Artigo Original
MORTALITY FROM HANGING, STRANGULATION AND SUFFOCATION AND EVENTS OF UNDETERMINED INTENT IN THE STATE OF PARÁ
Como citar: Dias MF, Gonçalves WGE. MORTALITY FROM HANGING, STRANGULATION AND SUFFOCATION AND EVENTS OF UNDETERMINED INTENT IN THE STATE OF PARÁ. Persp Med Legal Pericia Med. Vol. 11, 2026; 260424.
https://dx.doi.org/10.47005/260424
Recebido em 04/03/2026
Aceito em 20/04/2026
The authors report no conflict of interest.
MORTALITY FROM HANGING, STRANGULATION AND SUFFOCATION AND EVENTS OF UNDETERMINED INTENT IN THE STATE OF PARÁ
Resumo
INTRODUÇÃO: O enforcamento, o estrangulamento e a sufocação configuram importantes causas de morte violenta, com relevância médico-legal na distinção entre lesões autoprovocadas, agressões e eventos de intenção indeterminada. A análise epidemiológica dessas categorias contribui para a qualificação da informação em saúde e para a compreensão do perfil sociodemográfico das vítimas. MATERIAL E MÉTODO: Estudo ecológico, descritivo e retrospectivo, com dados secundários do Sistema de Informações sobre Mortalidade, referentes aos óbitos por enforcamento, estrangulamento e sufocação no Estado do Pará, classificados nas categorias X70, X91 e Y20, no período de 2015 a 2024. Foram analisadas as variáveis ano do óbito, categoria da Classificação Internacional de Doenças, município de ocorrência, sexo, faixa etária, cor ou raça, escolaridade e local de ocorrência. RESULTADOS: Foram registrados 3.892 óbitos, com predomínio da categoria lesão autoprovocada (80,8%), seguida por agressão (9,8%) e intenção indeterminada (9,5%). Observou-se maior frequência no sexo masculino (78,2%), na faixa etária de 15 a 34 anos (52,5%) e na população parda (83,9%). O domicílio foi o principal local de ocorrência (68,8%). DISCUSSÃO: Os achados demonstram predominância de mortes autoprovocadas em ambiente domiciliar, em consonância com a literatura, e evidenciam a persistência de registros com intenção indeterminada, indicando desafios na determinação da causa básica. CONCLUSÃO: A mortalidade por enforcamento no Pará apresenta perfil concentrado em homens jovens, com predomínio de lesões autoprovocadas e ocorrência domiciliar, reforçando a necessidade de aprimoramento da vigilância epidemiológica e das estratégias de prevenção.
Palavras Chave: Mortalidade; Suicídio; Violência; Medicina Legal
Abstract
INTRODUCTION: Hanging, strangulation, and suffocation represent significant causes of violent death, with medico-legal relevance in distinguishing self-inflicted injuries, assaults, and events of undetermined intent. Epidemiological analysis of these categories contributes to improving health information quality and understanding victims’ sociodemographic profiles. MATERIAL AND METHODS: Ecological, descriptive, and retrospective study using secondary data from the Mortality Information System, including deaths from hanging, strangulation, and suffocation in the State of Pará, classified as X70, X91, and Y20, from 2015 to 2024. Variables analyzed were year of death, International Classification of Diseases category, municipality, sex, age group, race or color, education level, and place of occurrence. RESULTS: A total of 3,892 deaths were recorded, predominantly classified as self-inflicted injuries (80.8%), followed by assault (9.8%) and undetermined intent (9.5%). Most victims were male (78.2%), aged 15 to 34 years (52.5%), and identified as mixed race (83.9%). The home was the main place of occurrence (68.8%). DISCUSSION: Findings indicate predominance of self-inflicted deaths occurring at home, consistent with the literature, and highlight the persistence of undetermined intent records, reflecting challenges in defining the underlying cause of death. CONCLUSION: Mortality from hanging in Pará is concentrated among young men, predominantly involving self-inflicted injuries occurring at home, underscoring the need to strengthen epidemiological surveillance and prevention strategies.
Keywords (MeSH): Mortality; Suicide; Violence ;Forensic Medicine
1. INTRODUCTION
Mechanical asphyxia constitutes an important cause of violent death, with significant medico-legal and epidemiological relevance, as it involves events resulting both from self-inflicted behavior and interpersonal violence. Among these, hanging, strangulation, and other forms of suffocation stand out as mechanisms that may result in death due to cerebral hypoxia, airway obstruction, or cervical vascular compression, and are classified according to the presumed intent of the event.
From a medico-legal perspective, hanging is characterized by cervical constriction produced by a ligature tightened by the weight of the body itself, totally or partially suspended, and is classically associated with suicide. Strangulation, in turn, occurs through constriction of the neck without the action of body weight, generally by external force applied by a third party, and is frequently related to homicide. Suffocation comprises various mechanisms of respiratory impairment, such as airway occlusion or thoracoabdominal compression, and may occur in self-inflicted, assault-related, or accidental contexts (1). The distinction between these mechanisms requires careful forensic analysis, including autopsy examination, assessment of cervical furrows, bruises, internal signs of compression, and circumstantial investigation.
In the International Classification of Diseases – 10th Revision (ICD-10), deaths resulting from these mechanisms are categorized according to presumed intent as intentional self-harm (X70), assault (X91), or event of undetermined intent (Y20). However, in forensic practice, there are situations in which, even after autopsy and investigation, it is not possible to safely establish whether the event resulted from suicide or homicide, particularly in the absence of witnesses, conclusive clinical history, or robust circumstantial elements (2).
From the perspective of classical forensic medicine, the determination of the legal cause of death must be based on the available body of evidence, and it is scientifically more appropriate to acknowledge indeterminacy when insufficient elements exist to support a secure conclusion. Thus, category Y20 represents not merely an administrative classification, but the expression of technical-forensic uncertainty in borderline or poorly clarified cases.
From a public health standpoint, the exclusion of events of undetermined intent may lead to underestimation of the true magnitude of both suicides by hanging and homicides by strangulation or suffocation, in addition to introducing bias into sociodemographic and territorial analyses. Therefore, the joint inclusion of categories X70, X91, and Y20 allows for a more comprehensive epidemiological approach consistent with the principles of forensic medicine, contributing to a more accurate assessment of mortality due to mechanical asphyxia (3).
In this context, the present study proposes to analyze, in an integrated manner, deaths from hanging, strangulation, or suffocation in the state of Pará, according to sociodemographic, spatial, and circumstantial characteristics, incorporating events of undetermined intent as a methodological differential and central element for improving the quality of epidemiological analysis.
2. MATERIALS AND METHODS
This is an epidemiological, descriptive, exploratory study with a quantitative approach, documentary and retrospective in nature, conducted using secondary data in the public domain.
Deaths occurring in the state of Pará between 2015 and 2024 were analyzed, as recorded in the Mortality Information System (SIM), made available by the Department of Informatics of the Brazilian Unified Health System (DATASUS). Tabulation was performed according to the year of death occurrence and municipality of occurrence, as these variables more accurately reflect the temporal and territorial distribution of fatal events (4).
The study population comprised all deaths whose underlying cause was classified according to the following codes of the International Classification of Diseases – 10th Revision (ICD-10): X70 (intentional self-harm by hanging, strangulation, or suffocation), X91 (assault by hanging, strangulation, or suffocation), and Y20 (hanging, strangulation, or suffocation of undetermined intent).
The inclusion of the three categories is grounded in the medico-legal understanding that the asphyxial mechanism alone does not define the legal cause of death. The distinction between suicide, homicide, and undetermined intent depends on the integrated analysis of autopsy findings, forensic evidence, and investigative circumstances, and may remain inconclusive in certain cases. Thus, the incorporation of category Y20 reduces potential biases resulting from misclassification and enables a broader epidemiological approach to fatal mechanical asphyxia.
The following variables were analyzed: year of death, number of cases by ICD-10 category (X70, X91, and Y20), sex, age group, race/color, education level, place of occurrence, and municipalities with the highest incidence of records. Race/color and education categories followed the standardization adopted by the Ministry of Health within the SIM.
Data were extracted in aggregated format, organized, and tabulated in electronic spreadsheets for descriptive analysis. Variables were analyzed using absolute and relative frequencies, allowing characterization of the victims’ sociodemographic profile, identification of municipalities with the highest concentration of cases, and assessment of the temporal distribution of deaths over the ten-year historical series.
As this study was conducted exclusively using secondary, publicly available data without individual identification, submission to a Research Ethics Committee was not required, in accordance with Resolution No. 510/2016 of the National Health Council. The authors declare no conflict of interest.
3. RESULTS
Between 2015 and 2024, a total of 3,892 deaths were recorded in the state of Pará due to external causes involving hanging, strangulation, or suffocation, classified according to ICD-10 categories X70, X91, and Y20, encompassing suicides, homicides, and events of undetermined intent.
Analysis of the temporal distribution revealed variations throughout the ten-year historical series, with annual fluctuations in the absolute number of cases; however, there was a consistent predominance of records classified as intentional self-harm (X70), totaling 3,143 cases.
Regarding the sociodemographic profile, a higher concentration of deaths was observed among males, accounting for 3,043 cases (78.2%), whereas females corresponded to 845 cases (21.7%), with a residual percentage of records classified as unknown (0.1%). Age distribution showed higher incidence among adolescents and young adults of economically active age, particularly in the 15–24 and 25–34 age groups, which concentrated the largest proportion of cases.
The race/color variable demonstrated a predominance of mixed-race individuals, with 3,266 records (83.9%), followed by White individuals (333 / 8.6%), Black individuals (225 / 5.8%), Indigenous individuals (7 / 0.2%), and Asian individuals (6 / 0.2%), in addition to records classified as unknown (55 / 1.4%). This pattern reflects the demographic composition of the state and highlights the influence of social determinants on the distribution of violent mortality.
Regarding education level, a higher frequency of deaths was observed among individuals with lower formal education, particularly those with 8 to 11 years of schooling (1,176 / 30.2%), followed by those with 4 to 7 years and 1 to 3 years of education. A relevant proportion of records was classified as unknown (468 / 12%), indicating limitations in the completion of death certificates.
Tabela : Distribuição dos óbitos por características sociodemográficas.
|
Variável |
Categoria |
n |
% |
|
Sexo |
Masculino |
3.043 |
78,2 |
|
Feminino |
845 |
21,7 |
|
|
Ignorado |
4 |
0,1 |
|
|
Faixa etária (anos) |
14< |
168 |
4,3 |
|
15 a 24 |
1.147 |
29,5 |
|
|
25 a 34 |
897 |
23,0 |
|
|
35 a 44 |
676 |
17,4 |
|
|
45 a 54 |
391 |
10,0 |
|
|
≥55 |
576 |
14,8 |
|
|
Ignorada |
37 |
1,0 |
|
|
Cor/Raça |
Branca |
333 |
8,6 |
|
Preta |
225 |
5,8 |
|
|
Amarela |
6 |
0,2 |
|
|
Parda |
3.266 |
83,9 |
|
|
Indígena |
7 |
0,2 |
|
|
Ignorado |
55 |
1,4 |
|
|
Total |
3.892 |
100,0 |
Fonte: Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Sistema de Informação sobre Mortalidade (SIM). Brasília: DATASUS, 2026.
Regarding distribution by ICD-10 category, a predominance of deaths classified as X70 – intentional self-harm by hanging, strangulation, or suffocation was observed, corresponding to 3,143 cases (80.8%) of the total analyzed. Records classified as X91 – assault by hanging, strangulation, or suffocation totaled 380 cases (9.8%), while events categorized as Y20 – undetermined intent accounted for 369 cases (9.5%), evidencing the presence of a proportion of deaths whose legal cause remained inconclusive.
Concerning place of occurrence, there was a marked predominance of records at home (2,679 / 68.8%), followed by other locations (853 / 21.9%) and public roads (163 / 4.2%). Deaths occurring in hospitals corresponded to 146 cases (3.8%), while 29 cases (0.7%) occurred in other healthcare facilities and 22 (0.6%) were classified as unknown.
With respect to place of occurrence according to ICD-10 category, deaths classified as X70 occurred predominantly at home (2,679 / 61.3%). Although X91 records also showed higher incidence at home, they presented a relatively greater concentration on public roads (75 / 1.9%) compared to self-inflicted deaths. Events classified as Y20 demonstrated a statistically predominant distribution at home when compared to public roads, reflecting a contextual pattern more similar to intentional self-harm.
Tabela : Distribuição dos óbitos segundo características do evento
|
Variável |
Categoria |
n |
% |
|
Categoria CID-10 |
X70 – Lesão autoprovocada |
3.143 |
80,8 |
|
X91 – Agressão |
380 |
9,8 |
|
|
Y20 – Intenção indeterminada |
369 |
9,5 |
|
|
Total |
3.892 |
100,0 |
|
|
Local de ocorrência |
Hospital |
146 |
3,8 |
|
Outro estab. de saúde |
29 |
0,7 |
|
|
Domicílio |
2.679 |
68,8 |
|
|
Via pública |
163 |
4,2 |
|
|
Outros |
853 |
21,9 |
|
|
Ignorado |
22 |
0,6 |
|
|
Total |
3.892 |
100,0 |
Fonte: Fonte: Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Sistema de Informação sobre Mortalidade (SIM). Brasília: DATASUS, 2026.
Spatial distribution analysis revealed a concentration of deaths in municipalities with greater population density and regional relevance. Altamira, Ananindeua, Belém, Itaituba, Marabá, Parauapebas, and Santarém stood out, all presenting more than 100 recorded cases during the analyzed period, highlighting both the interiorization and territorial dispersion of fatal mechanical asphyxia in the state of Pará.
4. DISCUSSION
The findings of this study demonstrate that mortality due to hanging, strangulation, or suffocation in the state of Pará represents a phenomenon of high epidemiological and medico-legal relevance, with a marked predominance of intentional self-inflicted injuries (X70). The higher incidence of this category, particularly when compared to assaults (X91) and events of undetermined intent (Y20), confirms hanging, strangulation, and suffocation as recurrent methods of suicide.
The predominance of self-inflicted deaths occurring at home was notable, totaling 2,388 cases in domiciliary settings compared to 69 occurrences on public roads. This pattern reinforces previously described evidence indicating that suicide by hanging tends to occur in private environments, characterized by greater isolation, reduced likelihood of immediate intervention, and prior planning of the act. In this context, the home constitutes a setting of silent vulnerability, hindering early identification of risk and limiting preventive action by health services (5).
In contrast, deaths classified as assault by hanging, strangulation, or suffocation (X91) showed a more balanced distribution between home (122 cases) and public roads (75 cases), although still with slight predominance in domestic settings. The relatively higher proportion of occurrences in public spaces, when compared to self-inflicted injuries, suggests a distinct dynamic of interpersonal violence, often associated with interpersonal conflicts, social vulnerability, and urban contexts with greater exposure (6). The proportional difference between places of occurrence underscores the importance of circumstantial context as an interpretative element in determining the legal cause of death.
The inclusion of events classified as undetermined intent (Y20) reinforces the complexity involved in establishing the legal cause of death in cases of mechanical asphyxia. In certain situations, the absence of witnesses, inconsistencies at the scene, or investigative limitations may prevent a reliable differentiation between suicide and homicide, justifying maintenance of the undetermined classification. From an epidemiological standpoint, incorporating this category prevents underestimation of violent deaths and contributes to a more accurate assessment of the magnitude of the problem (7).
Overall, the predominance of self-inflicted injuries and their strong association with the domestic environment highlight the central role of suicide by hanging as a public health issue in the state of Pará. Simultaneously, the non-negligible presence of homicides by strangulation or suffocation, with a relatively greater proportion occurring on public roads compared to self-inflicted injuries, demonstrates that mechanical asphyxia is also part of the spectrum of interpersonal violence. These findings emphasize the need for integrated strategies that articulate suicide prevention, violence reduction, and the strengthening of medico-legal investigation.
5. CONCLUSION
Mortality due to hanging, strangulation, or suffocation in the state of Pará between 2015 and 2024 presented a substantial burden of deaths, with a marked predominance of intentional self-inflicted injuries (X70), particularly those occurring in the domestic setting. An increasing trend was observed throughout the historical series when comparing the beginning and the end of the analyzed period, indicating progressive growth of these events within the state.
The epidemiological profile remained characterized by male predominance, higher incidence among adolescents and young adults, concentration among individuals identified as mixed race, and greater occurrence among those with lower educational attainment, highlighting the influence of social determinants on the distribution of mortality due to mechanical asphyxia. Spatial distribution demonstrated higher concentration in municipalities with greater population density, including Altamira, Ananindeua, Belém, Itaituba, Marabá, Parauapebas, and Santarém.
The proportional difference between the predominance of self-inflicted injuries occurring at home and the relatively greater participation of public roads in assault-related cases underscores the importance of contextual and forensic analysis in determining the legal cause of death. The inclusion of events classified as undetermined intent proved essential for a more comprehensive epidemiological assessment aligned with medico-legal principles.
These findings highlight the need to strengthen suicide prevention policies, address interpersonal violence, and improve the qualification of investigations of deaths from external causes, as well as to enhance health information systems to ensure more accurate data production and the development of effective life-protection strategies.
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