Cause Of Death Statistics Research Articles

Regional deprivation and suicide mortality in Germany

Abstract Background Regional deprivation has been shown to be an important determinant of suicide risk. However, little is known about regional differences in suicide mortality in Germany. Methods Data from cause of death statistics (2015 to 2021) were analyzed. Regression analysis for data with negative binomial distribution was used to examine the association between the German Index of Multiple Deprivation 2015, covering 401 districts and district-free cities in Germany, and suicide mortality. Results The adjusted rate ratio for suicide in the most deprived deprivation area compared to the least deprived area was 1.18 (95% CI [1.72, 2.00]). A sensitivity analysis shows similar rate ratios for men (1.99 (95% CI [1.80, 2.18])) and women (1.69 (95% CI [1.49, 1.92])), but a higher rate ratio for rural areas (2.29 (95% CI [2.04, 2.57])) compared with urban areas (1.51 (95% CI [1.36, 1.68])). Conclusions The findings suggest that regional deprivation is associated with suicide mortality, and call for a more targeted approach to suicide prevention in deprived regions. Key messages • Study reveals higher suicide rates in deprived regions in Germany. • Study calls for tailored prevention strategies to address this disparity.

Mortality from prostate cancer in the years 2007–2021 in North Rhine-Westphalia, Germany

BackgroundThe crude mortality rate and the lifetime mortality risk from prostate cancer in Germany are above international average. However age-standardised mortality and years of life lost per capita from prostate cancer are declining. This study analyses the mortality-related measures for the federal state of North Rhine-Westphalia (NRW) in Germany.MethodsBased on the cause of death statistics and data from the NRW State Cancer Registry on 45,300 deaths in the years 2007–2021, mortality rates, the lifetime mortality risk from prostate cancer, median age at death and years of life lost are presented. Additionally, the 15 most frequent causes of death of 95,013 patients diagnosed with prostate cancer are reported.ResultsWith a stable lifetime mortality risk from prostate cancer, age-standardised mortality and years of life lost per capita are decreasing while crude mortality and median age at death are increasing in NRW. Less than half of the patients die from their prostate cancer. Cancers of the urinary bladder and other urinary organs also occur more frequently as a cause of death than it would be expected based on the age-specific risk in the total population.ConclusionsMore people in North Rhine-Westphalia are dying of prostate cancer over time due to demographic ageing alone. At the same time, the age-specific mortality risk has not increased and when patients die of prostate cancer, it is at an increasingly older age. However, there is a statistical association with deaths from cancers of the lower urinary tract in patients diagnosed with prostate cancer, which demands further evaluation.

The emergence of bromazolam in Jefferson County, AL: a case series.

Postmortem toxicology is an ever-changing landscape presenting challenges for toxicologists and medical examiners. Trends can vary for certain benzodiazepines. While diazepam use tends to remain constant, alprazolam and clonazepam ebb and flow depending on prescription trends and street popularity. Novel benzodiazepines like etizolam vary in casework depending on legal restrictions and black market availability. In May 2022, the first case of the designer benzodiazepine, bromazolam, was detected in Jefferson County Coroner/Medical Examiner's Office casework. Between then and December 2023, an additional nine cases have been observed. Bromazolam is the brominated analog of the low-dose benzodiazepine, alprazolam, and is likely similar in potency. As bromazolam is a potent benzodiazepine, low concentrations of this novel drug are likely to contribute to central nervous system depression in opioid overdose cases. We present 10 cases in which bromazolam was detected in postmortem samples at the University of Alabama at Birmingham toxicology laboratory. The decedents ranged in age from 20 to 41 years. Most of the decedents were White (n = 8; 80%) and male (n = 7; 70%). Bromazolam concentrations ranged from 21 to 3220 ng/mL (mean 401 ng/mL). All but one case were polydrug, and all deaths were related to drug toxicity. Fentanyl was detected in 8 of the 10 decedents, with concentrations ranging from <2.5 to 97 ng/mL (mean 30 ng/mL). Additional drugs detected were methamphetamine, ethanol, oxycodone, methadone, cocaine, amphetamine, morphine, and diphenhydramine. While all manners of death were ruled as accidental, bromazolam was included in the cause of death statements in 9 of the 10 cases. Capturing important emerging drug trends in the death certificate is critical to help inform public health and medical colleagues for preventive measures and treatment in the continued drug epidemic.

Comparison of fatalities due to COVID-19 and other nonexternal causes during the first five pandemic waves

BackgroundOlder age is a risk factor for a fatal course of SARS-CoV‑2 infection, possibly due to comorbidities whose exact role in this context, however, is not yet well understood. In this paper, the characteristics and comorbidities of persons who had died of COVID-19 in Bavaria by July 2022 are shown and compared with the characteristics of other fatalities during the pandemic.MethodsBased on data from multiple cause of death statistics, odds ratios for dying from COVID-19 (compared to dying from other nonexternal causes of death) were calculated by using logistic regression models, stratified by age, sex, and pandemic waves.ResultsIn Bavaria, a total of 24,479 persons (6.5% of all deaths) officially died from COVID-19 between March 2020 and July 2022. In addition to increasing age and male sex, preexisting diseases and comorbidities such as obesity, degenerative diseases of the nervous system, dementia, renal insufficiency, chronic lower respiratory diseases, and diabetes mellitus were significantly associated with COVID-19–related deaths. Dementia was mainly associated with increased COVID-19 mortality during the first and second waves, while obesity was strongly associated during the fourth wave.DiscussionThe frequency of specific comorbidities in COVID-19 deaths varied over the course of the pandemic. This suggests that wave-specific results also need to be interpreted against the background of circulating virus variants, changing immunisation levels, and nonpharmaceutical interventions in place at the time.

Treatment of Acute Coronary Syndromes

Despite significant advances in the detection and rapid management of acute coronary syndromes (ACS), it continues to lead the cause of death statistics and they continuously represent the leading cause of death and living with disabilities, globally. Since ACS combine a spectrum of different diagnoses, a high degree of variability in possible clinical presentation and relevant gender differences, Individualised treatment is not always easy and is constantly changing due to novel evidence from research studies. Therefore, the aim of this article is therefore to explain relevant treatment options and to present the current state of science in the context of clinical patient treatment.

Territorial gaps on quality of causes of death statistics over the last forty years in Spain

BackgroundThe quality of the statistics on causes of death (CoD) does not present consolidated indicators in literature further than the coding group of ill-defined conditions of the International Classification of Diseases. Our objective was to assess the territorial quality of CoD by reliability of the official mortality statistics in Spain over the years 1980–2019.MethodsA descriptive epidemiological design of four decades (1980-, 1990-, 2000-, and 2010–2019) by region (18) and sex was implemented. The CoD cases, age-adjusted rates and ratios (to all-cause) were assigned by reliability to unspecific and ill-defined quality categories. The regional mortality rates were contrasted to the Spanish median by decade and sex by the Comparative Mortality Ratio (CMR) in a Bayesian perspective. Statistical significance was considered when the CMR did not contain the value 1 in the 95% credible intervals.ResultsUnspecific, ill-defined, and all-cause rates by region and sex decreased over 1980–2019, although they scored higher in men than in women. The ratio of ill-defined CoD decreased in both sexes over these decades, but was still prominent in 4 regions. CMR of ill-defined CoD in both sexes exceeded the Spanish median in 3 regions in all decades. In the last decade, women’s CMR significantly exceeded in 5 regions for ill-defined and in 6 regions for unspecific CoD, while men’s CMR exceeded in 4 and 2 of the 18 regions, respectively on quality categories.ConclusionsThe quality of mortality statistics of causes of death has increased over the 40 years in Spain in both sexes. Quality gaps still remain mostly in Southern regions. Authorities involved might consider to take action and upgrading regional and national death statistics, and developing a systematic medical post-grade training on death certification.

Evaluation of early skin cancer detection in Germany with cancer registry data - challenges, solutions and current trends.

The evidence for the benefit of the skin cancer screening introduced in Germany in 2008 is weak. We investigate to what extent data from the German epidemiological cancer registries are suitable to contribute to the evaluation of skin cancer screening and report these evaluation results. Skin cancer-related cancer registry data from 1999-2019 were described in terms of completeness and comprehensiveness. Regional pools with data of different validity were defined, missing data were multiply imputed where appropriate, and temporal trends were analyzed. In addition, data from the cause of death statistics were used. Reliable estimates of completeness are only available for malignant melanoma (ICD-10: C43). Based on a regional data pool covering approximately 21% of the German population, melanoma-related incidence can be validly described since 2005. Sufficient information for multiple imputation is available for T-stage and localization. The trend analyses show incidence changes that can be expected in the short term in the temporal context of the introduction of early detection, which changes into a long-lasting high incidence. The rate of advanced stages does not decrease significantly. From 2014 onwards, the melanoma mortality rate, which had been rising until then, decreases. Adequately selected and processed cancer registry data are suitable for population-based evaluation of skin cancer screening. An explanation of the persistently high incidence level is not possible based on the cancer registry data. Overdiagnosis or an increase in the background incidence can be considered. The benefit of skin cancer screening remains open.

Information on Death Certificates: Comparison Between Inpatient and Outpatient Sectors

The death of a person and the circumstances of death are documented on the death certificate in Germany. The path of the corpse to burial as well as the quality of the cause of death statistics are significantly influenced by the information in the official death certificate. The quality of the information in the death certificates has been repeatedly criticized. The aim of the present study was to identify typical sources of error in death certificates and to obtain information on whether qualitative differences exist between death certificates completed in the outpatient and inpatient sectors. A retrospective evaluation was performed of 218 death certificates of deaths examined by the Institute of Legal Medicine as part of a second postmortem examination prior to cremation. Of these, 118 death certificates were issued in the hospital and 100 death certificates were issued on an outpatient basis by the family physician or a physician on duty in the outpatient sector. All but one of the death certificates issued on an outpatient basis were legible. The information on the underlying disease was plausible. More than one-third of the epicrises had no significant findings or were not completed at all. The entry on the immediate causes of death in the designated field on the death certificate (Ia in the causal chain) were inadequate in one third of the cases. The error rate in the entries was higher in outpatient than in inpatient deaths. In the future, therefore, it will be necessary to prepare for the special situation of a post-mortem examination by means of further and advanced training events and to convey the importance of the diagnoses determined in the process, in order to eliminate these avoidable sources of error.

An investigation of the coronial jurisdictions of Australia for the relationship between the cause of death provided on a post-mortem examination report and the corresponding coronial finding when the cause of death was determined, indeterminate and undetermined

ABSTRACT This study investigated the relationship between the cause of death stated on a post-mortem (medical) examination report and the subsequent cause of death given in a finding by a legal or judicial coroner (non-medical). A review of causes of death provided by forensic pathologists in their reports found the majority of cases (89%) were given in the traditional death certificate format, but were transformed to a sentence format in just over two thirds of coronial findings (68.5%). There was no evidence that converting the format of the cause of death statements caused a delay in finalizing the case. Of note, the post-mortem examination report provided an indefinite cause of death in 3.8% of cases and around a quarter (25.3%) of these were converted to a definite cause of death in the coronial finding (for example, by removing the word ‘probable’). Where the post-mortem examination did not determine a cause of death (5.2% of cases), most remained undetermined in the coronial finding. It is suggested that pathologists could work with coroners to ensure the cause of death provided on post-mortem examination reports are in the preferred style for their jurisdiction.

ICD-Based Cause of Death Statistics Fail to Provide Reliable Data for Medical Aid in Dying.

Objectives: To evaluate the most recent developments of medical aid in dying (MAID) in Switzerland and to test the reliability of reporting this phenomenon in cause of death statistics. Methods: By reviewing the MAID cases between 2018 and 2020, we compared the diseases and conditions underlying MAID reported by the ICD-based statistics provided by the Swiss Federal Statistical Office (FSO, n = 3,623) and those provided by the largest right-to-die organization EXIT (n = 2,680). Results: EXIT reported the motivations underlying the desire for death in a mixture of disease-specific and symptom-oriented categories; the latter including, for example, multimorbidity (26% of cases), and chronic pain (8%). Symptom-oriented categories were not included in the ICD-based FSO statistics. This led to the fact that the distribution of the diseases/conditions underlying MAID differed in 30%-40% of cases between both statistics. Conclusion: In order to reliably follow developments and trends in MAID, the diseases/conditions underlying the wish to die must be accurately recorded. Current methods of data collection using the ICD classification do not capture this information thoroughly ("MAID gap"). Newly created ICD codes for MAID must include both disease-specific and symptom-oriented categories.

Cause of death certificates in nursing homes: Does quality matter? A retrospective review from two counties in Norway.

One half of Norwegians die in nursing homes, where death certificates (DCs) are completed by two types of physicians: in-house physicians or physicians on call. The aims of this study were to examine differences in the quality of DCs due to type of physician and to uncover possible implications of errors for the public statistics. DCs from the year 2013 from nursing homes in the catchment area of Akershus University Hospital were examined with regard to logical deficiencies, garbage code diagnoses and type of certifying physician. In one third of cases, the registered causes of death were compared to information in the medical records. A total of 873 DCs from 24 nursing homes were evaluated. Physicians on call certified 46% of all deaths. Logical deficiencies were found in 34% of all DCs and were more common in DCs from physicians on call. Garbage code diagnoses were used in every third DC, with 'sudden death' or 'cause of death unknown' preferred by physicians on call and 'unspecified pneumonia' preferred by in-house physicians. Comparisons against medical records uncovered missing information in 49% and 35% of DCs from physicians on call and in-house physicians, respectively. A dementia diagnosis was frequently overlooked by both physician types. Garbage code diagnoses were more common in DCs with missing information from medical records. Error rates in DCs in nursing homes in Norway are high. The results raise concerns about the validity of public cause of death statistics.

Transformers for cardiac patient mortality risk prediction from heterogeneous electronic health records

With over 17 million annual deaths, cardiovascular diseases (CVDs) dominate the cause of death statistics. CVDs can deteriorate the quality of life drastically and even cause sudden death, all the while inducing massive healthcare costs. This work studied state-of-the-art deep learning techniques to predict increased risk of death in CVD patients, building on the electronic health records (EHR) of over 23,000 cardiac patients. Taking into account the usefulness of the prediction for chronic disease patients, a prediction period of six months was selected. Two major transformer models that rely on learning bidirectional dependencies in sequential data, BERT and XLNet, were trained and compared. To our knowledge, the presented work is the first to apply XLNet on EHR data to predict mortality. The patient histories were formulated as time series consisting of varying types of clinical events, thus enabling the model to learn increasingly complex temporal dependencies. BERT and XLNet achieved an average area under the receiver operating characteristic curve (AUC) of 75.5% and 76.0%, respectively. XLNet surpassed BERT in recall by 9.8%, suggesting that it captures more positive cases than BERT, which is the main focus of recent research on EHRs and transformers.

The Rising Incidence of Early-Onset Colorectal Cancer.

The incidence of early-onset (diagnosis before age 50) colorectal cancer (EOCRC) is increasing in some high-income countries. In this study, we examined the trends in EO-CRC incidence in Germany. We obtained data on CRC (ICD-10 C18-C20) incidence from the Centre for Cancer Registry Data (excluding cases reported via death certificate only) and on mortality from the official cause of death statistics for 1999-2018 from registries with sufficient incidence coverage. To assess time trends for persons aged 20-49 we calculated the average annual percent changes (AAPC) and corresponding 95% confidence intervals (95% CI). The incidence analyses were stratified by sex, site (proximal colon, distal colon, rectum), age group (20-29, 30-39, and 40-49) and tumor size (T). EO-CRC accounted for 5.1% (9529 cases) of all colorectal cancers in the selected German regions. The EO-CRC incidence rose annually by 1.16% (95% CI: [0.51; 1.81]) in men and 1.32% [0.80; 1.84] in women. The incidence of proximal colon cancer increased in both sexes (men: AAPC = 3.26 [2.00; 4.53]; women: AAPC = 2.99 [2.17; 3.83]), while the incidence of distal colon cancer remained unchanged. The incidence of EO-CRC in Germany is rising. The reasons are probably multifactorial, reflecting the changing prevalence of early life exposure to risk and protective factors.

Assessing the design of road traffic death information systems in Iran: A participatory systems approach

AimTo describe and analyze the information architecture and information pathways of the road traffic death recording, registration and reporting system in Guilan Province, northernIran. MethodsWe used Business Process Mapping, a qualitative approach. This participatory and iterative approach consists of a document review, key informant interviews, development of a process map and a participatory workshop with key stakeholders to illuminate and validate the findings. We classified the tasks performed in the system into three phases: (1) Identification and recording; (2) Notification and registration, and (3) Production of statistics. ResultsWe identified 13 stakeholders, with operating and influencing roles in the process of identification, registration and production of statistics about road traffic deaths in Guilan province. The three main sources of road traffic death statistics are the Ministry of Health and Medical Education, the National Organization for Civil Registration and the Forensic Medicine Organization. Our results reveal a highly fragmented system with minimal cross-sectoral data exchange. Each stakeholder operates in a silo resulting in delays and redundancies in the operating system. In the absence of an effective communication among stakeholders, the information exchange was dependent on the family of the deceased. These fragmented information silos alter the compilation of cause of death statistics and result in under-reporting and discrepancies in road traffic deaths figures. ConclusionsDesigning a comprehensive road traffic information system that provides accurate and timely information requires an understanding of the information flow and the entangled web of different stakeholders operating in the system. Participatory systems approaches such as process mapping can assist in capturing the complexity of the system and the integration process by facilitating stakeholders’ engagement and ownership in improving the design of the system.

Trends in suicide methods in Switzerland from 1969 to 2018: an observational study

Suicide is a serious societal and health problem. We examined changes in rates of completed suicides in Switzerland between 1969-2018 with particular regard to different methods of suicide used in different subgroups of the resident population. We used data of the Swiss cause of death statistics and Poisson regression models to analyse annual incidence rates and calendar time trends of specific suicide methods used in population subgroups by sex (men vs women), age (10-29, 30-64, >64 years), and nationality (Swiss vs other citizenship). There were 64,996 registered suicides between 1969 and 2018. Across these 5 decades, the overall suicide rate was higher in men than in women (incidence rate ratio [IRR] 2.62, 95% confidence interval [CI] 2.58-2.67), in Swiss citizens than in foreigners (IRR 2.02; 95% CI 1.97-2.07), and in older residents (>64 years) than in the age groups 30-64 years (IRR 1.35, 95% CI 1.32-1.37) and 10-29 years (IRR 2.37, 95% CI 2.32-2.43). After peaking in the 1980s, the overall suicide rate had declined in all of these population subgroups, with flattening trends over most recent years. The most common specific methods of suicide were hanging (accounting for 26.7% of all suicides) and firearms (23.6%). The rates of the specific suicide methods were usually higher in men, in Swiss citizens and in older residents, and they had typically declined over most recent decades in the population subgroups examined. However, some methods diverged from this general pattern, at least in some population subgroups. For instance, railway suicides most recently increased in younger and in male residents whereas suicides by gas and by drowning were only at a low level after rapid declines in the last millennium. Restricting access to lethal means (e.g., detoxification of domestic gas), improvements in health care and media guidelines for responsible reporting of suicides are possible explanations for the generally declining suicide rates in Switzerland. Whereas some methods (e.g., poisoning by gases or drowning) had become rare, others continue to account for many suicides every year, at least in some population subgroups (e.g., firearms in older Swiss men or railway suicides in younger and in male residents). As different methods of suicide are chosen by different people or subgroups of the population, preventive efforts should include differentiated strategies and targeted measures to further reduce suicides in Switzerland and elsewhere.

The Burden of Disease in Germany at the National and Regional Level.

.Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates. DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers. In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region. The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy.

Evaluation of the quality of cause of death statistics of the last decades in the European Union

Abstract Introduction The European Union (EU) do not publish the quality of cause-of-death statistics, when is possible to assess quality by reliability. Quality does not present consolidated indicators. Ill-defined and other inaccurate causes have presented different groupings. Objective To assess the quality of official cause-of-death statistics of the European Union by member states from 2006 to 2020. Methods Cases and population were from the WHO repertory. We selected causes in EU27 countries by up to fourth code-character of ICD10 -on the EuroStat website were not available-. Case counts were grouped into ill- defined, unspecific, less specific (the latter two, in inaccurate), and judicial (inaccurate external causes) categories, based on literature and expertise. We calculated age-adjusted rates to the Standard European Population by country, sex, period (2006-, 2011- and 2016-2020), and quality category. We tested the Comparative Mortality Ratio (CMR) of each country to the European Union median by a Bayesian approach, at 5% statistical significance. We plotted the rates proportion of each quality category in its all causes. Results We included 25 countries. Some did not report all years. Six countries showed &amp;gt;19% for ill-defined causes and 3 member states had &amp;lt;5% in both sex and last period. In inaccurate, for the same time period and sex, average pointed 10% with a range of 3-19%. In the same period, CMR exceeded significantly the EU median in 19 and 18 countries for women and men, respectively; and exceeded in unspecific causes in 12 countries for women and men. Discussion Literature showed that incorrect causes of death were random distributed. Probably major causes were biased and underestimated. Conclusions Quality of cause of death is a useful indicator of mortality statistics reliability. Quality indicators targeted national gaps across EU. We need a new EU task force on statistics of causes of death in accordance with the XXI century. Key messages • Quality indicators of causes of death statistics targeted national gaps across the European Union. • The statistics of death causes underestimated the main causes of death in the European Union.

Analysis of High-risk Areas by Typology of Causes of Death

The health disparities among regions are more severe and complex than before, even though, little approach to objective and practical evidence for locally-tailored policy making. In this context, this study aims to develop and use a typology of regions, figure out high-risk areas for each cause of death, and explore the characteristics of high-risk areas. To do so, we collected raw data on the cause of death statistics from the National Statistical Office in 2018, 2019, and 2020 and used a statistics program SAS. We made a typology of the cause of death was classified into 'illness', 'maternal deaths', 'accidental deaths', 'suicides' reference to previous research and government policies. The result for grouping of high risk areas in terms of illness death types, the metropolitan area and other regions showed a large proportion, and suicide death types mainly included urban areas.&#x0D; These findings were suggested that it is necessary to examine the proportion of each death type by region, to discover vulnerabilities in each region in a horizontal dimension, and to discuss support tailored to each policy demand through relevant policy support.

Mortality of Suicide and Cerebro-Cardiovascular Diseases by Occupation in Korea, 1997-2020.

Although studies on occupational mortality have been conducted in Korea, the results for occupations with high mortality around 2010 are inconsistent. This study aimed to examine occupational mortality from overwork-related suicide and cerebro-cardiovascular diseases (CCVD) from 1997 to 2020. We used microdata of the Causes of Death Statistics (CDS) and Economically Active Population Survey (EAPS) to obtain indirect standardized mortality ratio (SMR) and standardized proportional mortality ratio (PMR) of suicide (X60–X84) and CCVD deaths (I20–I25 and I60–I69) by gender and eight occupational categories. The trend of SMR of suicide and CCVD by occupation was similar within individual genders. The SMR of managers (MNG) was the highest for men and women in 2012–2017 and 2008–2020, respectively, whereas the SMR of professionals and related workers (PRF) was consistently low. Despite the similar socioeconomic status of MNG and PRF, we suggest that their mortality should be analyzed separately in Korea. SMR of suicide and CCVD in female MNG were consistently highest, although the PMR was low. Female MNG may have been more directly affected by the economic crisis. There is a need for work-related stress management, early intervention, and prevention policies in occupations vulnerable to mortality.

What are the effects of different places of death of old people?

HintergrundEine unzureichende Qualität der ärztlichen Leichenschau wird seit vielen Jahren in der rechtsmedizinischen Fachliteratur diskutiert. Es ist bekannt, dass bei älteren Verstorbenen im Vergleich zu jüngeren seltener eine nichtnatürliche Todesart attestiert wird und seltener Obduktionen durchgeführt werden.MethodeEs wurden die Todesbescheinigungen aller Sterbefälle analysiert, die in München im Sterbezeitraum vom 01.01.2013 bis zum 31.12.2014 mit einem Alter ≥ 75 Jahre verstarben. Es erfolgte eine standardisierte, anonymisierte Dateneingabe. Die erhobenen Daten wurden deskriptiv ausgewertet.ErgebnisseIm Untersuchungszeitraum verstarben insgesamt 26.303 Personen. Von diesen Sterbefällen waren 16.146 (60,7 %) ≥ 75 Jahre. Häufigste Sterbeorte der Betagten waren Krankenhaus (56,1 %), Privatadresse (21,8 %) und Altenheim (20,0 %). Eine natürliche Todesart wurde bei 88,5 %, eine ungeklärte bei 8,8 % und eine nichtnatürliche bei 2,7 % angegeben. Häufigste unmittelbare Todesursachen waren Krankheiten des Kreislaufsystems (23,5 %), ungenau bezeichnete bzw. unbekannte Todesursachen (20,0 %) und Krankheiten des Atmungssystems (16,3 %). Obduziert wurden 4,9 %, weit überwiegend gerichtlich. Die untersuchten Parameter zeigten bei den sterbeortabhängigen Analysen große Unterschiede.DiskussionDiese Untersuchung zeigt erneut erhebliche Qualitätsmängel bei der Ausfertigung von Todesbescheinigungen. Deren Qualität konnte in den letzten Jahren trotz des dualen Ansatzes der Münchner Gesundheitsbehörde (Kontrolle, Schulung) nicht nachhaltig verbessert werden. Todesarten und -ursachen zeigen teils erhebliche Unterschiede in Abhängigkeit von Sterbeort und leichenschauendem Arzt. Die festgestellten Defizite der unter der Rubrik „Todesursachen“ gemachten Angaben dürften auch auf die Todesursachenstatistik negative Auswirkungen haben.