Characteristics Of Decedents Research Articles

Examining mortality among formerly homeless adults enrolled in Housing First: An observational study.

BackgroundAdults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older.MethodsThis observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process.ResultsThe majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72 % died from natural causes, compared to 49 % from the homeless group. This included 21 % of HF participants and 7 % from the homeless group who died from cancer. Among homeless adults, 40 % died from an accident, which was significantly more than the 14 % of HF participants who died from an accident. HIV or other infectious diseases contributed to 13 % of homeless deaths compared to only 2 % of HF participants. Hypothermia contributed to 6 % of homeless deaths, which was not a cause of death for HF participants.ConclusionsResults suggest HF participants face excess mortality in comparison to members of the general population and that mortality rates among HF participants are higher than among those reported among members of the general homeless population in prior studies. However, findings also suggest that causes of death may differ between HF participants and their homeless counterparts. Specifically, chronic diseases appear to be more prominent causes of death among HF participants, indicating the potential need for integrating medical support and end-of-life care in HF.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2552-1) contains supplementary material, which is available to authorized users.

A method for reclassifying cause of death in cases categorized as "event of undetermined intent".

BackgroundWe present a method for reclassifying external causes of death categorized as “event of undetermined intent” (EUIs) into non-transport accidents, suicides, or homicides. In nations like Russia and the UK the absolute number of EUIs is large, the EUI death rate is high, or EUIs comprise a non-trivial proportion of all deaths due to external causes. Overuse of this category may result in (1) substantially underestimating the mortality rate of deaths due to specific external causes and (2) threats to the validity of studies of the patterns and causes of external deaths and of evaluations of the impact of interventions meant to reduce them.MethodsWe employ available characteristics about the deceased and the event to estimate the most likely cause of death using multinomial logistic regression. We use the set of known non-transport accidents, suicides, and homicides to calculate an mlogit-based linear score and an estimated classification probability (ECP). This ECP is applied to EUIs, with varying levels of minimal classification probability. We also present an optional second step that employs a population-level adjustment to reclassify deaths that remain undetermined (the proportion of which varies based on the minimal classification probability). We illustrate our method by applying it to Russia. Between 2000 and 2011, 521,000 Russian deaths (15 % percent of all deaths from external causes) were categorized as EUIs. We used data from anonymized micro-data on the ~3 million deaths from external causes. Our reclassification model used 10 decedent and event characteristics from the computerized death records.ResultsResults show that during this period about 14 % of non-transport accidents, 13 % of suicides, and 33 % of homicides were officially categorized as EUIs. Our findings also suggest that 2011 levels of non-transport accidents and suicides would have been about 24 % higher and of homicide about 82 % higher than that reported by official vital statistics data.ConclusionsOveruse of the external cause of death classification “event of undetermined intent” may indicate questionable quality of mortality data on external causes of death. This can have wide-ranging implications for families, medical professionals, the justice system, researchers, and policymakers. With our classification probability set as equal to or higher than 0.75, we were able to reclassify about two-thirds of EUI deaths in our sample. Our optional additional step allowed us to redistribute the remaining unclassified EUIs. Our method can be applied to data from any nation or sub-national population in which the EUI category is employed.

Structural Violence and Migrant Deaths in Southern Arizona: Data from the Pima County Office of the Medical Examiner, 1990–2013

This article analyzes numeric trends and demographic characteristics of undocumented border crossers (UBCs) who have perished in southern Arizona between 1990 and 2013 in the area covered by the Pima County Office of the Medical Examiner (PCOME) in Tucson, Arizona. Of 2,413 UBC decedents investigated during this period, 95 percent died after 1999 and 65 percent after 2005. The rate of UBC deaths in the Tucson Border Patrol Sector has been consistently high, with an average of nearly 163 deaths investigated per year between 1999 and 2013. The increase in border enforcement during the mid-to-late 1990s, which led to a shifting of unauthorized migration flows into more desolate areas, coincided with an increase in migrant remains investigated by the PCOME. Despite a decrease in the number of unauthorized crossers traversing the area as measured by the number of Border Patrol apprehensions in the Tucson Sector, the number of remains examined for every 100,000 apprehensions nearly doubled between 2009 and 2011. These findings suggest that migrants are being forced to travel for longer periods of time through remote areas in an attempt to avoid detection by US authorities, thus increasing the probability of death. The typical UBC decedent can be described as a male near the age of 30 from central or southern Mexico who perished in a remote area of southern Arizona after attempting to cross into the United States. Nevertheless, the share of non-Mexican UBCs in the region has increased notably over time. The findings show other important differences in UBC decedent characteristics across time periods, which speak to the dynamic nature of unauthorized migration as a social process. The authors contend that these deaths and demographic changes are the result of structural and political transformations over the past two decades. They argue that the tragic, yet mostly preventable, migrant deaths in southern Arizona constitute a form of structural violence.

Characteristics of Suicide Decedents Receiving Mental Health Treatment Prior to Suicide: United States, 2005-2010

Background Suicide is one of the most serious adverse outcomes of mental ill-health, and more than one million people globally die by suicide each year. Mental health treatment helps reduce suicidal behavior, but data from the United States and Europe indicate that suicide decedents often receive mental health treatment prior to suicide, suggesting that providers may have opportunities to improve suicide prevention efforts. This study is among the first large-scale studies using U.S. data …

Transfer of residents to hospital prior to cardiac death: the influence of nursing home quality and ownership type

ObjectivesWe hypothesised that among nursing home decedents, nursing home for-profit status and poor quality-of-care ratings, as well as patient characteristics, would lower the likelihood of transfer to hospital prior to...

Redistribution of heart failure as the cause of death: the Atherosclerosis Risk in Communities Study

BackgroundHeart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined.MethodsWe used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55 years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records.ResultsAfter redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P < 0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study.ConclusionsRedistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends.

Surgery at the End of Life

BACKGROUND More than a quarter of medical costs for Medicare beneficiaries are incurred in the last year of life; surgical intensity during this time is significant. This study was performed to determine types of operations patients undergo in their terminal year, and compare characteristics of decedents with those of survivors. METHODS Population of 747 consecutive all-payer patients seen at the preoperative assessment center of a tertiary care hospital. Patient characteristics were obtained from the electronic medical record. Surgical indication (palliative, curative, diagnostic, elective) was assessed based on procedure performed and underlying diagnosis. Vital status was determined using the electronic medical record with confirmation via social security national death master file. Descriptive statistics were performed to compare patient characteristics and procedures performed on those who died within 1 yr of procedure with those of survivors. RESULTS Thirty-seven patients (5%) were confirmed dead at 1 yr. Ten (27%) of these had palliative procedures, 11 (30%) diagnostic, 14 (38%) curative, and 2 (5%) elective. Decedents were more likely to have undergone a palliative (27 vs. 3%) or diagnostic (30 vs. 14%) procedure and less likely to have undergone an elective procedure (5 vs. 42%) than survivors (P < 0.0001). Nearly half of decedents did not have an advanced directive by the date of surgical intervention. CONCLUSIONS Nearly 1 in 20 patients seen at the preoperative assessment clinic of a tertiary care hospital died within 1 yr of their procedure. Patient characteristics and procedure indication for decedents differed from those of survivors. Similar analyses based on institution and region may provide methodologies to compare variation in surgical intensity and assist preoperative care providers in evaluating appropriateness of resource allocation.

Beyond suicide: action needed to improve self-injury mortality accounting.

Beyond suicide: action needed to improve self-injury mortality accounting.

Suicides in Urban and Rural Counties in the United States, 2006–2008

Suicide rates are higher in rural areas. It has been hypothesized that inadequate access to care may play a role, but studies examining individual decedent characteristics are lacking. We sought to characterize the demographic, socioeconomic, and mental health features of individual suicide decedents by urban-rural residence status. We analyzed suicides in 16 states using 2006-2008 data from the National Violent Death Reporting System and examined associations between decedent residence type and suicide variables with separate logistic regressions adjusted for age, sex, race, and ethnicity. Of 17,504 analyzed suicides, 78% were in urban, 15% in rural adjacent, and 8% in rural nonadjacent locations. Rural decedents were less likely than urban decedents to have a mental health diagnosis or mental health care, although the prevalence of depressed moods appeared similar. Most suicides were by firearm, and rural decedents were more likely than urban decedents to have used a firearm. Rural decedents were less likely to be receiving mental health care and more likely to use firearms to commit suicide. A better understanding of geographic patterns of suicide may aid prevention efforts.

Structural Violence and Migrant Deaths in Southern Arizona: Data from the Pima County Office of the Medical Examiner, 1990-2013

This article analyzes numeric trends and demographic characteristics of undocumented border crossers (UBCs) who have perished in southern Arizona between 1990 and 2013 in the area covered by the Pima County Office of the Medical Examiner (PCOME) in Tucson, Arizona. Of 2,413 UBC decedents investigated during this period, 95 percent died after 1999 and 65 percent after 2005. The rate of UBC deaths in the Tucson Border Patrol Sector has been consistently high, with an average of nearly 163 deaths investigated per year between 1999 and 2013. The increase in border enforcement during the mid-to-late 1990s, which led to a shifting of unauthorized migration flows into more desolate areas, coincided with an increase in migrant remains investigated by the PCOME. Despite a decrease in the number of unauthorized crossers traversing the area as measured by the number of Border Patrol apprehensions in the Tucson Sector, the number of remains examined for every 100,000 apprehensions nearly doubled between 2009 and 2011. These findings suggest that migrants are being forced to travel for longer periods of time through remote areas in an attempt to avoid detection by US authorities, thus increasing the probability of death.The typical UBC decedent can be described as a male near the age of 30 from central or southern Mexico who perished in a remote area of southern Arizona after attempting to cross into the United States. Nevertheless, the share of non-Mexican UBCs in the region has increased notably over time. The findings show other important differences in UBC decedent characteristics across time periods, which speak to the dynamic nature of unauthorized migration as a social process. The authors contend that these deaths and demographic changes are the result of structural and political transformations over the past two decades. They argue that the tragic, yet mostly preventable, migrant deaths in southern Arizona constitute a form of structural violence.

Surgery at the End of Life

More than a quarter of medical costs for Medicare beneficiaries are incurred in the last year of life; surgical intensity during this time is significant. This study was performed to determine types of operations patients undergo in their terminal year, and compare characteristics of decedents with those of survivors. Population of 747 consecutive all-payer patients seen at the preoperative assessment center of a tertiary care hospital. Patient characteristics were obtained from the electronic medical record. Surgical indication (palliative, curative, diagnostic, elective) was assessed based on procedure performed and underlying diagnosis. Vital status was determined using the electronic medical record with confirmation via social security national death master file. Descriptive statistics were performed to compare patient characteristics and procedures performed on those who died within 1 yr of procedure with those of survivors. Thirty-seven patients (5%) were confirmed dead at 1 yr. Ten (27%) of these had palliative procedures, 11 (30%) diagnostic, 14 (38%) curative, and 2 (5%) elective. Decedents were more likely to have undergone a palliative (27 vs. 3%) or diagnostic (30 vs. 14%) procedure and less likely to have undergone an elective procedure (5 vs. 42%) than survivors (P < 0.0001). Nearly half of decedents did not have an advanced directive by the date of surgical intervention. Nearly 1 in 20 patients seen at the preoperative assessment clinic of a tertiary care hospital died within 1 yr of their procedure. Patient characteristics and procedure indication for decedents differed from those of survivors. Similar analyses based on institution and region may provide methodologies to compare variation in surgical intensity and assist preoperative care providers in evaluating appropriateness of resource allocation.

Causes of death and characteristics of decedents with viral hepatitis, United States, 2010.

Previous research indicates that the mortality burden from viral hepatitis is growing, particularly among middle-aged persons. To monitor progress toward prevention goals, it is important to continue to document characteristics and comortalities of these deaths. This study sought to examine demographic characteristics and the most frequent causes of death among decedents with a viral hepatitis-related death. A cross-sectional study was performed on approximately 2.4 million death records from 2010. We calculated mortality rates for decedents with and without hepatitis A, B, and C virus (HAV, HBV, and HCV) and relative risks for the most frequently cited conditions in decedents with and without HBV and HCV. In 2010, there were 18 473 (0.7%) deaths with HAV, HBV, and HCV listed among causes of death, disproportionately in those aged 45-64 years. Among the 10 frequent causes of death, decedents listing HBV or HCV died, on average, 22-23 years earlier than decedents not listing these infections. HBV- and HCV-infected decedents aged 45-64 years had an increased risk of having the following conditions reported than decedents without these infections: cancer of liver and intrahepatic bile duct; fibrosis, cirrhosis, and other liver diseases; alcohol-related liver disease; gastrointestinal hemorrhage; human immunodeficiency infection; acute and unspecified renal failure; and septicemia (HCV only). Decedents with other causes of death that include HBV or HCV died 22-23 years earlier than decedents not listing these infections. These data suggest and support the need for prevention, early identification, and treatment of HBV and HCV.

Using multiple cause-of-death data to improve surveillance of drug-related mortality.

Many states and local areas are affected by the national epidemic of drug-related mortality, which recently has shown signs of a rising "licit-to-illicit drug" death ratio. Appropriate local public health surveillance can help monitor and control this epidemic. Using our state as an example, we sought to illustrate how to describe the changes in drug death rates, causes, and circumstances. In contrast to most other surveillance reports, our approach includes both drug-induced and drug-related deaths as well as both demographic and socioeconomic characteristics of decedents. Cross-sectional study. All residents of the state of Wisconsin. Decedents from 1999 to 2008. Annual numbers and population-based rates of deaths due to drugs, including both identified and unidentified drugs. Information was obtained from death certificates with any of approximately 270 underlying, immediate, or contributing cause-of-death codes from the International Classification of Diseases, 10th Revision. Drug-related death rates increased during much of the 10-year study period, and the male-to-female death ratio rose. The median age at death from drug-related causes was 43 years. Opioid analgesic poisoning surpassed cocaine and heroin poisoning as the most frequent type of fatal drug poisoning. Of all 4828 deaths from drug-related causes--virtually all of which were certified by a county medical examiner or coroner--3410 (71%) were unintentional and 1053 (22%) were suicides. The unintentional-to-suicide death rate ratio grew from 1.6 to 3.5 during the study period. Methadone-related deaths increased from 10 in 1999 to 118 in 2008 (1080%), while benzodiazepine-related deaths rose from 23 to 106 (361%). Although premature deaths from drug use and abuse continue to rise, even surpassing deaths due to motor vehicle crash in some states, "multiple causes of death" information from death certificates is available to monitor their occurrence and nature and to inform selection of prevention strategies.

Changing the focus of suicide research in China from rural to urban communities.

Changing the focus of suicide research in China from rural to urban communities.

Ned Kelly tattoos – Origins and forensic implications

Tattoos depicting Ned Kelly, a 19th-century Australian bushranger (outlaw) are occasionally encountered in the contemporary Australian population at forensic autopsy. To determine the characteristics of decedents with such tattoos, twenty cases were identified in the autopsy files at Forensic Science SA. All of the decedents were white males (100%) with an age range of 20–67yrs (average 37yrs). Seventeen of the deaths (85%) were unnatural, due to suicide in eight cases (40%), accidents in seven cases (35%) and homicide in two cases (10%). Compared to the general autopsy population suicides and homicides were 2.7 and 7.7 times higher, respectively, than would be expected, with a striking male predominance. A Ned Kelly tattoo identified at autopsy in another country or in a disaster victim identification situation may suggest that the decedent was Australian or had a connection with that country. Although the population studied is highly selected, individuals with these tattoos had an above average incidence of traumatic deaths.

Increasing deaths involving oxycodone, Victoria, Australia, 2000–09

ObjectiveIn light of an emerging epidemic identified in the United States and Canada, to identify trends in fatal drug toxicity involving oxycodone and the demographic characteristics and indicators of socioeconomic...

Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?

BackgroundSuicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non-Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites.MethodsThis cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide.ResultsBlacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84-0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active."ConclusionsData disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.

Characteristics of adult male and female firearm suicide decedents: findings from the National Violent Death Reporting System

Objective:To examine the risk factors and precipitating circumstances associated with firearm suicide.Methods:Data from the restricted National Violent Death Reporting System (2003–6) for 25 491 male and female suicide decedents aged...

Multiple Imputation of the Supplementary Homicide Reports, 1976–2005

The Supplementary Homicide Reports (SHR), assembled by the Federal Bureau of Investigation (FBI), have for many years represented the most valuable source of information on the patterns and trends in murder and non-negligent manslaughter. Despite their widespread use by researchers and policy makers alike, these data are not completely without their limitations, the most important of which involves missing or incomplete incident reports. In this analysis, we develop methods for addressing missing data in the 1976–2005 SHR cumulative file, related to both non-reports (unit missingness) and incomplete reports (item missingness). For incomplete case data (that is, missing characteristics on victims, offenders or incidents), we implement a multiple imputation (MI) approach based on a log-linear model for incomplete multivariate categorical data. Then, to adjust for unit missingness, we adopt a weighting scheme linked to FBI annual estimates of homicide counts by state and National Center for Health Statistics mortality data on decedent characteristics in coroners’ reports for deaths classified as homicide. The result is a fully-imputed SHR database for 1976–2005. This paper examines the effects of MI and case weighting on victim/offender/incident characteristics, including standard errors of parameter estimates resulting from imputation uncertainty.

Characteristics of Black and White Suicide Decedents in Fulton County, Georgia, 1988–2002

We compared the prevalence of risk factors for Black and White suicide decedents in Fulton County, Georgia, from 1988-2002. We used data from the Fulton County Medical Examiner's Office to compile information on suicides that occurred in Fulton County between 1988 and 2002. We used the chi(2) test and logistic regression to identify associations between suicide risk factors and race. Black suicide decedents were more likely than White suicide decedents to be male (odds ratio [OR]=2.06; 95% confidence interval [CI]=1.38, 3.09), to be younger, (>or=24 y [OR = 4.74; 95% CI = 2.88, 7.81]; 25-34 y [OR = 2.79; 95% CI = 1.74, 4.47]; 35-44 y [OR = 1.86; 95% CI = 1.13, 3.07]), and to hurt others in a suicide (OR = 4.22; 95% CI = 1.60, 11.15) but less likely to report depression (OR=0.63; 95% CI=0.48, 0.83), to have a family history of suicide (OR=0.08; 95% CI=0.01, 0.61), or to leave a suicide note (OR=0.37; 95% CI=0.26, 0.52). Future research should consider that Black suicide decedents are less likely to report depression than White suicide decedents. This suicide risk difference is important when developing effective suicide prevention programs.