In a follow-up study of 1289 alcoholics 6-9 years after treatment, 52 had died by violent means. Suicide and homicide were the leading causes of violent death, with deaths in fires and pedestrian accidents also occurring with some frequency.

To the Editor.— Although the accuracy of death certificates has been questioned, 1-3 they continue to be the primary source of mortality statistics. Death certificates may seriously underestimate the prevalence of certain diseases. 4 This may be especially true for alcoholism. 1-5 In an ongoing study of alcoholism, mortality was confirmed in 246 of 1,289 (19%) known alcoholics five to eight years after treatment of alcoholism or its complications. Autopsies were performed on 102 patients (43.6%). Two raters compared the death certificates and the available autopsies of 50 of these patients to determine the validity of death certificate information, with special regard to alcohol-related diseases or conditions. Using the autopsy as the standard for determining the cause of death, both raters agreed that only 60% of the death certificates gave an accurate general epidemiological description of the patient's death. In the 40% of certificates, where discrepancies occurred between the two