding over face 10 3.5 0 0.0 0 0.0 10 3.3Other 2 0.7 0 0.0 0 0.0 2 0.7Not known 72 25.2 4 36.4 1 12.5 77 25.2TOTAL for AEROSOLS 286 100.0 11 100.0 8 100.0 305 100.0

GLUESDirectly into mouth 7 2.5 0 0.0 0 0.0 7 2.4Sniffed from container 9 3.2 1 20.0 1 16.7 11 3.8Sniffed from cloth or sleeve 3 1.1 0 0.0 0 0.0 3 1.0Sniffed from plastic bag 131 47.1 4 80.0 4 66.7 139 48.1Plastic bag over head 47 16.9 0 0.0 0 0.0 47 16.3Mask or padding over face 6 2.2 0 0.0 0 0.0 6 2.1Other 1 0.4 0 0.0 0 0.0 1 0.3Not known 74 26.6 0 0.0 1 16.7 75 26.0TOTAL for GLUES 278 100.0 5 100.0 6 100.0 289 100.0

OTHERDirectly into mouth 26 7.4 0 0.0 0 0.0 26 7.0Sniffed from container 63 17.9 4 26.7 0 0.0 67 17.9Sniffed from cloth or sleeve 93 26.5 1 6.7 0 0.0 94 25.1Sniffed from plastic bag 34 9.7 0 0.0 0 0.0 34 9.1Plastic bag over head 29 8.3 3 20.0 2 25.0 34 9.1Mask or padding over face 14 4.0 0 0.0 0 0.0 14 3.7Other 10 2.8 0 0.0 1 12.5 11 2.9Not known 82 23.4 7 46.7 5 62.5 94 25.1TOTAL for OTHER 351 100.0 15 100.0 8 100.0 374 100.0"Other" includes fire extinguishers

St George's Hospital Medical SchoolBack to Contents Back to Commentary


33

TABLE 14

Mechanism of Death1971-1987 and each year to 1997

YEAR71-87 88 89 90 91 92 93 94 95 96 97 TOTAL

DIRECT No. 362 82 70 95 60 46 35 33 40 42 37 902 TOXIC EFFECTS % 50.6 59.9 61.9 62.5 49.2 54.1 46.1 50.8 54.8 53.2 50.7 53.3

INHALATION No. 98 21 13 19 18 15 14 16 9 15 12 250 of VOMIT % 13.7 15.3 11.5 12.5 14.8 17.6 18.4 24.6 12.3 19.0 16.4 14.8

PLASTIC BAG No. 111 16 13 6 8 6 9 3 7 7 9 195% 15.5 11.7 11.5 3.9 6.6 7.1 11.8 4.6 9.6 8.9 12.3 11.5

TRAUMA No. 108 14 15 29 26 17 16 11 15 13 10 274% 15.1 10.2 13.3 19.1 21.3 20.0 21.1 16.9 20.5 16.5 13.7 16.2

OTHER No. 12 1 1 1 2 1 1 2 0 2 4 27% 1.7 0.7 0.9 0.7 1.6 1.2 1.3 3.1 0.0 2.5 5.5 1.6

NOT KNOWN No. 25 3 1 2 8 0 1 0 2 0 1 43% 3.5 2.2 0.9 1.3 6.6 0.0 1.3 0.0 2.7 0.0 1.4 2.5

TOTAL No. 716 137 113 152 122 85 76 65 73 79 73 1691% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0




34


VSA Deaths by Year1971 to 1997 : All ages ( n = 1691)

2 4 3 2

9 8 8

1721

31

46

63

8285

117

102

116

137

113

152

122

85

76

65

7379

73

0

50

100

150

71 73 75 77 79 81 83 85 87 89 91 93 95 97

Year

Nu

mb

er o

f D

eath

sFIGURE 2

Data collection methods stable from 1983



35

FIGURE 3




36

FIGURE 4




37



Age Distribution of DeathsAll ages : 1971-1996 and 1997

0

10

20

30

40

50

60

10-14 15-19 20-24 25-29 30+

Age Group

Per

cen

tag

e

1971-1996

1997

FIGURE 5

(258*)

(3**)

(856)

(247)

(117)

(15)

(139)

(14)8

Values in brackets are numbers of deaths

(32)

(8)


38


Cumulative Distribution of Age at DeathAll ages : 1971-1996 and 1997

0

25

50

75

100

7 9 11 13 15 17 19 25- 45- 65-

Age at Death

Cu

mu

lati

ve P

erce

nta

ges

1971-1996

1997

FIGURE 6


39


Age Distribution of DeathsAll age groups : 1971 - 1997

0

10

20

30

40

50

60

70

80

90

100

71 73 75 77 79 81 83 85 87 89 91 93 95 97

Year

Nu

mb

er o

f D

eath

s

7-14

15-19

20+

FIGURE 7



40



Quartiles of Age Distributionby Year of Death: 1983 - 1997

10

15

20

25

30

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year of Death

Ag

e at

Dea

th

75th centile

Median age

25th centile

FIGURE 8

This graph shows the three quartiles of age. 25% of ages are less than the 25th centile. 50% are less than the median and 75% are less than the 75th centile.


41


VSA deaths 1983 - 1997males and females, under 18s and adults

0

10

20

30

40

50

60

70

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97

Year of Death

Per

cen

tag

e o

f D

eath

s

Males <18

Males 18+

Females <18

Females 18+

FIGURE 9



42



VSA Mortality Rates 1988 to 1997Males and females aged 10 - 14

0

2

4

6

8

10

88 89 90 91 92 93 94 95 96 97

Year

Rat

e p

er m

illio

n p

er y

ear

Males

Females

Rates quoted are for the UK

FIGURE 10


43



VSA Mortality Rates 1988 to 1997Males and females aged 15 - 19

0

10

20

30

40

50

88 89 90 91 92 93 94 95 96 97

Year

Rat

e p

er m

illio

n p

er y

ear

Males

Females

FIGURE 11

Rates quoted are for the UK


44



45



46



Substances Abused 1988 - 1997(all ages)

0

10

20

30

40

50

60

70

88 89 90 91 92 93 94 95 96 97

Year

Nu

mb

ers

of

Dea

ths

Gas fuels

Aerosols

Glues

Other (inc Fire Ext.)

FIGURE 14


47



Principal Mechanisms of Death 1988 - 1997

0

10

20

30

40

50

60

70

80

90

100

88 89 90 91 92 93 94 95 96 97

Year

Nu

mb

ers

of

Dea

ths

Direct Toxic Effects

Inhalation of Vomit

Plastic Bag

Trauma

FIGURE 15


48



Place of DeathPercentages for 1997

Home38.4%

Public place13.7%

N/K4.1%

Workplace1.4%

Institution1%

Home of friend2.7%

Hospital/DOA38.4%

FIGURE 16


49



Place Where Substance was AbusedPercentages for 1997

Public place24.7%

Home53.4%

Not known9.6%

Institution1%

Home of friend8.2%

Workplace2.7%

FIGURE 17


50



Place Where Substance Was AbusedMales and females 1990 - 1997 (n = 725)

0

10

20

30

40

50

60

Home Friend's Public Inst'n Work Other N/K

Place of Abuse

Per

cen

tag

e

Males (n=618)

Females (n=107)

FIGURE 18


51



Place Where Substance Was AbusedMales and females 1990 - 1997 (n = 725)

0

10

20

30

40

50

60

70

Home Friend's Public Inst'n Work Other N/K

Place of Abuse

Per

cen

tag

e

19901991199219931994199519961997

FIGURE 19

Documents

Trends in Deaths Associated With Abuse of Volatile ... · 1971-1987 and each year to 1997, using GORs Table 5 Number of VSA deaths in each Region and Coun try: 2 4 1971-1987 and each