The dissertation concerns the manner of death “homicide” as seen from the perspective of forensic medicine. In three studies, homicides are approached going from a broad overview of all homicide methods (Study I) to a narrow focus on the findings in the group of homicide victims killed by sharp force trauma (Study II) and how developments in medical treatment have impacted the group of victims killed with stab wounds (Study III). The studies are based on autopsy reports of homicide victims killed in Denmark during 1992-2016.

Study I:​ Homicide in general

1,417 homicide victims were included. The most common homicide methods were sharp force trauma (33.2%), gunshots (22.2%), blunt force trauma (21.9%) and asphyxia (17.6%). There was a significant decrease in the annual number of homicides in all the four most common homicide methods and for homicidal events with single and multiple victims during the period. Two thirds of the victims were male, while nine in ten offenders were male. There were clear differences between male and female victims, with a large proportion of female victims killed in a family setting and a large proportion of male victims killed by a friend/ acquaintance in the setting of nightlife/intoxication.

Study II:​ Sharp Force Homicide

471 homicide victims were killed by sharp force trauma, the most common homicide method. Most sharp force homicides occurred inside, often committed with a kitchen knife. Female victims had more sharp force wounds, stab wounds and defense wounds than male victims. There were clear differences in the number of injuries between various homicide types and thereby between male and female victims. The thorax was the most commonly injured region, often with injuries to the lungs and heart.

Study III:​ Stab wounds and better treatment

428 homicide victims died from stab wounds. The decrease in the annual number of stab wound homicides only affected victims with a single stab wound and not victims with multiple stab wounds. The victims of single stab wound homicides differed from victims of multiple stab wound homicides in the severity of injuries, level of treatment and survival time. Despite the decrease in single stab wound homicides, the survival time has increased from the first to the last half of the period and the proportion of victims undergoing surgery before dying has tripled. This indicates that faster and better medical treatment could be responsible for the decrease in single stab wound homicides and thus possibly for the decrease in stab wound homicides in general.

The three studies demonstrate that homicide epidemiology is ever changing and follows general developments in society. The broad overview (Study I) will hopefully serve as a spark for further specific studies in forensic medicine, as well as a basis for policy development related to interpersonal violence. The specific studies of homicides by sharp force trauma (Study II and III) should serve as a reference in death investigations and daily autopsy work, but also as a link to understanding the underlying factors that direct the broader homicide statistics.

Afhandlingen omhandler dødsmåden “drab”, som den tager sig ud fra et retsmedicinsk perspektiv. Gennem tre forskningsstudier undersøges drab, først med en overordnet undersøgelse af alle drabsmetoder (Studie I), derefter med en afgrænset undersøgelse af drab ved skarp vold (Studie II) og hvordan udviklingen i behandling har påvirket gruppen af drabsofre udsat for stiklæsioner (Studie III). Studierne er baseret på obduktion-serklæringer fra ofre for drab i Danmark i perioden 1992-2016.

Studie I:​ Drab - overordnet

Der var 1.417 drabsofre. De hyppigste drabsmetoder var skarp vold (33,2%), skud (22,2%), stump vold (21,9%) og kvælning (17,6%). Der var et signifikant fald i det årlige antal drab ved alle de fire hyppigste drabsmetoder, samt i drabsepisoder med både et enkelt drabsoffer og flere drabsofre. To ud af tre drabsofre var mænd, og ni ud af ti gerningspersoner var mænd. Der var tydelige forskelle mellem mandlige og kvindelige ofre, idet en stor andel af kvindelige drabsofre blev dræbt i familien, og en stor andel af mandlige ofre blev dræbt af en ven/bekendt i forbindelse med fuldskab/i nattelivet.

Studie II:​ Drab ved skarp vold

471 drabsofre blev slået ihjel ved skarp vold, den hyppigste drabsmetode. De fleste drab ved skarp vold blev begået indendørs, ofte med en køkkenkniv. Kvindelige ofre havde flere skarprandede læsioner, stiklæsioner og afværgelæsioner end mandlige ofre. Der var tydelige forskelle i antallet af skader ved de forskellige drabstyper, hvilket forklarer forskellene mellem mandlige og kvindelige drabsofre. Brystkassen var den hyppigst skadede region, ofte med skade på lunger og hjerte.

Studie III:​ Drab ved stik vs. bedre behandling

428 drabsofre blev dræbt med stiklæsioner. Faldet i det årlige antal drab med stiklæsioner skyldtes et fald i antallet af drab med en enkelt stiklæsion og ikke drab med flere stiklæsioner. Drabsofre med en enkelt stiklæsion adskilte sig fra drabsofre med flere stiklæsioner med hensyn til alvorlighed af skader, behandlingsniveau og overlevelsestid. På trods af faldet i antallet af drab med en enkelt stiklæsion er overlevelsestiden steget fra den første halvdel af perioden til den sidste halvdel og andelen af drabsofre, der er nået på operationsbordet er tredoblet. Dette tyder på, at hurtigere og bedre lægebehandling kunne være årsag til faldet i drab med et enkelt knivstik og derfor muligt også for faldet i drab med stiklæsioner i det hele taget.

De tre studier viser, at drabsepidemiologi er foranderlig og følger den generelle samfundsudvikling. Den overordnede undersøgelse (Studie I) kan forhåbentlig give anledning til yderligere retsmedicinske forskningsstudier og danne grundlag for offentlig debat og politikudvikling relateret til vold. De afgrænsede undersøgelser (Studie II og III) kan bruges som støtte i efterforskning af dødsfald og obduktionsarbejde, men også som en uddybning af de underliggende forhold, der påvirker drabsstatistikkerne.