Journal of Forensic and Legal Medicine 65 (2019) 55–60

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Journal of Forensic and Legal Medicine

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Research Paper

Epidemiological and toxicological profile of homicide victims in a legal T

medicine unit in Brazil
Yara Vieira Lemosa,b, Alberto Julius Alves Wainsteina,b, Larissa Miranda Savoia,
Ana Paula Drummond-Lagea,b,∗
a
Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Belo Horizonte, MG, 30110-130, Brazil
b
Instituto Médico Legal de Belo Horizonte, Rua Nícias Continentino 1291, Belo Horizonte, MG, 30510-160, Brazil

A R T I C LE I N FO A B S T R A C T

Keywords: Objectives: The use of illicit drugs is considered a risk factor for victimization by lethal violence and is frequently
Forensic toxicology found in necropsies of homicide victims. This study aimed to evaluate the profile of these victims.
Forensic medicine Methods and material: A cross-sectional retrospective study was performed on homicide victims in 2014 with a
Violence sample composed of all homicide cases in 2014 for which toxicology had been performed in an Official Forensic
Homicides
Laboratory (Minas Gerais- Brazil).
Illicit drugs
Legal medicine
Results: 1382 homicide victims composed the sample. The group with a positive toxicology test (N = 943)
presented higher proportions of men (p = 0.003), black/brown skin (p < 0.001), firearm history (p = 0.007)
and a lower mean age (p < 0.001). In 72.2% of the positive tests, cocaine and benzoylecgonine were found; in
67.7%, THC and/or its metabolite was found; and in 43.1%, both illicit drugs were found.
Conclusions: The role of illicit drugs in early death goes far beyond intoxication as they are directly associated
with age, skin color and gender. Young black/mixed men have an increased risk of homicide. Our findings point
to the importance of investing in social actions, public safety and efforts to reduce drug use in this at-risk
population.

1. Introduction
More than 8 million people have been killed by interpersonal vio-
lence worldwide since the beginning of this century, which demon-
strates that homicides account for more deaths than all combined
deaths from combat-related to wars in the 21st century.1 Every year,
almost half a million people are murdered throughout the world. Their
families are also affected, and with these losses, security and the per-
ception of security in societies are deeply strained.2 In general, societies
with high murder rates have pronounced government corruption, low
investment in education and public health, low democratic stability,
repressive practices at the expense of preventive actions and in-
vestigation, and high socioeconomic inequality.3
Some studies point to the actual growth of violence in Brazil, par-
ticularly homicides, since the end of 1970 with worrying and alarming
data.4 The geographic regions and their respective municipalities,
especially larger cities, show an increase in mortality from external
causes since 1990.5 Among other explanations, this fact might be re-
lated to the expansion of organized crime; vulnerability, consumption,
and trafficking of illicit drugs; and exposure to the occurrence of
violence.
In recent years, there has been general stability in the homicide
rates in Brazil, but considerable heterogeneity between the regions and
various states of this continental country. The homicide rate in Brazil,
per year, is 28.9:100,000 inhabitants, with gunshots being the most
common cause (71.9%).4
Minas Gerais, the focus of this study, is a state located in
Southeastern Brazil. It ranks as the second most populous state, third
largest by gross domestic product (GDP), and fourth largest by area.
The state's capital and largest city, Belo Horizonte, is a major urban area
and the sixth largest municipality in Brazil, but its metropolitan area is
the third largest in Brazil with just over 5,500,000 inhabitants. The
state has a high rate of homicides, 21.7:100,000, and the lethality by
gunshot ratio is 71%.6,7
The morbidity and mortality rates of violence in Brazil expose the
population to constant health risks, making this issue a public health
priority.8 Information on mortality is essential to health because death
is a single event and recording incidences of mortality are fundamental.
In Brazil, homicide requires mandatory notification of public autho-
rities.

∗
Corresponding author. Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Belo Horizonte, MG, 30110-130, Brazil.
E-mail addresses: anapdru@gmail.com, ana.wainstein@cienciasmedicasmg.edu.br (A.P. Drummond-Lage).

https://doi.org/10.1016/j.jflm.2019.05.008
Received 20 November 2018; Received in revised form 15 January 2019; Accepted 12 May 2019
Available online 14 May 2019
1752-928X/ © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Y.V. Lemos, et al. Journal of Forensic and Legal Medicine 65 (2019) 55–60

In cases of suspicious death, a police report is required. These cases, Table 1

including those assessed in this study, are required to undergo a stan- Case characteristics of deaths due to homicide.
dardized autopsy by a forensic expert doctor, including supplementary Variables Total Toxicology Analysis P-value
exams.9 The cause of death is determined by the expert based on the
circumstances of death, autopsy findings, toxicological analyses and Negative Positive
other complementary tests.10
(n = 1.382) (n = 439) (n = 943)
Studies indicate a high risk of violent death between illicit drug
users.1,11,12 Darke et al. provided comparative toxicological data on the Gender* 0.003Q
use of psychoactive substances as well as death by suicide and murder Female 85 (6.5%) 37 (9.8%) 48 (5.2%)
and concluded that psychoactive substances are more frequent among Male 1.214 (93.5%) 340 (90.2%) 874 (94.8%)

victims of violent death.13 Age (years)* 28.3 ± 11.2 33 ± 14.4 26.8 ± 9.5 < 0.001T
The present study was aimed at determining the relationship be- 10 - 19 223 (19.5%) 34 (12.7%) 189 (21.6%)
tween illicit drugs and homicide in the state of Minas Gerais in 2014 20–30 554 (48.5%) 109 (40.7%) 445 (50.9%)
through the epidemiological and toxicology profile analyses of homi- 31–64 346 (30.3%) 112 (41.8%) 234 (26.8%)
> 65 19 (1.7%) 13 (4.9%) 6 (0.7%)
cide victims.
Skin color* < 0.001Q
2. Methods Mixed 450 (66.7%) 30 (42.3%) 420 (69.5%)
White 135 (20%) 33 (46.5%) 102 (16.9%)
This study assessed toxicological data from LabTox, Forensic Black 90 (13.3%) 8 (11.3%) 82 (13.6%)

Laboratory of Toxicology, which is located in Belo Horizonte, capital of Location < 0.001Q
Minas Gerais, Brazil and is the primary forensic toxicology center, Metropolitan 1.291 (93.4%) 379 (86.3%) 912 (96.7%)
conducting approximately 12.000 exams per year. The study protocol Others 91 (6.6%) 60 (13.7%) 31 (3.3%)
was approved by the institutional review board (IRB) for human subject
Method* 0.007Q
investigations under No. 1.038.218.
Gunshot 1.151 (86.3%) 336 (83.6%) 815 (87.5%)
Study type and data sources: A retrospective descriptive study was Cuts/stabbing 109 (8.2%) 39 (9.7%) 70 (7.5%)
performed using autopsy reports and police summaries of all finalized Blunt force injury 39 (2.9%) 13 (3.2%) 26 (2.8%)
homicide cases that underwent a toxicology analysis at LabTox, be- Asphyxia 25 (1.9%) 14 (3.5%) 11 (1.2%)
tween 1st January and 31st December 2014. All cases of death due to Othersa 9 (0.7%) – 9 (1.0%)

murder or manslaughter were included in the homicide group. All cases

related to suicide, accidents and suspicious deaths were excluded. Other
sources, such as incident reports, were collected from the database of
the Integrated System of Social Defense of Minas Gerais. It is a modular,
integrated system that allows the management of Social Defense in-
formation and research and defense policies amongst firefighters, police
investigation, judicial process and criminal prosecution, respected as
legal attributions of the organizations that compose it. Besides, the
System of Social Defense aims to articulate an integration of criminal
information into the operational planning of the organizations in-
volved. This data is available through the Record Events of Social
Defense (REDS) system.14
Variables: Specific data retrieved from the autopsy and police re-
ports included circumstance of death, social and demographic char-
acteristics, the location of the fatal incident, date of the fatal incident
and toxicological findings of each case. Toxicological data were re-
ported for cannabis [as determined by the presence of D-9- tetra-
hydrocannabinol (THC) and/or THC acid], morphine (the major me-
tabolite of heroin), methadone, methamphetamine, cocaine (as
determined by the presence of cocaine itself and/or the presence of
metabolites of cocaine), 3,4-methylenedioxymethamphetamine
(MDMA), benzodiazepines, antidepressants, opioids and antipsychotic
medications. For statistical analysis, the presence of illicit substances
was defined by the presence of any of the following: cannabis, me-
thamphetamine, cocaine or MDMA. It was not possible from the tox-
icological exam to determine whether the use of a pharmaceutical was
prescribed, illicit or in excess of the prescribed dosage because quan-
tification analysis was not available. All of the presented toxicological
analyses were of blood, urine or viscera by validated analytical
methods, such as thin-layer chromatography (TLC), high-performance
liquid chromatography (HPLC), gas chromatography-mass spectro-
metry (GC-MS) and immunochromatographic technique (ICT).
Statistical Analysis: Distributions were calculated according to the
means and included the instrument that caused the homicide, geo-
graphic location of the autopsy, gender, age, skin color and the result of
the toxicological examination. The age groups were stratified according
to the WHO criteria: child: from 1 to 9 years; teenager: from 10 to 19
years old; young: from 20 to 30 years old; adult: from 31 to 64 years
Notes: * Variables that were missing.
The p-values refer to the tests: Qchi-square of independence and T-Student for
independent samples.
a
The category “others” includes fire (n = 5), multiple (n = 3) and exo-
genous intoxication (n = 1).
old; and elderly: age greater than 65 years. The categorical variables are
presented as counts and percentages, and the numerical variables are
presented as the means ± standard deviation. Evaluation of normality
was performed using the Shapiro-Wilk test. For comparison of numer-
ical variables between groups, Student's t-test or the Wilcoxon Mann-
Whitney test was used for independent samples. The association be-
tween qualitative variables was assessed by the chi-square test of in-
dependence or Fisher's exact test. The analyses were performed in R
version 3.3.2 at 5% significance.
3. Results
Initially, a database that included all analysis performed at Labtox
(N = 6.240) was created including the toxicological results and cir-
cumstances of the death. Later, only the exams related to homicide
were selected and included in this study, with a sample of 1.382 in-
dividuals, of which 93.5% were male, and 66.7% were black/brown.
The average age was 28.3 ± 11.2 years (10–90 years), and 48.5% of
the individuals were between 20 and 30 years old (Table 1).
Regarding the geographic area where the toxicology tests were re-
quested, there was a wide prevalence of exams from the Belo Horizonte
Metropolitan region (93.4%). The most common cause of the lethal
violence was homicide by gunshot (86.3%), followed by cuts/stabbing
(8.2%), blunt force injury (2.9%) and asphyxia (1.9%) (Table 1). The
asphyxiation cases were related to manual strangulation (57.1%), li-
gature strangulation (14.3%) and suffocation (28.6%).
Concerning the toxicological test results, the group of individuals
with positive tests (N = 944) included more massive proportions of
men (p = 0.003), mixed/black (p < 0.001), and a history of gunshot
(p = 0.007); lower average age (p < 0.001), and a higher proportion
of individuals from the Belo Horizonte Metropolitan area (p < 0.001).

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Y.V. Lemos, et al. Journal of Forensic and Legal Medicine 65 (2019) 55–60

Table 2
Findings of the exams with positive toxicological results by homicidal method.
Findings Total (n = 944) Gunshot Cuts/stabbing Blunt force injury Asphyxia Others
(n = 815) (n = 70) (n = 26) (n = 11) (n = 9)

Cocaine/benzoylecgonine 682 (72.2%) 582 (71.4%) 59 (84.3%) 21 (80.8%) 8 (72.7%) 2 (22.2%)

Male 635 (93.1%) 553 (95%) 48 (81.4%) 18 (85.7%) 6 (75%) 2 (100%)
Cannabis 639 (67.7%) 574 (70.4%) 36 (51.4%) 14 (53.8%) 4 (36.4%) 2 (22.2%)
Male 601 (94%) 546 (95.1%) 29 (80.6%) 13 (92.9%) 4 (100%) 2 (100%)

Anticonvulsants. barbiturates. sedatives and hypnotics 14 (1.5%) 8 (1%) 2 (2.9%) 4 (15.4%) – –

Male 10 (71.4%) 7 (87.5%) - 3 (75%) – –

Benzodiazepines 11 (1.2%) 9 (1.1%) – 2 (7.7%) – –

Male 9 (81.8%) 8 (88.9%) - 1 (50%) - -

Anesthetics 11 (1.2%) 9 (1.1%) – 1 (3.8%) – 1 (11.1%)

Male 10 (90.9%) 9 (100%) - 1 (100%) - -

Others 9 (1%) 1 (0.1%) – 2 (7.7%) 2 (18.2%) 4 (44.4%)

Male 7 (77.8%) 1 (100%) – 2 (100%) 1 (50%) 3 (75%)

Cannabis + Cocaine/benzoylecgonine 407 (43.1%) 357 (43.8%) 27 (38.6%) 13 (50%) 3 (27.3%) –
Male 383 (94.1%) 341 (95.5%) 22 (81.5%) 22 (81.5%) 3 (100%) –

Notes: The same individual may present more than one finding in the toxicology examination.
In the category “others”. we included findings with up to 4 citations in the sample: carboxyhemoglobin (n = 4). antidepressants (n = 3). antipsychotics (n = 1).
antibiotics. antiparasitics. antiretrovirals. antifungals (n = 1).

(Table 2). exams corresponding to the winter months. (Fig. 1).

Regarding the results of the toxicological examinations, cocaine and
benzoylecgonine were found in 72.2% of cases, THC (tetra-
hydrocannabinol) and/or its metabolite in 67.7% of cases and antic-
onvulsants, barbiturates, sedatives, and hypnotics in only 1.5% of cases.
Other substances had little presence in the sample (Table 2).
Among the victims of homicide by firearm, the group with positive
toxicology tests was younger (p < 0.001) and presented a more sig-
nificant proportion of mixed or black individuals (p = 0.012).
The victims of homicide by gunshot (p = 0.010) or blunt force in-
jury (p = 0.038) with positive toxicological tests also showed higher
proportions of mixed or black individuals (Table 3).
The studied sample showed that there was also a seasonal variation
of toxicology tests requested from LabTox, with a higher number of
exams in the months corresponding to the Brazilian summer and fewer
4. Discussion
This study analyzed the profile of homicide victims subjected to
toxicological tests in Minas Gerais, Brazil in 2014. The search criteria
matched 29.25% of all homicides that occurred in the state that year.4
All of the toxicological analyses were conducted in a single lab using
validated analytical techniques, and autopsies were carried out by
medical services legal officers located in different major cities and the
Capital, Belo Horizonte.
A significant difficulty faced in this project was the lack of in-
formation about the circumstances of death according to the tox-
icological requisition form and autopsy exam. Gonsaga et al. also en-
countered this obstacle in a Brazilian study.15 To minimize this

Table 3
Demographic characteristics of fatalities according to homicidal method and results of the toxicological examination.
Variables Gunshot Cuts/stabbing Blunt force injury Asphyxia Other

Negative Positive Negative Positive Negative Positive Negative Positive Positive (n = 9)

(n = 336) (n = 815) (n = 39) (n = 70) (n = 13) (n = 26) (n = 14) (n = 11)

Gender* p = 0.063Q p = 1.000Q p = 1.000F p = 0.423F –

Female 17 (6%) 26 (3.3%) 7 (18.9%) 12 (17.9%) 1 (9.1%) 4 (16%) 6 (46.2%) 3 (27.3%) 2 (22.2%)
Male 266 (94%) 773 (96.7%) 30 (81.1%) 55 (82.1%) 10 (90.9%) 21 (84%) 7 (53.8%) 8 (72.7%) 7 (77.8%)

Age (years)* p < 0.001T p = 0.167T p = 0.139w p = 0.220w –

30.6 ± 13.3 26.1 ± 9 39.4 ± 16.7 34.2 ± 9.6 40.9 ± 16.5 33 ± 13.7 35.6 ± 15.2 26.8 ± 9.5 28.1 ± 15.1
10–19 31 (15.9%) 177 (23.3%) 2 (8.3%) 3 (5%) – 3 (12%) – 2 (20%) 2 (22.2%)
20–30 87 (44.6%) 399 (52.5%) 6 (25%) 23 (38.3%) 5 (38.5%) 6 (24%) 5 (55.6%) 5 (50%) 5 (55.6%)
31–64 70 (35.9%) 180 (23.7%) 13 (54.2%) 34 (56.7%) 7 (53.8%) 15 (60%) 3 (33.3%) 3 (30%) 1 (11.1%)
> 65 7 (3.6%) 4 (0.5%) 3 (12.5%) – 1 (7.7%) 1 (4%) 1 (11.1%) – 1 (11.1%)

Skin Color p = 0.012Q p = 0.010Q p = 0.038Q p = 0.222Q –

Mixed/Black 24 (64.9%) 433 (82.8%) 5 (45.5%) 39 (86.7%) 4 (50%) 18 (90%) 2 (40%) 6 (85.7%) 5 (71.4%)
White 13 (35.1%) 90 (17.2%) 6 (54.5%) 6 (13.3%) 4 (50%) 2 (10%) 3 (60%) 1 (14.3%) 2 (28.6%)

Location – – – – –
Metropolitan 307 (91.4%) 797 (97.8%) 35 (89.7%) 66 (94.3%) 10 (76.9%) 24 (92.3%) 8 (57.1%) 6 (54.5%) 8 (88.9%)
Othera 29 (8.6%) 18 (2.2%) – – 3 (23.1%) – 6 (42.9%) 3 (45.5%) –

Notes: * Variables that were missing.

The p-values refer to the tests: Q chi-square of independence. F Fisher's exact. W Wilcoxon Mann-Whitney and T t-Student's independent samples.
a
The “other” category includes less mentioned mesoregions in the sample: Jequitinhonha. West. Rio Doce Valley. Central. North. Mucuri Valley and Northwest.

57
Y.V. Lemos, et al.
Fig. 1. Seasonality of the REDS homicide records and requested toxicological exams in Labtox in 2014. LabTox - Toxicology Laboratory, REDS – Record Events of
Social Defense.
problem, searches were conducted in the REDS (Record Events of Social
Defense) database to access other sources of information that proved to
be very useful for understanding the circumstances of death. Ga-
wryszewski and collaborators also noted that the use of additional in-
formation was useful for improving the quality of information and
detailing murders.16
The dates of toxicological requisition records were compared with
the dates of occurrence of homicide records extracted from REDS and
showed a similarity of seasonality between the two records (Fig. 1). Our
results corroborate the work of Mandal and Singha, which indicated a
lower number of homicides were recorded in the periods of the year
with the lowest temperature.17
Epidemiological analysis of our sample showed that most of the
homicide victims, 93.5%, were male, 80% were mixed/black, 68% were
young (10–30 years), 93.4% were from Belo Horizonte Metropolitan
area, and a gun was used in 86.3% of cases. Studies in other parts of the
world showed regional differences, but maintained a strong male
dominance as victims of violent death, with a greater prevalence in
Latin America (88%) than Asia (71%) and Europe (72%).2,18 Villela and
collaborators also demonstrated a pronounced prevalence of younger
males and residents in metropolitan regions among homicide victims.19
The Brazilian Violence Atlas 2017 also found a large percentage of
homicides for young men (15–29 years), 47.8%, 71% of which included
black/mixed and 71.9% of which were due to a gunshot wound.4 This
finding indicates that in Brazil, the chance of a young mixed/black male
being murdered is 2.6 times greater than that of a young white male.4
The data from Brazil, according to the Violence Atlas, also showed
an increase of 18.2% in young black male murders in the period be-
tween 2005 and 2015, in contrast to a decrease of 12.2% in young
white murders.4 In other words, there was an increased victimization
group composed of young blacks. The vast majority of these crimes
were committed with a firearm and included mainly young low-income
victims.7,20
Outside the Belo Horizonte Metropolitan area, there was a hetero-
geneous distribution of requested toxicological exams, with a higher
concentration in the South area (codes: 3105, 3109, 3111, 3112, 3110).
An exception occurred in the Jequitinhonha area (3103), in the north
eastern part of the state, which presented similar requests to those of
the South regions. Little or no toxicology testing was requested in some
areas that were more concentrated in the northern state. The Central
area (3106), despite its relative proximity to the Capital, did not order
any toxicology tests. The Central area was also responsible for a lower
58
Journal of Forensic and Legal Medicine 65 (2019) 55–60
number of homicides in 2014 according to data from the State
Department of Social Defense.21 Although there are forensic services
spread across Minas Gerais, toxicological test requests in the context of
homicide occur in a non-standardized manner. These data indicate a
lack of standardization of toxicological test requests in homicide cases
by forensic doctors.
The group with positive toxicology tests included a large proportion
of the sample (66.6%), with a dominance of young, mixed/black male,
from the Metropolitan region. These findings reinforce those found for
the entire sample and indicate a difference in skin color and the victi-
mization of male youths in large cities, as evidenced by other stu-
dies.4,15 There was a broad dominance of firearms as the cause of ho-
micide, but there was no statistically significant difference between
groups (tested positive and negative) regarding the cause of death.
In the group with positive toxicology test results, there was a
dominance of illicit drugs represented by cocaine and benzoylecgonine
(72.2%) as well as THC and/or its metabolite (67.7%), and a significant
proportion of tests with an association between the two drugs, 43.1%.
Darke and collaborators also revealed the presence of psychoactive
substances, represented primarily by ethanol and illicit drugs, in more
than half of the victims of homicide.13 Sheehan et al., in Colorado, USA,
achieved a strong correlation for the presence of cocaine (Odds Ratio
(OR): 2.6; CI: 2.04, 3.31), THC (OR: 2.03; CI: 1.6, 2.58) and amphe-
tamines (OR: 1.79; CI: 1, to 34, 2.39) in tests of homicide victims in
comparison with suicide. These data indicate a robust relationship be-
tween circumstances that involve the use/trafficking of drugs and lethal
victimization.22 The literature data indicated a regional variation for
the type of illicit drugs consumed outside the hegemony of cannabis
usage.23 In Brazil, the use of cannabis and cocaine is dominant, and
heroin and amphetamines use are not as widespread as in other coun-
tries.11
Cocaine and metabolites, alcohol and amphetamines are listed
among the psychotropic substances that often have more to do with
violence, both in perpetrators and victims. However, the interaction
between illicit drugs and homicide varies not only from substance to
substance but also between nations and communities.2 There are sev-
eral situations in which users put themselves in places to buy and make
use of drugs that can potentially lead to violence and death.24
The association between cocaine and cannabis found in 43.1% of
the victims in our sample indicates the role of these drugs as a sig-
nificant factor. Arrantes et al. investigated a sample with 150 victims of
homicides and found 47.3% who were positive for cannabis, 36.7%
Y.V. Lemos, et al.
who were positive for cocaine and 20.6% who had an association be-
tween the two substances.25 The data underscore the important re-
lationship between drugs and murders as well as the regional variation
expressed in a percentage difference when these two publications are
compared.
Regardless of the field, in this work, there was a full predominance
of illicit drugs in victims of murder, without any significant differences
between men and women, as confirmed by other authors.26
Our toxicological findings are corroborated by the World Report on
Drugs as the production and consumption of traditional illicit drugs,
such as marijuana and cocaine, have led to growing seizures, con-
sumption, trafficking and production according to official Brazilian
data(2).
Although there are reports of designer drug seizures by Federal
Police in Brazil, in this work, these were not found.27 An explanation is
related to the analytical limitations of their detection by LabTox and
their low prevalence in our state.
The more substantial proportion of toxicological tests regarding il-
licit drugs in young men reinforces the results of Andrade et al. that
indicated a greater presence of young people as victims of homicides,
which may be related to the greater availability of illicit drugs and
circumstances involving their use.26
Proportionally, there were more mixed/black victims of homicides
with positive toxicology tests than negative: 83.1% and 53.6%, re-
spectively. This predominance of mixed/black skin color in the group
with positive toxicology tests suggests greater consumption of illicit
drugs by these individuals. Kuhns and collaborators suggested that
differences may exist in drug consumption between different ethnic
groups,28 which could partially explain our finding since in most Bra-
zilian studies (as well as in this study), skin color, with the absence of
ethnicity, was evaluated.26 Other authors showed a greater presence of
illicit drugs, mainly cocaine,29,30 and an increasingly early start of drug
use in Latinos.31
A strong association between illicit drugs and homicide victims was
also found in other polls.2,11,12,32,33
The primary means used to commit homicide was a firearm, re-
gardless of gender and toxicology test results: positive (87.5%) and
negative (83.6%). Our findings confirmed data from the Violence Atlas
2017, which found 71.3% of homicide by gunshots in Minas Gerais, and
also the 2016 Violence Map, which indicated that Brazil, has one of the
highest homicide rates by gunshot per 100,000 inhabitants in the
world.4,7
There are significant regional variations about the percentage of
gunshots in different Brazilian states, with rates ranging from
7.5:100,000 (Santa Catarina) to 56.1:100,000 (Alagoas).7 In Minas
Gerais, the rate is 16.4:100,000.7 In addition to Brazil, in the Americas,
there is also the dominance of gunshots as the cause of homicide in two-
thirds of cases.2 Moreover, due to its high lethality, the gun is the pri-
mary way to murder worldwide, accounting for 4 in 10 murders.2
Homicide causing instruments other than guns were found, in our
pool, in less than 14% of the total sample, with more than half of these
(8.2%) being represented by cuts/stabbing. There are substantial re-
gional variations between countries about the percentage of deaths
arising from assault by sharp instruments. These, globally, correspond
to 24% of total homicides and are more frequent in Oceania (55%) and
Europe (33%). In the Americas, this value is approximately 17%.2,18 A
Brazilian study also found a low significant percentage of sharp in-
struments, corresponding to only 6.7% of the total number of mur-
ders.26
Causes of homicide, such as a blunt instrument, asphyxiation, and
others, were rarely found in this study, making up only 5.5% of cases.
This value is close to that of another Brazilian study (6.7%) and a Latin
American multi-center study (12.7%), reinforcing the rarity of these
means as causes of homicide in Brazil.26,34
Anticonvulsants, barbiturates, sedatives, and hypnotics were pre-
sent in 1.5% of the total murders, with a higher relative proportion in
59
Journal of Forensic and Legal Medicine 65 (2019) 55–60
homicides by blunt force injury (15.4%), confirming the broad su-
premacy of illicit drugs, whose presence was greater than 80%, even in
this case.35
Data from Europe and the United States indicate that there is in-
creasing concern about the use of opioids. However, in this work, in the
Brazilian population, the percentage was less than 1% of cases.11 The
largest concentration of toxicology tests being requested in the Me-
tropolitan area may also have been caused by violence occurring in
municipalities around Belo Horizonte, which may have contributed to
the higher homicide rates in the Capital, as related to the higher con-
centration of emergency medical services, secondary units and tertiary
referrals where victims are usually forwarded. This finding is reinforced
by other publications that indicate that regions around major cities, due
to greater social inequality, have the highest concentration of vio-
lence.36–38
5. Conclusion
There is a strong relationship between illicit drugs, mainly the
principles and/or derivatives from cocaine and THC, and victimization
of men and women to homicide. The demographic profile of homicide
victims subjected to toxicology tests revealed mainly young mixed/
black men. The chief circumstance of death was a gunshot, and there
was a geographic concentration of homicides in the Belo Horizonte
Metropolitan area.
There are few national studies regarding toxicology testing of ho-
micide victims. Considering that Brazil is a country with one of the
highest homicide rates in the world, the findings of this work indicate
the importance of investing in social actions, public safety and pre-
vention efforts for this specific population group.
Conflicts of interest
The authors have no funding and conflicts of interest to disclose.
Ethical approval
All procedures performed in this study involving human partici-
pants were conducted in accordance with the ethical standards of the
institutional ethics committee (Approval No. 1.038.218) and the 1964
Declaration of Helsinki and its later amendments or comparable ethical
standards.
Acknowledgment
Policia Civil de Minas Gerais. No funds to disclosure.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.jflm.2019.05.008.
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