The Medium, not the Message: How Tattoos Correlate With Early Mortality

Henry J. Carson, MD


Am J Clin Pathol. 2014;142(1):99-103. 

In This Article

Abstract and Introduction


Objectives. At autopsy, tattoos are recorded as part of the external examination. An investigation was undertaken to determine whether negative messages that are tattooed on a decedent may indicate a predisposition to certain fatal outcomes.

Methods. Tattooed and nontattooed persons were classified by demography and forensics. Tattoos with negative or ominous messages were reviewed. Statistical comparisons were made.

Results. The mean age of death for tattooed persons was 39 years, compared with 53 years for nontattooed persons (P = .0001). There was a significant contribution of negative messages in tattoos associated with nonnatural death (P = .0088) but not with natural death. However, the presence of any tattoo was more significant than the content of the tattoo.

Conclusions. Persons with tattoos appear to die earlier than those without. There may be an epiphenomenon between having tattoos and risk-taking behavior such as drug or alcohol use. A negative tattoo may suggest a predisposition to violent death but is eclipsed by the presence of any tattoo.


Tattoos have been part of body art and expression in many cultures since antiquity.[1,2] The purposes of tattoos are as varied as the people who have them and may include such motives as personal expression, identification, military classification, gang affiliation, marking of prisoners, or memorializing personal history, among others.[1–3] The prevalence of tattoos is not certain, but estimates range from 6% to 24% in the United States.[1,4] Tattoos appear to be more prevalent in the teenage and young adult population than among people of the older decades,[1,3,5–7] although they are seen in all age groups. Until recently, there appears to have been a preference among men for obtaining tattoos,[7] but they have become widely accepted among women.

The circumstances under which people procure tattoos are varied, including ritual bonding,[7] expression of individuality, the influence of friends,[1] or no reason.[3,6] An association of wide-ranging risk-taking behavior has been observed among persons with tattoos, including drug abuse, risky sexual behavior, suicidal behavior risk, smoking, and truancy.[1,2,4,7] Eating disorders may also be risk factors among women with tattoos.[1]

While these associations are frequent, it is important to note that tattoos are not causally linked to these behaviors or risk factors.[1] Rather, these behaviors appear to be associations that may share underlying relationships with the person who has tattoos, but the tattoos per se do not cause a particular outcome.

Tattoos are recorded at autopsy as part of the external examination and can be useful for the identification of a decedent or may sometimes give an indication of a specific risk factor that could have been related to the cause of death, such as a gang affiliation in a violent death. This study investigated whether other associations exist between tattoos and cause or manner of death, particularly whether messages tattooed on a decedent might have connotations that may indicate a predisposition to types of fatal outcomes.