Circumstances Of Mortality Research Articles

Sex Differences in Violent Death During Incarceration and Legal Intervention

IntroductionThis study clarifies the differences in death during incarceration and legal intervention between males and females, delineating the differences in demographic features and the circumstances of the violent death including location, injury pattern, and perpetrator. MethodsThe data used are from the National Violent Death Reporting System database from 2003 to 2019. All victims were either in custody, in the process of custody, or in prison. Sex was coded as female or male and as assigned at birth. All analyses were conducted using SAS 9.4 software using chi-square tests, with an alpha of 0.05 to test significant differences in the circumstances of mortality and demographic characteristics for each group. ResultsOur findings show that suicide was the most common cause of death during incarceration for both females and males (89.8% versus 77.4%; P < 0.001). Homicide was less common in females (1.6% versus 14.8%; P < 0.001) and legal intervention only occurred in males (2.2%; P < 0.001). Male victims were more likely to be of non-White race/ethnicity compared to females, while females were more likely to be experiencing homelessness, have documented mental illness, and comorbid substance abuse. ConclusionsVictim sex is significantly associated with circumstances of violent death among the incarcerated and highlights the need for appropriate mental health and substance abuse treatment.

Mortality trends and access to care for cardiovascular diseases in Agincourt, rural South Africa: a mixed-methods analysis of verbal autopsy data

ObjectivesCardiovascular diseases are the second leading cause of mortality behind HIV/AIDS in South Africa. This study investigates cardiovascular disease mortality trends in rural South Africa over 20+ years and the...

Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa

BackgroundTime-critical conditions (TCC) are estimated to cause substantial mortality in low and middle-income countries. However, quantification of deaths and identification of contributing factors to those deaths are challenging in settings...

Moving from medical to health systems classifications of deaths: extending verbal autopsy to collect information on the circumstances of mortality.

BackgroundVerbal autopsy (VA) is a health surveillance technique used in low and middle-income countries to establish medical causes of death (CODs) for people who die outside hospitals and/or without registration. By virtue of the deaths it investigates, VA is also an opportunity to examine social exclusion from access to health systems. The aims were to develop a system to collect and interpret information on social and health systems determinants of deaths investigated in VA.MethodsA short set of questions on care pathways, circumstances and events at and around the time of death were developed and integrated into the WHO 2012 short form VA (SF-VA). Data were subsequently analysed from two census rounds in the Agincourt Health and Socio-Demographic Surveillance Site (HDSS), South Africa in 2012 and 2013 where the SF-VA had been applied. InterVA and descriptive analysis were used to calculate cause-specific mortality fractions (CSMFs), and to examine responses to the new indicators and whether and how they varied by medical CODs and age/sex sub-groups.ResultsOne thousand two hundred forty-nine deaths were recorded in the Agincourt HDSS censuses in 2012–13 of which 1,196 (96 %) had complete VA data. Infectious and non-communicable conditions accounted for the majority of deaths (47 % and 39 % respectively) with smaller proportions attributed to external, neonatal and maternal causes (5 %, 2 % and 1 % respectively). 5 % of deaths were of indeterminable cause. The new indicators revealed multiple problems with access to care at the time of death: 39 % of deaths did not call for help, 36 % found care unaffordable overall, and 33 % did not go to a facility. These problems were reported consistently across age and sex sub-groups. Acute conditions and younger age groups had fewer problems with overall costs but more with not calling for help or going to a facility. An illustrative health systems interpretation suggests extending and promoting existing provisions for transport and financial access in this setting.ConclusionsSupplementing VA with questions on the circumstances of mortality provides complementary information to CSMFs relevant for health planning. Further contextualisation of the method and results are underway with health systems stakeholders to develop the interpretation sequence as part of a health policy and systems research approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s41256-016-0002-y) contains supplementary material, which is available to authorized users.

The use of stable isotope ratio analysis to distinguish multiple prey kill events from mass kill events

Archaeologists working with prey animal bonebeds are interested in determining whether the animals were obtained through a single, mass kill event or instead accumulated over time from multiple hunting events. This is often difficult to determine. The author investigated the use of stable isotope ratio analysis to distinguish accumulations of individuals derived from multiple populations from mass kills of individuals from a single population. Carbon, oxygen and strontium stable isotope ratios were measured in tooth enamel from modern pronghorn ( Antilocapra americana) with known mortality circumstances. These ratios were then analyzed using basic statistical methods as well as a scaled distance technique that permits integrated analysis of multiple isotopes and multiple samples, and a bootstrap subsampling approach was used to quantify differences among populations. It appears that, in some circumstances, stable isotope analysis can contribute to distinguishing bonebeds originating as accumulations of individuals derived from multiple populations from mass kills of individuals from a single population. Three-element isotope ratio distance measures provide the best isotopic indicator of pronghorn bonebed population origins, especially when bootstrap subsampling is used to compare to sites of known pronghorn population composition.