Geographical characteristics and other factors associated with alcohol-related fatal fires in Ireland 2014 – 2021

1. Introduction

Alcohol use is the tenth leading risk factor for both deaths and disability-adjusted life years globally.¹ Over 5% of all deaths annually are attributable to alcohol and its use is associated with alcohol dependence and alcohol-related liver disease, along with health conditions including cardiovascular disease and cancer.² As well as health conditions, alcohol use is commonly linked with traumatic incidents such as road traffic collisions, suicides, drownings, and homicide.^2–5 Alcohol is also a risk factor for residential fire fatalities and existing global evidence indicates that up to one-half of those who died in fire incidents had been drinking prior to the event.^6–15 Fortunately, despite more than 20,000 emergency fire service callouts annually in Ireland, fatalities are relatively rare.¹⁶

Although declining, alcohol use remains high in Ireland at 9.9 litres of pure alcohol per adult (aged 15 years or greater) in 2023.² Of potential concern is the notable shift to drinking at home as opposed to drinking in licensed premises, a trend that has been especially pronounced since the COVID-19 pandemic and exacerbated by the cost-of-living crisis in Ireland. This pattern is also reflected elsewhere.^17–21 Drinking at home, and especially solitary drinking, is linked to heavier drinking and a higher risk of alcohol-related problems.^22,23 High blood alcohol concentration (BAC) levels are likely to reduce mobility, coordination, and sensory responses, affecting the ability to respond to escape or potentially extinguish a fire.^6,24

Alcohol can leave a person more vulnerable to residential fire incidents as otherwise normal behaviours may become hazardous while intoxicated, such as cooking or smoking and then falling asleep, as well disorientation and drowsiness resulting in a slower response or reduced awareness of smoke or an alarm sounding.^25–27 In addition to behavioural risk factors, previous research examining fatal fire incidents has indicated that geographic, individual, and building characteristics, are associated with higher likelihood of residential fire mortality.^{7,9–12,28–36}

Fatal fires involving alcohol have not been examined in detail in Ireland nor have the geographical characteristics of such events. Studies in other jurisdictions have examined alcohol-related fire fatalities^6,10,31 but the use of coronial data for such is less common.^37,38 Considering the high level of alcohol use in Ireland, the growing shift to drinking at home, and the prevalence of alcohol involved in fatal fires in Ireland, this exploratory study sought to examine the factors associated with alcohol-related fatal fires, including in comparison to non-alcohol-related fatal fires. It uses geocoded data to conduct a spatial analysis of the location of fatal fires, examining urban-rural location, area of deprivation, the distance and travel time to the nearest fire station. The findings will support fire prevention initiatives, in particular to inform campaigns to reduce alcohol-related fires.

2. Methods

3. Results

3.2 Geographical characteristics of alcohol-related fatal fires

3.2.1 Urban-rural variation of alcohol-related fatal fires

Rural areas were over-represented in fatal fires, and this also applied to those that were alcohol-related. According to the Irish Census, an average of 36.9% of the population resided in rural areas during the study period yet rural areas accounted for 47.3% of all alcohol-related fatal fires.^41,42 Urban areas accounted for 63.1% of the population and 52.7% of alcohol-related fatal fires ( Figure 1 and Supplementary Table 3).

Figure 1. Urban-rural distribution of the Irish population and the location of alcohol-related fatal fires.

3.2.2 Area-based socioeconomic status of alcohol-related fatal fires

Figure 2 shows the percentage of the population, and that of alcohol-related fire mortalities, by socioeconomic deprivation classification, according to the HP Pobal deprivation index.⁴⁰ During the study period, 44.7% of the population lived in disadvantaged or marginally below average areas and 49.1% of alcohol-related fatal fires occurred in these areas.⁴³ Although two in every five of the Irish population live in affluent areas (affluent, very affluent, or extremely affluent), no alcohol-related fatal fires occurred in these areas.

Figure 2. Rate of alcohol-related fatal fires by deprivation octile.

3.2.3 Distance and travel time from nearest fire station to alcohol-related fatal fire location

Distance from nearest fire station to alcohol-related fatal fire location

The mean distance from the nearest emergency response fire station to the location of the alcohol-related fatal fire was seven kilometres (ranging from 200 meters to 28 kilometres). Alcohol-related fatal fires that occurred in rural areas were significantly more likely to be greater distances from the nearest fire station. Over three-quarters of rural alcohol-related fatal fires were five kilometres or greater from the nearest fire station (77.4%) whereas urban alcohol-related fatal fires were more likely to be less than five kilometres from the nearest fire station (64.4%) (p<0.001) (Supplementary Table 4). There was no significant association between distance and level of deprivation of the location the fatal fire occurred (p=0.254) (Supplementary Table 5).

Travel time from nearest fire station to alcohol-related fatal fire location

The mean travel time from the nearest fire station to the location of the alcohol-related fatal fire was 10.5 minutes; the quickest journey time was 2 minutes, the longest was 35 minutes. There was no significant association between travel time and area of deprivation (p=0.690). Predictably, urban alcohol-related fatal fires had considerably less travel time from the nearest fire station (less than 5 minutes) (62.7%) compared to rural alcohol-related fatal fires (37.3%) (p<0.001) (Supplementary Table 4). There was no significant association between travel time and level of deprivation of the location the fatal fire occurred (p=0.180) (Supplementary Table 5).

4. Discussion

This is the first study in Ireland to examine alcohol and its role in fire fatalities. The results presented here indicate that alcohol is a key risk factor for fatal residential fires. We found a strong positive association between having a history of alcohol dependency and the likelihood of a fatal fire being alcohol-related. This finding should be considered along with other contextual factors to provide a more comprehensive understanding of the risk factors associated with alcohol-related fatal fires such as smoking, mobility issues, older age, being alone and other external risk factors.

Our study found that over three-quarters of alcohol-related fire fatalities were alone at the time of the incident (67.0%), a key risk factor identified in several other studies examining residential fires.^7,10,14,38 Being alone at the time of the fire is an obvious risk factor due to the vulnerability of not having immediate assistance to detect, and escape from a fire, risky behaviours may also be more likely when drinking alone as others are not around to advise against or prevent such activities.

Smokers were at a higher risk of alcohol-related fires (54.7%) compared to fires where alcohol was not involved and previous studies have noted the risk of drinking alcohol and falling asleep while smoking as a common cause of residential fires.^31,44,45 Where known, of the alcohol-related fires, smoking materials and cooking appliances were noted as contributory factors to fire ignition, suggesting that smoking and/or cooking while under the influence of alcohol poses a genuine risk. The practice of cooking while intoxicated is recognised as a risk factor for fire accidents in the home, including fatal injuries.^11,46,47 Given the notable shift to off-trade alcohol sales, drinking at home has become commonplace and this should be considered in the context of these findings.

There is limited prior evidence on the geographical characteristics of alcohol-related fire fatalities although previous research has identified rural areas as being a risk factor for fatal residential fires in general.^32,33,37,48 Our study found that alcohol-related fatal fires in rural areas were over-represented. Those living in rural areas are potentially at a greater risk likely due to the decreased likelihood of a fire being witnessed and subsequently reported, the higher likelihood of older homes that may be exempt from the same building regulations that newbuilds are, and the travel distances from fire services. We found that travel time to the incident from the nearest fire station was significantly longer when the fire occurred in a rural area. Other geographical characteristics associated with fatal fires identified in the literature indicate a higher prevalence in areas of deprivation.^{10,30,31,36,49–52} There are several explanations why those living in areas that are considered more deprived may be at higher risk of residential fires, including poor quality housing, the use of standalone heaters to avoid the expense of heating oil etc., lack of fire safety equipment, or older properties with fewer building regulations compliance.^12,50 However, area of deprivation was not a significant predictor of a fatal fire being alcohol-related in this study, consistent with findings from a US study.⁵⁰

This study has several strengths. The role of alcohol in fatal fires has not been considered in Ireland to date. Examining these incidents through a geographical lens, using precise location data, allowed a greater insight into the areas at highest risk of alcohol-related fires which may provide a novel approach to informing more focussed fire prevention initiatives. The toxicology reports permit a greater insight into the substances used by the individual before their death, including their level of alcohol use and whether other substances were consumed which may have further increased their risk of harm.

The small sample of alcohol-related fatal fires was a limitation of our analysis. Missing or unknown/not recorded data was also an issue. Due to the nature of fire incidents, damage or obliteration of evidence is commonplace, therefore there were several variables where the information was not obtained, especially in relation to the cause or source of the fire. Furthermore, as many of the fatalities were alone at the time of the incident, witness testimonials were not available to provide further information.

The analysis presented here considered the travel time from the nearest fire station to the location of the fatal fire, however it is not known if this was the fire station that despatched the fire engine to attend the scene or whether one was dispatched at all. Furthermore, travel times presented here did not consider whether routes were congested or restricted. It was also unknown at what stage fire services were alerted to the scene, i.e. the fire may have been well progressed by the time they were notified and therefore travel time may not be relevant. It should also be noted that some fires lead to more than one fatality, and the characteristics of these fires will therefore have greater representation in our data.

Drinking at home may pose additional risks due to larger measures being poured and consumed, as well as drinking for longer periods of time. This in turn may lead to riskier behaviours such as cooking while intoxicated and less care when tending to open fires. The evidence presented here is an important step in ensuring that alcohol use is considered when planning fire safety campaigns and the use data in this study is used to promote policy and practice. Alcohol use alone is not the leading risk factor for fatal fires but when combined with the other risk factors identified, increases the risk of accidental fires and potentially death.

Several recommendations can be proposed based on the findings of this study to help prevent alcohol increasing the risk of fire fatalities. These include provision of specialist alarms (e.g. louder and/or visual alarms, sprinkler systems, etc.) in the homes of those known to be alcohol dependent; targeted prevention campaigns at those living in older homes that precede the building regulations required of newer builds; implementation of rotating advice on labelling on alcohol products to include the risk of fire when cooking while intoxicated; urging family members, neighbours and friends to identify those in their community at greater risk and discourage hoarding, the use of candles, chip pans, and open fires, when drinking; and finally, to include alcohol as a risk factor in annual fire safety week.

Further research is required to deepen our understanding of alcohol-related fatal fires. Due to limited information about the presence of fire safety equipment, there is still more to be learned about their effectiveness in this study and further research to examine their use in non-fatal fires is warranted. Examining in greater detail, non-fatal fire hospitalisations where alcohol had been consumed, may identify protective factors for surviving residential fires.

However, knowing who is at an increased risk, and the geographical characteristics of fatal fires will inform policy development. Furthermore, in publicising the risk associated with alcohol use and fatal fires widely, public awareness will increase, encouraging preventative behaviours as well as potentially reducing hazardous drinking patterns. The findings can also provide advocacy groups with further evidence of the harms associated with alcohol use. This study allows a greater understanding of fatal fires and how alcohol represents a risk factor in such incidents which is rarely included when discussing alcohol-related harms more generally. These findings can also be used to inform alcohol-specific policies such as understanding the impact of the Public Health (Alcohol) Act, 2018, as well as contributing to a health impact assessment, recommended in consideration of proposed legislation to increase alcohol availability, the Intoxicating Liquor Bill, 2024 and the Sale of Alcohol Bill, 2021.^53–56

5. Conclusion

Over two in every five of those who died in a fire in Ireland had been drinking prior to the incident indicating that alcohol is a key risk factor for fire accidents and mortality, which is not often recognised. Alcohol-related fire fatalities are more common in rural areas and among those who are alcohol dependent. Fire prevention and safety efforts should seek to mitigate the impact of alcohol on increasing the risk of fatal fires.

Ethical approval statement

The information in this study is obtained from the National Drug-Related Deaths Index (NDRDI). Ethical approval for the data collection, and subsequent use (including analysis and publications) was received from Health Research Board ethics committee (no longer in operation), formerly located at Health Research Board, 73 Lower Baggot Street, Dublin 2, and from ethics committees covering each individual acute hospital providing hospitalisation data. Any changes to the remit of the NDRDI have been approved by the Irish College of GPs Research Ethics Committee (ICGP), Irish College of GPs, 15 Hogan Place, Dublin 2, D02 DK23. Approval for the use of Central Treatment List data was obtained from the Methadone Prescribing Protocol Implementation Committee. All work was carried out in accordance with International Epidemiological Association/European Epidemiology Group guideline document.⁵⁷

This study does not have an ethics approval reference number because it was approved prior to the introduction of formal numbering systems. At that time, the ethics committee issued confirmation letters rather than assigning approval codes. The original confirmation letter documenting the committee’s approval is available and can be provided upon request.

As the data used in this study are anonymised mortality data and no direct interaction with participants, informed consent was not possible.