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BACKGROUND: The aim was to investigate the differences in alcohol involvement in fatal injury events between females and males. METHODS: Information was obtained from the Forensic Medicine Database and the Forensic Toxicology Database of the National Board of Forensic Medicine, and from the inpatient register of the National Board of Health and Welfare. Alcohol was regarded to be involved in the injury event: if there was any indication that the deceased was a 'known alcoholic'; if the underlying or contributing causes of death were alcohol-related; if the deceased had alcohol-related inpatient diagnosis during a 3-year period prior to death; or if the deceased tested positive for blood alcohol at autopsy. All injured cases who underwent medico-legal autopsies (1992-1996) in Sweden were analysed (4471 females and 11 156 males). RESULTS: Compared to males, females died more often (P < 0.05) in intentional injury events (48.0% females, 44.2% males), were less often (P < 0.001) blood alcohol-positive (29% females, 43% males), had lower (P < 0.05) blood alcohol concentrations (0.17% in females, 0.18% in males), and were less likely (P < 0.001) to have an alcohol-related history (18.4% females, 24.4% males). For females, intentional deaths (31.4%) were significantly (P < 0.001) more often alcohol-related than unintentional deaths (22.9%). A significantly (P < 0.001) higher proportion of deaths in males (48.4%) were alcohol-related compared to females (32.9%). CONCLUSIONS: Almost every third injury event in females and in almost every other event in males is alcohol-related, showing that alcohol plays an important part in fatal injuries in females even though it is mostly a male problem.