Death Certificates

To determine the causes of death and risk factors in systemic sclerosis (SSc). Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was develop...

We used capture-recapture methodology to estimate total deaths and efficiency of reporting for 2 systems. During 1987-1992, there were 165 measles-associated deaths in the multiple-cause mortality database at the National Center for Health Statistics (NCHS) and 184 reported to the measles surveillance system at the National Immunization Program (NIP). We estimated that 259 measles deaths actually occurred; the reporting efficiencies were 64% for the NCHS and 71% for the NIP. Overall the death-to-case ratio was 2.54 and 2.83 deaths/1000 reported cases, using the NCHS and NIP data, respectively. Pneumonia was a complication among 67% of measles-related deaths in the NCHS data and 86% of deaths in the NIP data. Encephalitis was reported in 11% of deaths in both databases. Preexisting conditions related to immune deficiency were reported for 16% of deaths in the NCHS system and 14% in the NIP; the most common was human immunodeficiency virus infection. Overall, 90% of deaths reported to the NIP occurred in persons who had not been vaccinated against measles. During 1993-1999, only 1 acute measles-related death was reported to the NCHS and no deaths were reported to the NIP. This is consistent with the extremely low reported incidence of measles in the United States during these years.

Objectives: The objective of this study was to examine variation in place of death of older people dying from dementia in countries across 4 continents. Design: Study of death certificate data. Methods: We included deaths of older (65 þ years) people whose underlying cause of death was a dementia-related disease (ICD-10: F01,

Suspect classification of homicide deaths of Connecticut residents under 20 years of age was noted for 29 percent of cases examined. Misclassification was attributed to incomplete or erroneous information recorded on the death certificates, rather than errors in the designation of ICD-9 homicide codes. The results have important implications in the interpretation of vital statistics when homicide is listed as the cause of death and underscore the value of record linkage systems.

Introduction: Death certification is largely random and fragmented in most developing countries. Objective: This study is done to evaluate errors in medical & non-medical part and to determine causes of errors of cause of death. Material and Method: Two hundred and twenty death certificates were randomly selected that have been issued from November 2013 to April 2014 for the deceased who were admitted in Services Hospital, Lahore. A predetermined error grading scale was used to assess the accuracy and completeness of selected death certificates. Causes of errors were analyzed and confirmed after detailed scrutiny of the medical section of death certificates. Data was statistically analyzed using SPSS version 20. Results: Four percent of death certificates were incompletely written.7% had no errors. The most frequent errors included Grade I errors involving patients' demographics seen in 93% death certificates of which occupation was incorrect in 79.6% certificates. Grade IV and Grade V errors regarding cause/s of death were seen in 184(84%) and 128 (58%) certificates. Speculated causes of the errors of cause of death (99%) were lack of training and diagnostic incompetency. Conclusion: Errors in the completion of the death certificates are very common. Training for the doctors on induction to improve accuracy of death certificate is recommended during internship and at postgraduate level.

Objectives: We have compared mortality and risk factors for late deaths in patients with tetralogy of Fallot undergoing surgical repair in 1972 and 1982 in a Japanese multicentric study, examining in particular the impact of time of repair. Background: There is limited information on the effect that time of repair, and our constantly changing approach to it, has on late outcome in repaired tetralogy of Fallot. Methods: We analysed the Japanese registry of deaths occurring after surgical repair of tetralogy of Fallot. We studied two postoperative 1-year cohorts of survivors of surgery performed in 12 centers. Of the patients, 122, aged 29 6 12 years, had undergone repair in 1972, their age at repair being 9.6 years. An additional 186 patients, aged 23 6 8.7 years, had been repaired in 1982 at the age of 7.7 years. Results: Annual mortality, as judged per 100,000 population of patients with tetralogy of Fallot, declined from 0.387 in 1972 to 0.196 in 1982. Significant differences were deaths following surgery (27% vs. 13%, p , 0.001), patching of the subpulmonary outflow tract (48% vs. 89%, p , 0.001), and transjunctional patching (13% vs. 63%, p , 0.001). Late death was observed in 6 vs. 3 patients (9/308, 2.9%). The actuarial rate of survival calculated over 14 years was 97% vs. 98%. Reoperation was performed in 5 vs. 9 patients (14/308, 4.5%). Risk factors for late death were age at repair (p 5 0.01), and history of reoperation (p , 0.001). Transjunctional patching (p 5 0.01) proved to be associated with late mortality only in patients repaired in 1972. Conclusions: Late survival was excellent, with a low incidence of reoperations in both groups of patients. The era of repair has a big influence on total and operative mortality, but has only a small impact on late mortality. Ongoing analysis of follow-up will possibly reveal subsequent changes with time.

To determine the causes of death and risk factors in systemic sclerosis (SSc). Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was develop...

Objectives: To examine whether inequalities in mortality across socioeconomically diverse neighbourhoods changed alongside the decline in mortality observed in New York City between 1990 and 2000. Design: Cross-sectional analysis of neighbourhood-level vital statistics.

Climate change is increasing the frequency and severity of extreme heat events. These events affect cities in increasingly abrupt and catastrophic ways; yet, many of the deaths caused by exposure to heat have gone unnoticed or are inaccurately identified, resulting in a lack of urgency in addressing this issue. We aim to address this under-identification of deaths from heat waves in order to better assess heat risk. We investigated death records in New York City from 2010 to 2012 to identify characteristics that vary between deaths officially categorized as caused by heat wave exposure (oHDs) and those possibly caused by heat (pHDs). We found that oHDs were more often black and of a younger age than would typically be expected. We also found that there was a lack of evidence to substantiate that an oHD had occurred, using the NYC official criteria. We conclude that deaths from heat waves are not being accurately recorded, leading to a mis-estimation. Training regarding the collection and interpretation of evidence may improve preparedness for heat events.

Death during childhood is a rare event in Western societies. The factors that keep children healthy, and the reasons why some children die, are now well researched and understood (Goldman 1999). Unlike adults, whose deaths are more likely to occur in institutional settings , the majority of 'planned' childhood deaths will happen at home, usually following a long illness. A number also occur away from home in hospitals or children's hospices. This paper reports on the findings of a short survey that explored the numbers of families who took their child home with them after death, from a representative 24

5 Galve E, Ordi J, Barquiner4 heart disease in the primar syndrome. Ann Int Med 19 6 Kalashnikova LA, Nasonov I et al. Sneddon's syndrome; and antiphospholipid ant Rheumatol 1991;9:357-61. 7 Zelger B, Sepp N, Schmid F tory of cutaneous vas Sneddon's syndrome. Hu 668-75. e est la nature des ndrome des anti- rerne (in press). Pigrau C, et al. types, and evolulisease in systemic Engl JMed 1988;

Aim-Many deaths fall in the "grey" area between those that are clearly natural and those that are unnatural. There are no guidelines to help doctors in dealing with such cases and death certification is often arbitrary and inconsistent. In an attempt to initiate debate on these diYcult areas, and with the ultimate aim of achieving national consensus, the views of coroners in England and Wales were sought. Methods-Sixteen clinical scenarios, with causes of death, were circulated to all coroners in England and Wales. For each case they were asked to provide a verdict, with explanation. The deaths fell into three groups: (1) postoperative, (2) a combination of trauma and natural disease, and (3) infectious disease. Results-Sixty four questionnaires were returned. There was near consensus (> 80% concordance) in only two of the 16 cases. In five, there was no significant agreement between coroners in the verdicts returned ("natural causes" versus "misadventure/accidental"). These included all three cases in which death resulted from a combination of trauma and natural disease (a fall after a grand mal fit; falls resulting in fractures of bones aVected by metastatic carcinoma and osteoporosis), bronchopneumonia after hip replacement for osteoarthritis, and new variant Creutzfeldt-Jakob disease. The comments made for each case indicate that the variation between coroners in whether or not to hold an inquest, and the verdict arrived at, reflect the lack of a definition for natural causes, together with diVerences in the personal attitudes of each coroner. Conclusions-There is considerable variation in the way in which coroners approach these borderline cases, many of which are common in clinical practice. This study indicates a need for discussion, working towards a national consensus on such issues. It highlights the importance of good communication between coroners and medical staV at a local level.

To examine the factors used by Coroners to distinguish between suicide and accidental death among young men in Merseyside and Cheshire. Design -Retrospective epidemiological survey of deaths due to external causes. Data sources included Coroner's Inquest, GP and hospital data. Logistic regression was carried out to determine the multiple effect of individual factors on defining Coroner's verdict. Setting -Merseyside and Cheshire, United Kingdom. Males aged 15-39 years who died from unnatural causes during 1995 in Merseyside and Cheshire. Main outcome measure Coroner's verdict. An active mode of death was by far the strongest predictor of a suicide as opposed to an accident verdict. Other significant differentiating factors included expressed intent, behavioural change, deliberate self-harm and psychiatric contact. The validity of using method of death as a predictor of intent is questionable. Evidence left by drug users who kill themselves may differ from that left by nondrug users and may need to be sought in less conventional ways. There may be a discrepancy between those factors deemed important by health professionals as indicators of suicide, such as deliberate self-harm, and those given most weight by the Coroner. It may be more pragmatic, in terms of public health policy development, to challenge the concept that self-destructive behaviour can be categorized as being either intentional or unintentional. There is some evidence suggesting that deaths due to suicide and accidents both result from elements of self-destructive behaviour and therefore, the practice of categorizing deaths as either suicides or accidents could be misleading.

Background: On February 27, 2010 a powerful earthquake followed by a tsunami stroke Chile. The study of mortality during this emergency can provide important public health information. Aim: To describe the main characteristics of people who died during the earthquake and the following three months. Material and Methods: Cross sectional analysis of death records databases obtained from Department of Health Statistics and Information of the Ministry of Health and the Coroner offi ce. Results: Until May 25, 2010, 505 corpses were completely identifi ed. Seventy two of these corresponded to people aged 80 years or more. The higher age adjusted death rates per 100,000 inhabitants were observed among subjects aged more than 80 years and those aged 70 to 79 years (22.6 and 7.7 respectively). The higher rates of deaths were observed in regions where the earthquake had a higher intensity and coastal regions affected by the tsunami. The causes of death were trauma in 75% of cases and drowning in 25%. There was no association between the Mercalli scale of earthquake intensity and rates of death. Among deceased subjects, there was a concentration of unemployed, under educated and low socioeconomic status subjects. Conclusions: After the earthquake, the higher rates of deaths occurred among older people and in the region of the epicenter of the earthquake. Most deaths were due to trauma. (Rev Med Chile 2012; 140: 732-739).

Objectives-The purpose ofthis study is to describe and compare the distribution of injury deaths among rural and urban Colorado children that occurred between 1980-8. Method-Death certificates coded E800-E969 were obtained for children who were 0-14 years of age at death between 1980-8 and who were Colorado residents. Average annual rates were computed for rural and urban children, separately by gender. The 1980 census was used to compute rates. Rate ratios were calculated to summarize information related to specific external causes of deaths, contrasting rural and urban children. These differences were evaluated using Z tests. Results-Statistically significant elevated risks were found along rural children for motor vehicle injury deaths. Firearms were involved more often in rural deaths among unintentional injury deaths of children older than 4 years of age, and among homicide related deaths of children 5 years and younger. All rural children who committed suicide used a firearm. Conclusions-Comparisons between rural and urban injury deaths provide important information that can be used to guide prevention strategies. For example, in Colorado, a child restraint law, passed in 1984, covered children under 4 years of age or under 40 pounds. It was not until 1995, however, that legislation was passed requiring restraint of children 5-16 years of age. Traditionally, rural residents are slower to accept new ideas and to alter current practices than urban residents.

In Italy during the period 1968-78, female heart disease mortality decreased in all age groups up to age 79, with an average annual rate of decline in the 35-74 age-standardized rate of over 0.7 per cent. In males, age-specific death rates in some age groups were stable or increased moderately, but in middle-aged (50 to 59) males there was a consistent increase so that the rise in the 35-74 age standardized male death rate was approximately 1 per cent per year.

The aim of this analysis was to examine associations between lung health in childhood and mortality between ages 18 and 44 years in the Tasmanian Longitudinal Health Study (TAHS). The 1961 Tasmanian birth cohort who attended school in 1968 (n=8583) were linked to the Australian National Death Index (NDI) to identify deaths. Additional deaths were notified by families through a 37 year follow-up postal questionnaire. Information on lung health at age 7 years and on potential confounders was obtained from the original 1968 TAHS survey and school medical records. Cox proportional hazards modelling was used to assess determinants of mortality. A total of 264 (3%) deaths were identified. The principal causes of death were external injury (56.1%, n=97) and cancer (17.9%, n=31). Males were more likely than females to have died (p=<0.1). Only two (1.1%) participants had died from respiratory conditions. Having an FEV(1)<80% predicted at 7 years of age was associated with a 2-fold incr...

This report presents the results of an evaluation study of the validity of race and Hispanic origin reporting on death certificates in the United States and its impact on race- and Hispanic origin-specific mortality estimates. The National Longitudinal Mortality Study (NLMS) was used to evaluate death certificate classification of race and Hispanic origin by comparing death certificate with survey race-ethnicity classifications for a sample of decedents identified in NLMS. NLMS consists of a series of annual Current Population Survey files (1973 and 1978-1998) linked to death certificates for years 1979-1998. To identify and measure the effect of race-ethnicity misclassification on death certificates on mortality estimates, pooled 1999-2001 vital statistics mortality data and population data from the 2000 census were used to estimate and compare observed and corrected (for death certificate misclassification) race-ethnicity specific death rates. Race and ethnicity reporting on the d...

Objectives-This report analyzes education reporting and classification on the death certificate and their effect on estimates of mortality and life expectancy by education level in the United States. Methods-The National Longitudinal Mortality Study (NLMS) was used to analyze education information on the death certificate for participants in the Current Population Survey (CPS) from 1992 through 1998 who died by the end of 1998. Educational attainment reported on the death certificate for these persons was compared to their educational attainment reported in the CPS. NLMS wasalsousedtocalculate classification ratios consisting of the number of deaths by education level in the CPS compared to the number of deaths by education level on the death certificate. These classification ratios were then used to produce estimates of life expectancy by education level for the United States in 2005, adjusted for probable education misreporting on the death certificate. Results-Comparison of educa...

Objectives. We estimated complete period life tables for the non-Hispanic American Indian and Alaska Native (AI/AN) population residing in Contract Health Service Delivery Area (CHSDA) counties for the period 2007–2009. Methods. We used National Vital Statistics System mortality data files for years 2007–2009 corrected for AI/AN misclassification on death certificates, midyear 2008 revised census bridged race intercensal population estimates, and National Vital Statistics System birth data for years 2006–2009. We used the same methodology as that used to estimate official US annual life tables, with some minor modifications. Results. For the period 2007–2009, the non-Hispanic AI/AN population in CHSDA counties had the lowest life expectancy at birth (71.1 years) of any racial/ethnic group for which official US life tables are estimated. By comparison, in 2008, life expectancy at birth was 73.9 years for the non-Hispanic Black population, 78.4 years for the non-Hispanic White populat...

Objectives. We tested the data artifact hypothesis regarding the Hispanic mortality advantage by investigating whether and to what degree this advantage is explained by Hispanic origin misclassification on US death certificates. Methods. We used the National Longitudinal Mortality Study, which links Current Population Survey records to death certificates for 1979 through 1998, to estimate the sensitivity, specificity, and net ascertainment of Hispanic ethnicity on death certificates compared with survey classifications. Using national vital statistics mortality data, we estimated Hispanic age-specific and age-adjusted death rates, which were uncorrected and corrected for death certificate misclassification, and produced death rate ratios comparing the Hispanic with the non-Hispanic White population. Results. Hispanic origin reporting on death certificates in the United States is reasonably good. The net ascertainment of Hispanic origin is just 5% higher on survey records than on dea...

OBJECTIVES: Rates and trends for chronic liver disease mortality in the United States were examined. METHODS: National Center for Health Statistics data on underlying cause of death for chronic liver disease for the United States from 1979 through 1989 were analyzed. Four groups of diseases and conditions included under the International Classification of Diseases, 9th Revision, code for chronic liver disease were assessed separately. RESULTS: From 1979 through 1989, there were 303,875 deaths from chronic liver disease; 48% were in the cirrhosis without alcohol group, 42% in the alcohol-related liver disease group, 8% in the liver disease without alcohol group, and 1.5% in the biliary cirrhosis group. Chronic liver disease death rates for Blacks were more than 1.5 times greater than those for Whites and for other races. Chronic liver disease mortality declined 22% overall among both sexes. The largest decreases were for liver disease without alcohol (42%) and cirrhosis without alcoh...

Background-Elevated levels of circulating liver enzymes have been associated with increased risk of cardiovascular disease. Their possible association with atrial fibrillation (AF) has received little attention. Methods-We studied 9333 men and women, age 53-75, free of AF participating in the Atherosclerosis Risk in Communities Study followed up from 1996 to 2010. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transpeptidase (GGT) were measured in stored plasma samples. Incident AF was ascertained from hospitalizations and death certificates. Associations between liver enzymes and AF incidence were assessed using multivariable Cox proportional hazards models. Results-During a mean follow-up of 12 years, 1021 incident AF events were identified. Levels of AST, and to a lesser extent of ALT, showed a U-shaped association with AF risk, with higher AF risk among individuals in the two extremes of the distribution in minimally adjusted models. The associations were weakened after adjustment for potential confounders. In contrast, GGT,

Depuis 1986, l'Office Fédéral de la Statis-(OFS) a suspendu la collecte, le traiteet les analyses' sur les lieux de décès les statistique sanitaires et démogra-ll>~liques en Suisse. Cette décision compromet les travaux de lieltheJ•che sur-les soins fournis aux personnes fin de vie. Afin de montrer l'utilité et l'intérêt de la lco,nncJissanc:e de cette variable, l'article exasa nature, ses typologies et fonctions les politiques sociales et de santé. Il dresse un état des lieux de la recherche cette variable au niveau international. et 1\!mltiol~al, en montre les limites et en indique les perspectives en termes de champs de recherche à couvrir et des actions à mener.

There are very few detailed reports on the cause of death in patients with Parkinson syndrome, and most reports lack postmortem verification. Pulmonary embolism has been reported as an infrequent terminal event. We reviewed the results of 60 complete autopsies performed on patients with Parkinson syndrome personally cared for at our institution. Pulmonary embolism was second only to pneumonia as the most common cause of death overall.

At the beginning of each month, there is a spike in government payments to individuals, resulting in a beginning-of-the-month spike in purchases of prescription drugs and in increased pharmacy workloads. Studies suggest that pharmacy error rates increase with increased workloads. These facts raise an important and previously unanswered question: is there a spike in fatal medication errors at the beginning of each month? We examined all United States death certificates from 1979-2000 (> 47,000,000 deaths) and showed that medication error deaths for which the decedent was dead on arrival or died in the emergency room or as an outpatient spiked by 25% above normal at the beginning of each month. This beginning-of-the-month spike (25% ± 4%) was larger than for any other major cause of death. The beginning-ofthe-month spike did not vary by socioeconomic status and was not larger for substance abusers than for others. Five explanations for the findings were tested. Evidence suggested that the spike in medication error deaths cannot be solely attributed to a spike in the consumption of alcohol or drugs. An increase in pharmacy error rates might play a role.

Background— Research published in Circulation has shown that cardiac mortality is highest during December and January. We investigated whether some of this spike could be ascribed to the Christmas/New Year’s holidays rather than to climatic factors. Methods and Results— We fitted a locally weighted polynomial regression line to daily mortality to estimate the number of deaths expected during the holiday period, using the null hypothesis that natural-cause mortality is unaffected by the Christmas/New Year’s holidays. We then compared the number of deaths expected during the holiday period, given the null hypothesis, with the number of deaths observed. For cardiac and noncardiac diseases, a spike in daily mortality occurs during the Christmas/New Year’s holiday period. This spike persists after adjusting for trends and seasons and is particularly large for individuals who are dead on arrival at a hospital, die in the emergency department, or die as outpatients. For this group during t...

Background and Purpose— Intracranial vascular malformations (IVMs) are an important cause of intracranial hemorrhage, epilepsy, and long-term disability in adults. There are no published prospective, population-based studies dedicated to the detection of any type of IVM (cavernous malformations, venous malformations, and arteriovenous malformations [AVMs] of the brain or dura). Therefore, we established the Scottish Intracranial Vascular Malformation Study (SIVMS) to monitor detection and long-term prognosis of people with IVMs. Methods— We used multiple overlapping sources of case ascertainment to identify adults (aged ≥16 years) with a first-ever-in-a-lifetime diagnosis of any type of IVM made between January 1, 1999, and December 31, 2000, while resident in Scotland (mid-1999 adult population estimate 4 110 956). Results— Of 418 notifications to SIVMS, 190 adults (45%) were included, 181 (95%) of whom were deemed to harbor a definite IVM after review of diagnostic brain imaging a...

Background and Purpose— The rarity of intracranial vascular malformations (IVMs) and the infrequency of their outcomes make large, prolonged cohort studies the best means to evaluate their frequency and prognosis. Methods— The Scottish Intracranial Vascular Malformation Study (SIVMS) is a prototype prospective, population-based study of adults resident in Scotland and diagnosed for the first time with an IVM after January 1, 1999. We evaluated the design of SIVMS using 2 complete years of data for adults with arteriovenous malformations (AVMs) of the brain. Results— A collaborative network of clinicians, radiologists, and pathologists, combined with coding of hospital discharge data and death certificates, recruited a cohort distributed in proportion to the Scottish population. Coding (with International Classification of Diseases, 10th Revision [ ICD-10 ] codes Q28.2 and I60.8) had a sensitivity of 72% (95% CI, 61% to 80%) and a positive predictive value of 46% (95% CI, 38% to 55%)...

The objective of this study is to use a new data set to compare the circumstances of fatal poisoning in deaths ruled as suicides to those ruled as unintentional, particularly with regard to the prevalence of mental health, substance abuse, and other risk factors. Design: The design is an analysis of all fatal poisonings using data from the New Jersey Violent Death Reporting System. Patients or subjects: Decedents in New Jersey in 2003 whose cause of death was fatal poisoning, and whose manner of death was unintentional, intentional, or undetermined. Main outcome measures: The relation between risk factors, circumstances of death, and coded manner of death, particularly for those with both mental health and substance abuse related risk factors. Results: The prevalence of mental health risk factors was considerably higher among intentional poisonings (59.4% v 24.4%, p,0.0001), while that of substance abuse was higher among unintentional poisonings (90.0% v 24.5%, p,0.0001). Approximately 20% of unintentional poisonings and 25% of suicides had a physical health problem. Differences in circumstances by manner were smaller among those with a physical health problem. Conclusions: Substance abuse, mental health, and physical health problems were the most frequently cited risk factors for unintentional and intentional poisoning fatalities. There were many differences in characteristics and risk factors by manner of death. Those with physical health problems were more similar in terms of demographic characteristics and presence of other risk factors.

Objective: To examine predictors of death in young offenders who have received a custodial sentence using data routinely collected by juvenile justice services. Design: A retrospective cohort of 2849 (2625 male) 11-20-year-olds receiving their first custodial sentence between 1 January 1988 and 31 December 1999 was identified. Main outcome measures: Deaths, date and primary cause of death ascertained from study commencement to 1 March 2003 by data-matching with the National Death Index; measures comprising year of and age at admission, sex, offence profile, any drug offence, multiple admissions and ethnic and Indigenous status, obtained from departmental records. Results: The overall mortality rate was 7.2 deaths per 1000 person-years of observation. Younger admission age (hazard ratio [HR], 1.4; 95% CI, 1.0-1.9), repeat admissions (HR, 1.8; 95% CI, 1.1-2.9) and drug offences (HR, 1.5; 95% CI, 1.0-2.1) predicted early death. The role of ethnicity/Aboriginality could only be assessed in cohort entrants from 1996 to 1999. The Asian subcohort showed higher risk of death from drug-related causes (HR, 2.5; 95% CI, 1.1-5.5), more drug offences (relative risk ratio [RRR], 13; 95% CI, 8.5-20.0) and older admission age (oldest group v youngest: RRR, 9.3; 95% CI, 1.3-68.0) than non-Indigenous Australians. Although higher mortality was not identified in Indigenous Australians, this group was more likely to be admitted younger (oldest v youngest: RRR, 0.31; 95% CI, 0.15-0.63) and experience repeat admissions (RRR, 1.6; 95% CI, 1.0-2.4). Conclusions: Young offenders have a much higher death rate than other young Victorians. Early detention, multiple detentions and drug-related offences are indicators of high mortality risk. For these offenders, targeted healthcare while in custody and further mental healthcare and social support after release appear essential if we are to MJA 2004; 181: 473-477 reduce the mortality rate in this group.

Background-To support health research on the unique cohort of women with a history of military service, this study assessed the completeness of mortality ascertainment for Texas women veterans in Department of Veterans Affairs (VA) and non-VA databases. Methods-We examined female-veteran-specific mortality ascertainment comparing the VA Beneficiary Identification and Records Locator Subsystem Death File (BIRLS DF), VA Patient Treatment Files (PTF) and Social Security Administration-Death Master File (SSA-DMF) with Texas death certificate data. Databases were deterministically crosslinked using female sex and social security numbers. Deterministic and probabilistic linkage methods were also compared. Results-Of 6,297 decedents identified by death certificates, SSA-DMF, BIRLS DF, and PTF databases identified 97.5 percent collectively and 94 percent, 77 percent, and 5 percent individually. Compared with Texas death certificates, sensitivity of VA and SSA databases improved with increasing age. Conclusions-This study highlights that although the VA and SSA administrative databases have less complete ascertainment for younger decedents, combined these electronic databases provide nearly complete ascertainment for women veterans. Challenges related to large female-specific cross-linkage studies are explored and a need to examine methods for female-specific health research studies in the general population is identified.

Exsanguination from hemodialysis vascular sites may cause a rapid death. Due to extensive blood loss at the scene, investigators may initially suspect a homicide or suicide. We reviewed 100 deaths due to hemorrhage from hemodialysis shunt sites. The majority (81%) of these hemorrhages occurred at home and 44% subsequently died at home. Recognition of this medical complication at the scene is important to prevent the dispatch of the crime scene or homicide unit. In these instances, the common causes of kidney failure included hypertensive cardiovascular disease and diabetes mellitus. The manners of death were certified as therapeutic complication (93%), accident (5%), and suicide (2%). These fatal shunt hemorrhages are rapid and large due to their superficial subcutaneous locations and elevated shunt pressures from the arterial-venous anastamosis. The cause of death statement must include the proximate cause of death, which is usually the disease that resulted in kidney failure, if it is known.

We describe the methodology and impact of merging detailed statewide mortality data into the master patient index tables of the clinical data repository (CDR) of the University of Virginia Health System (UVAHS). We employ three broadly inclusive linkage passes (designed to result in large numbers of false positives) to match the patients in the CDR to those in the statewide files using the following criteria: a) Social Security Number; b) Patient Last Name and Birth Date; c) Patient Last Name and Patient First Name. The results from these initial matches are refined by calculation and assignment of a total score comprised of partial scores depending on the quality of matching between the various identifiers. In order to validate our scoring algorithm, we used those patients known to have died at UVAHS over the eight year period as an internal control. We conclude that we are able to update our CDR with 97% of the deaths from the state source using this scheme. We illustrate the pote...

In Germany, data on place of death is recorded from death certificates, but not further analyzed. Consequently, hardly any information is available at the population level regarding the distribution of place of death (e.g. home, hospital, palliative care unit, nursing home, hospice). We carried out a descriptive statistical analysis of the registered places of death in evaluated death certificates from selected areas of Westphalia-Lippe for the years 2001 and 2011. Factors affecting the place of death were determined with binary multivariate regression. We analyzed 24 009 death certificates (11 585 for 2001 and 12 424 for 2011). The distribution of places of death for the overall population was as follows (2001 vs. 2011): at home, 27.5% vs. 23.0% (p<0.001); in the hospital, 57.6% vs. 51.2% (p<0.001); on a palliative care unit, 0.0% vs. 1.0%, in a care or nursing home, 12.2% vs. 19.0% (p<0.001); in a hospice, 2.0% vs. 4.6% (p<0.001); elsewhere, 0.6% vs. 0.6% (p = 0.985); ...

We examined the risk of bacteremia in patients with liver cirrhosis (compared with the risk for all Danish citizens 120 years of age who were living in North Jutland County, Denmark), as well as the type of bacteremia and the 30-day case-fatality rate. We used the Danish National Registry of Patients to identify 1339 patients with liver cirrhosis, and we used the North Jutland County Bacteremia Database to identify episodes of bacteremia. We observed 117 cases of bacteremia in patients with liver cirrhosis (11.0 cases were expected), which yielded a standardized incidence ratio of 10.5 (95% confidence interval [CI], 8.8-12.7). Sixty-two cases of bacteremia were nosocomial infections. There were 53 cases of gram-positive bacteremia, 55 cases of gram-negative bacteremia, and 8 cases of polymicrobial bacteremia (1 case of candidemia was excluded from the analysis). The most common cause of death was bleeding from gastroesophageal varices; the second most common cause of death was infection in the respiratory system. The 30-day case-fatality rate was 0.53 (95% CI, 0.39-0.73). Patients with liver cirrhosis had an increased risk of bacteremia and a poor prognosis.

With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death. In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased's demographic characteristics, place of death, healthcare supply. i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in ...

Background: Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries. Methods: Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium,

CONTEXT AND OBJECTIVE: Mortality measurements are traditionally used as health indicators and are useful in describing a population's health situation through reporting injuries that lead to death. The aim here was to analyze the temporal trend of proportional mortality from ill-defined causes (IDCs) among the elderly in Brazil from 1979 to 2013. DESIGN AND SETTING: Ecological study using data from the Mortality Information System of the Brazilian Ministry of Health. METHODS: The proportional mortality from IDCs among the elderly was calculated for each year of the study series (1979 to 2013) in Brazil, and the data were disaggregated according to sex and to the five geographical regions and states. To analyze time trends, simple linear regression coefficients were calculated. RESULTS: During the study period, there were 2,646,194 deaths from IDCs among the elderly, with a decreasing trend (ß -0.545; confidence interval, CI: -0.616 to -0.475; P < 0.000) for both males and fem...

Background: On February 27, 2010 a powerful earthquake followed by a tsunami stroke Chile. The study of mortality during this emergency can provide important public health information. Aim: To describe the main characteristics of people who died during the earthquake and the following three months. Material and Methods: Cross sectional analysis of death records databases obtained from Department of Health Statistics and Information of the Ministry of Health and the Coroner offi ce. Results: Until May 25, 2010, 505 corpses were completely identifi ed. Seventy two of these corresponded to people aged 80 years or more. The higher age adjusted death rates per 100,000 inhabitants were observed among subjects aged more than 80 years and those aged 70 to 79 years (22.6 and 7.7 respectively). The higher rates of deaths were observed in regions where the earthquake had a higher intensity and coastal regions affected by the tsunami. The causes of death were trauma in 75% of cases and drowning in 25%. There was no association between the Mercalli scale of earthquake intensity and rates of death. Among deceased subjects, there was a concentration of unemployed, under educated and low socioeconomic status subjects. Conclusions: After the earthquake, the higher rates of deaths occurred among older people and in the region of the epicenter of the earthquake. Most deaths were due to trauma. (Rev Med Chile 2012; 140: 732-739).

Study objective: Syncope is a common condition that is usually benign but occasionally associated with death. This study evaluates the incidence of death after an emergency department (ED) visit for syncope and whether these deaths can be predicted. Methods: A prospective cohort study was conducted during a 45-month period. All patients were followed up 1-and-a-half years after their initial ED visit to determine whether they had died. Death certificates were independently reviewed by 2 physicians for the cause and date of death to determine whether the death was possibly related to the initial visit for syncope. Sensitivity and specificity of risk factors (defined by the San Francisco Syncope Rule) or age greater than 65 years was calculated for all-cause mortality and mortality thought possibly related to syncope. Results: There were 1418 consecutive patients with syncope during the study period, representing 1.2% of all ED visits. The all-cause death rate was 1.4% at 30 days, 4.3% at 6 months, and 7.6% at 1 year. It was believed that the death rates from causes possibly related to syncope were 2.3% and 3.8% at 6 months and 1 year. Of the 112 deaths at 1 year, 37% were cardiac related. At 6 months, the risk factors had a sensitivity of 89% (95% confidence interval [CI] 79% to 95%) and specificity of 53% (95% CI 52% to 53%) for all-cause mortality and sensitivity of 100% (95% CI 90% to 100%) and specificity 52% (95% CI 52% to 53%) for predicting deaths likely or possibly related to syncope. Age greater than 65 years had similar sensitivity but much worse specificity compared with the set combined risk factors. Deaths related to syncope after an ED visit are low, especially in the first 6 months and can usually be predicted by risk factors.

Aims: Assessment was made of the validity of mortality estimates based on data collected during 1999 - 2000 by quarterly follow-up visits and compared with other methods (re-census, communal death registration, and neighbourhood survey). Methods: This study was carried out within a longitudinal epidemiological laboratory in Bavi District, Vietnam (called FilaBavi), covering a sample of 11,089 households with 51,024 inhabitants. Deaths within FilaBavi during 1999 - 2000 were collected by four methods and compared: quarterly household follow-ups, the re-census carried out in 2001, the Commune Population Registration System (CPRS), and a neighbourhood survey. Results: Within these four methods, a total of 471 deaths were detected in the FilaBavi sample. Quarterly household follow-ups detected 470 deaths (99.8%). The re-census missed 19 deaths, of which eight were infants, and two-thirds of the missed deaths fell in 1999. The CPRS missed 89 cases (19%), the majority being infant and eld...