Temporal Trends and Medico-Legal Profile of Fatal Poisoning Cases in Rewari, Haryana: A Seven-Year Autopsy-Based Retrospective Study

Introduction

Poisoning remains an important cause of preventable morbidity and mortality and continues to pose a substantial public health as well as medico-legal challenge worldwide. Its epidemiological pattern varies according to geographical location, socioeconomic conditions, occupational exposure, availability of toxic substances, agricultural practices and prevailing psychosocial factors. Suicide is a major global health problem, and pesticide self-poisoning accounts for a substantial proportion of suicides, particularly in low-and middle-income countries where highly hazardous pesticides may be readily accessible [1][2].

Intentional pesticide ingestion is an important method of self-harm in many agrarian populations. The high case fatality associated with pesticide poisoning is related to the intrinsic toxicity of the compounds, quantity consumed, delays in recognition and transport, and the lack of a specific antidote for several highly toxic agents. Global evidence has demonstrated that pesticide self-poisoning contributes substantially to suicide mortality, particularly in rural Asian populations [3]. Regulatory restriction of highly hazardous pesticides is therefore regarded as an important population-level suicide-prevention strategy [2][4].

India carries a particularly important burden of acute pesticide poisoning because of its large agricultural population and widespread availability of agrochemicals. A systematic review and meta-analysis of Indian studies published between 2010 and 2020 found pesticides to be the predominant agents among adult poisoning cases, with the highest pooled prevalence reported from North India [5]. Another systematic review of lethal poisoning in India during 1999-2018 found pesticides to account for the overwhelming majority of poisoning deaths and documented important temporal changes in the relative contribution of aluminium phosphide and organophosphorus insecticides [6].

Among agricultural poisons, aluminium phosphide has particular relevance in northern India. Metal phosphides are potent insecticides and rodenticides used for protection of stored crops and food grains. Aluminium phosphide releases phosphine gas on contact with moisture and may produce severe cardiovascular toxicity, shock, metabolic disturbances and multiorgan dysfunction [7]. More recent reviews continue to emphasize its use as a grain-storage fumigant, its high lethality and the absence of a specific antidote [8].

The circumstances surrounding fatal poisoning extend beyond the toxic agent itself. Age, sex, occupation, rural or urban residence, psychosocial stressors and manner of poisoning influence the epidemiological profile, whereas season and time of ingestion may reflect differences in agricultural activity, pesticide availability, work patterns and social behaviour. From a forensic perspective, fatal poisoning also requires evaluation of the manner of death, circumstances of exposure, survival-related information and toxicological evidence.

Temporal analysis is important because poisoning patterns may change with pesticide regulation, availability of toxic substances, agricultural practices, socioeconomic conditions and access to emergency medical care. Indian literature demonstrates marked regional and temporal variability in the poisons responsible for fatal outcomes [5][6]. Long-term autopsy-based datasets can therefore provide valuable district-level information that may not be captured by hospital admission studies alone.

Rewari district of Haryana represents an agrarian north Indian setting where agricultural chemicals and grain-storage fumigants remain relevant sources of toxic exposure. Detailed multi-year autopsy-based information integrating demographic characteristics, manner of death, seasonal patterns and year-wise toxicological trends from this district is limited. The present study was therefore undertaken to analyse temporal trends and the medico-legal profile of fatal poisoning cases subjected to autopsy in Rewari, Haryana, during the calendar years 2020-2026, with 2026 data available up to August.

Aim and Objectives

Aim

To study the temporal trends and medico-legal profile of fatal poisoning cases subjected to medico-legal autopsy in Rewari, Haryana, during the study period from 2020 to 2026.

Objectives

1. To analyse the sociodemographic profile of fatal poisoning cases with respect to age, gender, residence and occupation.

2. To study the manner of poisoning and classify the cases as suicidal, accidental or homicidal.

3. To identify the types of poisons involved in fatal poisoning cases and assess their year-wise distribution.

4. To evaluate the reasons or circumstances associated with consumption of poison.

5. To analyse the seasonal and diurnal pattern of poison intake.

6. To study the distribution of time since death among fatal poisoning cases.

7. To assess the association of manner of poisoning with age, gender, rural/urban residence, type of poison and season.

8. To evaluate year-wise trends in the manner and type of poisoning during the study period.

Materials and Methods

This retrospective, autopsy-based observational study was conducted on fatal poisoning cases subjected to medico-legal post-mortem examination at Civil Hospital, Rewari, Haryana. Records from January 2020 through August 2026 were reviewed. A total of 204 fatal poisoning cases fulfilling the study criteria were included.

Data were retrieved retrospectively from available medico-legal records, post-mortem reports, police inquest papers, hospital records, and other relevant case documents maintained during the study period. Information regarding age, gender, rural or urban residence, occupation, reason for consumption of poison, type of poison, manner of death, season, time of poison intake, time since death, and year of occurrence was recorded in a predesigned data collection format.

Inclusion Criteria

1. All fatal poisoning cases subjected to medico-legal post-mortem examination at Civil Hospital, Rewari, Haryana, during the study period from January 2020 to August 2026.

2. Cases in which poisoning was established as the cause of death on the basis of available medico-legal records, clinical history, post-mortem findings, police inquest papers, and/or toxicological information, wherever available.

3. Cases having sufficient demographic, circumstantial, and medico-legal information required for inclusion in the study and subsequent analysis.

Exclusion Criteria

1. Cases in which poisoning could not be reasonably established as the cause of death from the available records.

2. Cases with incomplete or inadequate medico-legal documentation that prevented extraction of essential study variables.

3. Cases in which the available records were insufficient to determine the relevant circumstances or manner of poisoning.

4. Non-fatal poisoning cases and poisoning cases not subjected to medico-legal post-mortem examination at Civil Hospital, Rewari.

The manner of poisoning was categorized as suicidal, accidental, or homicidal on the basis of available medico-legal records and circumstances of the case. Seasonal distribution was classified as summer (March–June), rainy/monsoon (July–October), and winter (November–February). Age was categorized into predefined age groups. Similar occupational categories, reasons for poison consumption, and types of poisons were grouped where appropriate for statistical presentation.

Categorical variables were expressed as frequencies and percentages. Age was summarized using mean, standard deviation, and range. Associations between categorical variables were assessed using Pearson's chi-square test when expected cell frequencies were adequate, Fisher's exact test for 2 × 2 tables, and the Fisher–Freeman–Halton exact test with Monte Carlo estimation for larger sparse contingency tables. A p-value of less than 0.05 was considered statistically significant.

Ethical considerations

The study was retrospective and based exclusively on medico-legal records of deceased individuals. Administrative permission to access and analyse the relevant records was obtained from the Principal Medical Officer, Civil Hospital, Rewari, Haryana. As there was no direct interaction or intervention with living participants, individual participant consent was not obtained. Confidentiality was maintained throughout data collection and analysis, and no personally identifiable information was recorded in the study dataset or disclosed in reporting. The data were used solely for academic and research purposes.

Results

A total of 204 fatal poisoning cases were analysed. The principal findings are presented in Tables 1-7.

Mean age ± SD: 38.72 ± 15.14 years; range: 1-75 years. One case with unrecorded age was included in the 11-20-year group for grouped analysis but excluded from calculation of mean and SD.

Among the 204 cases, the maximum number was observed among males, 155 (75.98%), followed by females, 49 (24.02%). Age-wise, the maximum number of cases belonged to the 31-40 years age group, 60 (29.41%), followed by 21-30 years, 49 (24.02%), and 41-50 years, 31 (15.20%). The mean age of cases with recorded age was 38.72 ± 15.14 years (range 1-75 years). Rural residents constituted the maximum number of cases, 145 (71.08%), followed by urban residents, 59 (28.92%). Occupation-wise, the maximum number of cases were unemployed, 43 (21.08%), followed by private job/company workers, 36 (17.65%), housewives and farmers, 31 (15.20%) each, and students, 23 (11.27%).

No case of homicidal poisoning was noted during the study period.

Suicidal poisoning constituted the maximum number of cases, 161 (78.92%), followed by accidental poisoning, 43 (21.08%). Celphos was the most frequently recorded poison, accounting for 193 (94.61%) cases, followed by chlorpyrifos, 3 (1.47%); HCl, zinc phosphide and methyl alcohol accounted for 2 (0.98%) cases each. Stress or mental pressure was the most commonly recorded reason for poison consumption, 66 (32.35%), followed by an unknown reason, 38 (18.63%), old disease/disease-related causes, 34 (16.67%), and addiction, 22 (10.78%). Regarding time of intake, the maximum number occurred during evening, 84 (41.18%), followed by morning, 78 (38.24%), night, 22 (10.78%), and afternoon, 20 (9.80%).

Season-wise, the maximum number of cases occurred during summer, 81 (39.71%), followed by rainy/monsoon, 71 (34.80%), and winter, 52 (25.49%). With respect to time since death, the maximum number of cases had an interval of 12-24 hours, 120 (58.82%), followed by less than 12 hours, 68 (33.33%). Cases with 24-36 hours and 1-5 days/prolonged interval accounted for 7 (3.43%) each, followed by 36-48 hours in 2 (0.98%) cases.

Among males, suicidal poisoning was maximum, 124 (80.00%), followed by accidental poisoning, 31 (20.00%). Among females, suicidal poisoning was maximum, 37 (75.51%), followed by accidental poisoning, 12 (24.49%). Age-wise, the maximum number of suicidal cases was observed in the 31-40-year group, 52 cases, followed by 21-30 years, 39 cases, and 41-50 years, 23 cases. Rural residents showed 111 suicidal and 34 accidental cases, while urban residents showed 50 suicidal and 9 accidental cases. No statistically significant association was observed between manner of poisoning and gender, age group or residence.

HCl = hydrochloric acid; OP = organophosphorus. No case of homicidal poisoning was noted during the study period.

Celphos accounted for 157 suicidal and 36 accidental cases and showed a statistically significant association with manner of poisoning (p<0.001). Among suicidal cases, Celphos was followed by zinc phosphide in 2 cases, while chlorpyrifos and OP accounted for 1 case each. Season-wise, suicidal poisoning was maximum during summer, 64 cases, followed by rainy/monsoon, 58 cases, and winter, 39 cases. The association between season and manner was not statistically significant (p=0.668).

*2026 data were available only up to August. No case of homicidal poisoning was noted during the study period.

Year-wise, the maximum number of cases was recorded in 2025, 46 cases, followed by 2021, 33 cases, 2023, 31 cases, 2022, 29 cases, and 2026, 28 cases. Suicidal poisoning was maximum in 2025 with 38 cases, followed by 2021 with 26 and 2026 with 24. Accidental poisoning was maximum in 2023 with 9 cases, followed by 2022 and 2025 with 8 cases each. The association between year and manner was not statistically significant (p=0.798).

*2026 data were available only up to August. HCl = hydrochloric acid; OP = organophosphorus. Fisher-Freeman-Halton exact test with Monte Carlo estimation: p=0.198.

Celphos remained the most frequently recorded poison throughout the study period and accounted for 193 (94.61%) cases overall. The maximum number of Celphos cases was recorded in 2025, 45 cases, followed by 2021, 31 cases, and 2023 and 2026, 28 cases each. Among the remaining poisons, chlorpyrifos accounted for 3 cases, followed by HCl, zinc phosphide and methyl alcohol with 2 cases each, while phenyl and OP were recorded in 1 case each. The year-wise poison distribution was not statistically significant (Fisher-Freeman-Halton exact test with Monte Carlo estimation, p=0.198).

Discussion

The present autopsy-based retrospective study analysed 204 fatal poisoning cases from Rewari, Haryana, during 2020-2026. The study demonstrated a predominance of males, rural residents and individuals in economically productive age groups. Suicidal poisoning was the most common manner of death, while aluminium phosphide (Celphos) emerged as the overwhelmingly predominant toxic agent. Seasonal, diurnal and year-wise patterns were also evident.

The mean age was 38.72 ± 15.14 years, with the maximum number of cases in the 31-40-year age group, followed by 21-30 years. Dahiya et al. reported a similar concentration of fatal poisoning deaths in the 30-39-year age group in Haryana [9]. The earlier J-SIMLA study from Haryana also demonstrated a substantial burden among adolescents and young adults [10]. Priya et al. reported young adults as an important affected group in Jharkhand [11], while Yadav et al. found the second and third decades to be prominently involved in southern Haryana [12]. Krishnasamy et al. and Samaria et al. likewise described acute poisoning as a problem predominantly affecting young and economically productive individuals [13][14]. The present male predominance of 75.98% was also consistent with Dahiya et al. and several of these Indian cohorts, although Yadav et al. reported female predominance, illustrating regional variation [9][12][14].

Rural residents constituted 71.08% of cases, followed by urban residents. This was consistent with the earlier Haryana studies, including the J-SIMLA series, which reported 82.8% rural cases, and Dahiya et al., who also observed rural predominance [9][10]. The high rural burden in Rewari may reflect agricultural activity, household access to pesticides and fumigants, and delayed access to definitive medical care. Occupation-wise, unemployed individuals were the largest group, followed by private employees, housewives and farmers. Yadav et al. reported homemakers, workers and students among the major occupational categories [12], while Samaria et al. emphasized the contribution of psychosocial stressors to intentional poisoning [14].

Stress or mental pressure was the most frequently recorded reason for poison consumption, followed by unknown reasons, disease-related factors and addiction. Priya et al. also identified socioeconomic and interpersonal circumstances as relevant precipitating factors in their study population [11], and Samaria et al. documented psychosocial contributors to deliberate poisoning [14]. The substantial proportion of unknown reasons in the present series reflects an inherent limitation of retrospective medico-legal records, where detailed psychosocial histories are not consistently available.

Recent Indian clinical studies further demonstrate heterogeneity in the substances involved in poisoning. Patil et al. reported pesticides as a major category, with organophosphates predominating [15], while Kumar and Reddy described a large contribution from agricultural poisons in a tertiary care setting [16]. Singh et al., in an autopsy-based comparison of pre-pandemic and pandemic unnatural mortality in Varanasi, showed that major societal disruptions such as COVID-19 can alter mortality patterns, supporting the importance of temporal surveillance [17].

Suicidal poisoning was the predominant manner in the present study, accounting for 78.92% of cases, followed by accidental poisoning in 21.08%; no homicidal case was noted. This was closely consistent with Dahiya et al., who reported 80.93% suicidal poisoning, and with the J-SIMLA Haryana study, which reported 85% suicidal cases [9][10]. George et al. similarly reported suicidal intent in 78.4% of acute poisoning patients in Western Rajasthan [18]. In contrast, Yadav et al. reported accidental poisoning as the predominant manner in their southern Haryana autopsy series [12]. These differences may reflect regional exposure patterns, study setting and variation in classification of poisoning circumstances.

Aluminium phosphide or Celphos was the most striking toxicological finding, being recorded in 193 (94.61%) cases. The finding was strongly consistent with the J-SIMLA Haryana study, in which Celphos accounted for 166 (81.37%) cases [10]. Sharma et al. also identified aluminium phosphide as the most common poison in a rural Himachal Pradesh autopsy series [19], whereas Kidiyoor and Jayprakash found organophosphorus compounds to be the leading poison in their ten-year Bangalore autopsy study [20]. Dahiya et al. likewise reported organophosphorus compounds as the predominant toxic agents in a separate Haryana cohort [9]. These contrasts reinforce substantial geographical variation in the toxicological profile of poisoning across India.

Khan et al., studying acute poisoning in an industrial city of eastern India, reported a mixed exposure profile with prominent pharmaceutical and corrosive poisoning rather than the aluminium phosphide dominance seen in Rewari [21]. Together with the findings of Priya et al., Krishnasamy et al. and other regional studies [11][13], this supports the view that local availability, occupation, socioeconomic environment, urbanisation and healthcare access strongly influence the toxic agent involved.

The overwhelming predominance of Celphos in Rewari is of particular public-health and regulatory concern. Aluminium phosphide is included among pesticides for which restrictions apply to the use of certain formulations in India. Continued fatal use despite regulatory measures suggests that access to highly hazardous fumigants remains an important preventive challenge. Stronger implementation of existing restrictions, controlled dispensing, safe storage and purchaser-level accountability may therefore be relevant preventive measures [22].

A statistically significant association was observed between type of poison and manner of poisoning (p<0.001), with Celphos accounting for the overwhelming majority of suicidal deaths. In contrast, gender, age group and rural/urban residence were not significantly associated with manner. This suggests that suicidal poisoning occurred across demographic groups, whereas choice of toxic agent may be more closely related to local availability and accessibility. The result should be interpreted cautiously because several non-Celphos categories contained very small numbers.

Season-wise, the maximum number of cases occurred during summer, followed by rainy/monsoon and winter. This pattern was consistent with the J-SIMLA Haryana study, which also documented summer predominance followed by the rainy season [10]. In contrast, Dahiya et al. reported the monsoon season as the period with the maximum fatal poisoning burden [9]. Seasonal variation may reflect agricultural cycles, pesticide availability, climatic conditions, work patterns and psychosocial stress. In the present study, season was not significantly associated with manner of poisoning (p=0.668).

Regarding time of poison intake, the maximum number of cases occurred during evening, followed by morning, night and afternoon. This differed from Dahiya et al., who reported night-time as the commonest period followed by evening [9], and from the J-SIMLA study, which also documented night-time as the most common period followed by morning [10]. These differences may relate to local routine, occupation and differing operational definitions of morning, evening and night.

With respect to time since death, the maximum number of cases had an interval of 12-24 hours, followed by less than 12 hours. This was closely comparable with the earlier J-SIMLA study from Haryana, in which 65% of cases were reported in the 12-24-hour interval, followed by 24% within 12 hours [10]. Such similarity may reflect comparable medico-legal procedures, transportation and referral logistics within Haryana.

When gender, age and residence were analysed against manner, suicidal poisoning predominated in both sexes, across most age groups and in both rural and urban populations, but none of these associations were statistically significant. These findings support broad population-level mental-health and suicide-prevention strategies rather than focusing on a single demographic category.

Year-wise, the maximum number of cases was recorded in 2025, followed by 2021 and 2023. The association between year and manner was not statistically significant (p=0.798). No clear linear increase or decrease was evident across the available calendar-year data. Interpretation of 2026 counts should take into account that cases were available only up to August. Singh et al. have similarly demonstrated that temporal context can influence patterns of unnatural mortality [17].

Celphos remained the dominant poison in every year of the study, and the association between year and type of poison was not statistically significant (p=0.198), indicating persistence of a broadly stable local toxicological pattern. The finding is notable because the 2020 Haryana J-SIMLA study also identified Celphos as the principal toxic agent, whereas Dahiya et al. reported organophosphorus compounds as the leading agents in a separate Haryana cohort [9][10]. This variation between neighbouring populations supports district-level toxicological surveillance.

Overall, fatal poisoning in Rewari was predominantly characterized by suicidal ingestion among males, rural residents and individuals in productive age groups, with aluminium phosphide as the principal toxic agent. The findings are broadly consistent with recent Indian literature regarding young-adult involvement and suicidal intent, while the exceptionally high proportion of Celphos distinguishes Rewari from several other regions where organophosphorus compounds, other pesticides, pharmaceuticals or corrosives predominate. The sustained burden of aluminium phosphide-related mortality supports stricter implementation of pesticide regulation, safer storage, early referral and strengthened mental-health and suicide-prevention services.

Conclusion

The present study demonstrated that fatal poisoning in Rewari, Haryana, predominantly affected males, rural residents and individuals in economically productive age groups. The maximum number of cases occurred in the 31-40-year group, followed by 21-30 years. Suicidal poisoning was the most common manner of death, while accidental poisoning constituted a smaller proportion and no homicidal case was recorded. Celphos was the overwhelmingly predominant poison and showed a significant association with manner of poisoning. Stress or mental pressure was the most commonly recorded reason for poison consumption. Summer recorded the highest seasonal burden, evening was the most common time of poison intake, and most cases had a time since death of 12-24 hours. The persistence of aluminium phosphide-related deaths highlights the need for stricter enforcement of existing restrictions on highly hazardous fumigants, safer storage practices, early recognition and referral, and strengthening of mental-health and suicide-prevention services, particularly in rural and agricultural communities.

Limitations of the Study

The retrospective design made the study dependent on the completeness and accuracy of available medico-legal records, post-mortem reports, police inquest papers and related documents. Some variables, particularly the exact reason for poison consumption, occupation, time of intake and circumstantial details, were not uniformly documented.

The study was conducted at a single centre in Rewari; therefore, the findings may not be directly generalizable to other districts or regions with different socioeconomic, agricultural and toxicological profiles. Only fatal poisoning cases subjected to medico-legal autopsy were included, and non-fatal cases or patients who recovered following treatment were not represented.

Toxicological confirmation and quantitative poison levels were not uniformly available for every case, and several poison subgroups contained very small numbers, limiting the strength of some statistical comparisons. Exact or Monte Carlo methods were therefore used for sparse contingency tables.

The 2026 dataset was incomplete for the full calendar year and contained cases only up to August. Consequently, year-wise comparisons involving 2026 should be interpreted as partial-year observations rather than a complete annual burden.

Declarations

Ethics Approval and Consent to Participate

Administrative permission was obtained from the Principal Medical Officer, Civil Hospital, Rewari, Haryana, to access and analyse medico-legal records. As the study was retrospective and involved deceased individuals, individual consent was not required. Confidentiality and anonymity were maintained throughout the study.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request and subject to institutional approval.

Conflict of Interest

The authors declare no conflict of interest.

Funding

None

Acknowledgements

None

Authors' Contribution Statement

All authors have read and agreed to the published version of the manuscript:

Conceptualization: Dr. Naveen Yadav, Dr. Sunil Kumar Dahiya; Methodology: Dr. Jitender Kumar Jakhar, Dr. Naveen Yadav; Validation: Dr. Smriti Chawla, Dr Naveen Yadav; Formal Analysis: Dr. Sunil Kumar Dahiya, Dr. Dr D. N. Bharadwaj; Investigation: Dr Naveen Yadav; Resources: Dr Naveen Yadav; Data Curation: Dr. Naveen Yadav; Dr. Smriti Chawla; Writing (Original Draft): Dr. Sunil Kumar Dahiya; Dr. DN Bharadwaj; Writing (Review and Editing): Dr Smriti Chawla, Dr. Sunil Kumar Dahiya.