Deaths In England Research Articles

Advance care planning in England: Is there an association with place of death? Secondary analysis of data from the National Survey of Bereaved People

ObjectivesTo explore whether advance care planning is associated with place of death in England, as well as with sufficiency of support to care for a dying person at home, overall...

MICROBES AND MARKETS: WAS THE BLACK DEATH AN ECONOMIC REVOLUTION?

Abstract:Recent papers have suggested that the Industrial Revolution in Europe ultimately derives from the labor scarce economy of northwest Europe, which some trace back to the Black Death [Voigtländer and Voth (2013a) and Allen (2011)]. This paper examines the effects of the Black Death in England. Specifically, did it merely change relative factor prices, or did it lead to lasting gains in the efficiency of the economy after 1348? Extensive wage and price data from England 1210–1800 suggest that the population losses of the Black Death were associated with a surprising increase in economic efficiency, despite the decline in the scale of the economy. But this efficiency gain disappeared when population rose again in the 16th century. There is no sign of a connection between a labor scarce economy, and a switch to faster long run economic growth through technological advance.

Cardiovascular disease and lipid-regulating drugs

Cardiovascular disease (CVD) accounts for approximately one-third of deaths in England and Wales, and its associated morbidity cost the NHS in England alone almost £8 million in 2010 (National Institute for Health and Care Excellence (NICE), 2014). Modifiable risk factors include hypertension, smoking and raised cholesterol level. The Joint Formulary Committee (2016) recommends the preventative use of lipid-regulating drugs where there is a high risk of developing CVD and to prevent recurrence in those with recognised CVD

Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?

Providing a palliative approach in an ICU is not an oxymoron and is within our reach today. Implementing a palliative approach will better ensure the needs of older patients and their families are met. Investing in developing the palliative care capabilities of ICUs and implementing appropriate policies that support the delivery of best evidence-based palliative care, will help ICU clinicians move seamlessly from implementing intensive therapies focusing on cure to palliation and relief of symptoms and care of families.

The timing of general population and patient suicide in England, 1997–2012

BackgroundThere have been conflicting findings on temporal variation in suicide risk and few have examined the phenomenon in clinical populations. The study investigated seasonal and other temporal patterns using national data. MethodsData on 73,591 general population and 19,318 patient suicide deaths in England between 1997 and 2012 were collected through the National Confidential Inquiry into Suicide examining suicide rates in relation to month of the year, day of the week, and individual days of national or religious significance. ResultsSuicide incidence fell over successive months of the year and there was evidence of an overall spring peak. Monday was associated with the highest suicide rates and in the patient population this effect appeared to be more pronounced in those aged over 50 or those who lived alone. Suicide risk was significantly lower during Christmas, particularly for women. There was a peak in suicide on New Year's Day in the general population. Other ‘special days’ were not associated with a change in suicide incidence. LimitationsWe were limited to identifying associations between the variables investigated and were unable to explore causal mechanisms. We did not carry out comprehensive multi-variable adjustment in our regression models. ConclusionsThere is substantial seasonal and temporal variation in suicide deaths, and there appears to be some evidence in the clinical as well as the general population in England. Clinical services should be aware of the risk of suicide just after the weekend, especially in people who live alone, and the potential need for closer supervision during this period.

Regionalisation of major trauma services in England: a post-implementation analysis

BackgroundThere is strong evidence that severely injured patients are optimally treated within inclusive trauma networks. One feature of such networks is prehospital triage of the most injured patients to designated trauma hospitals. In April, 2012, major trauma services across England were reconfigured into regional trauma networks based around designated major trauma centres (MTCs). This study explored the early effects of the regionalisation of major trauma services in England. MethodsThe Trauma & Audit Research Network (TARN) identified severely injured patients treated in the 9 months before and after each MTC became fully operational. Outcomes included quality indicators (eg, time to CT scanning for head injured patients) and clinical outcomes (eg, in-hospital mortality). Completeness of the TARN dataset was quantified with Hospital Episode Statistics. Death registrations were used to identify any change in the overall number of traumatic deaths in England. FindingsThe number of severely injured patients treated in MTCs increased from 7705 to 12 476. All care quality indicators improved: treatment by a consultant (30·4% before MTC vs 54·3 after MTC, p<0·0001), administration of tranexamic acid to bleeding patients (17·0% vs 58·5, p=0·006), and time to CT scanning for head injured patients (49·2 min vs 31·2, p<0·0001). Fewer patients required secondary transfer between hospitals (31·3% vs 25·9, p<0·0001) and a greater proportion were discharged with a Glasgow Outcome Scale of good recovery (52·4% vs 64·5, p<0·0001). There were no differences in either crude or adjusted mortality between the periods for all patients or for those with an Injury Severity Score of more than 15. The overall number of traumatic deaths in England did not change. InterpretationThere is early evidence of improved care associated with trauma service regionalisation, including some process measures, enhanced case reporting for national audit, and reduced need for secondary transfer of patients between hospitals. However, in this early post-implementation analysis, significant reductions in patient mortality were not observed. FundingRoyal College of Surgeons of England Fulbright Scholarship.

Gross negligence manslaughter and the healthcare professional

Jenny Vaughan looks at the escalating trend of criminal investigation into healthcare-related deaths in England and Wales and asks: did we see this coming?

Influenza-like illness, deaths and health care costs

British Journal of Healthcare ManagementVol. 21, No. 12 Money MattersInfluenza-like illness, deaths and health care costsRod JonesRod JonesSearch for more papers by this authorRod JonesPublished Online:14 Dec 2015https://doi.org/10.12968/bjhc.2015.21.12.587AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ellis J, Galiano M, Pebody R, et al. (2011) Virological analysis of fatal influenza cases in the United Kingdom during the early wave of influenza in winter 2010/11. Euro Surveil 16(1): Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19760 Google ScholarHealth Protection Agency (2010) Weekly national influenza report, 08 January 2010 (week 01). Available at: http://webarchive.nationalarchives.gov.uk/20140714084352/ http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1262704894811 Google ScholarJones R (2013) Analysing excess winter mortality: 2012/13. BJHCM 19(12): 601–5 Google ScholarJones R (2014a) Infectious-like Spread of an Agent Leading to Increased Medical Admissions and Deaths in Wigan (England), during 2011 and 2012. Brit J Med Res 4(28): 4723–41 Crossref, Google ScholarJones R (2014b) A study of an unexplained and large increase in respiratory deaths in England and Wales: is the pattern of diagnoses consistent with the potential involvement of cytomegalovirus? Brit J Med Medical Res 4(33): 5179–92 Crossref, Google ScholarJones R (2015a) A previously uncharacterized infectious-like event leading to spatial spread of deaths across England and Wales: Characteristics of the most recent event and a time series for past events. Brit J Med Medical Res 5(11): 1361–80 Crossref, Google ScholarJones R (2015b) Unexpected and Disruptive Changes in Admissions Associated with an Infectious-like Event Experienced at a Hospital in Berkshire, England around May of 2012. Brit J Med Medical Res 6(1): 56–76 Crossref, Google ScholarJones R (2015c) Recurring outbreaks of an infection apparently targeting immune function, and consequent unprecedented growth in medical admission and costs in the United Kingdom: A Review. Brit J Med Medical Res 6(8): 735–70 Crossref, Google ScholarJones R (2015d) Are emergency admissions contagious? BJHCM 21(5): 227–35 Google ScholarJones R (2015e) Unexpected increase in deaths from Alzheimer's, dementia and other neurological disorders in England and Wales during 2012 and 2013. J Neuroinfectious Dis 6: 172 Crossref, Google ScholarJones R (2015f) Small area spread and step-like changes in emergency medical admissions in response to an apparently new type of infectious event. Fractal Geometry and Nonlinear Analysis in Medicine and Biology 1(2): 42–54 Crossref, Google ScholarJones R (2016) Is cytomegalovirus involved in recurring periods of higher than expected death and medical admissions, occurring as clustered outbreaks in the northern and southern hemispheres? Brit J Med Medical Res 11(2): 1–31 Crossref, Google ScholarJones R, Goldeck D (2014) Unexpected and unexplained increase in death due to neurological disorders in 2012 in England and Wales: Is cytomegalovirus implicated? Medical Hypotheses 83(1): 25–31 Crossref, Google ScholarJones R, Beauchant S (2015) Spread of a new type of infectious condition across Berkshire in England between June 2011 and March 2013: Effect on medical emergency admissions. Brit J Med Medical Res 6(1): 126–48 Crossref, Google ScholarOffice for National Statistics (2015) Excess Winter Mortality in England and Wales 2014/15. Available at: www.ons.gov.uk/ons/rel/subnational-health2/excess-winter-mortality-in-england-and-wales/2014-15--provisional--and-2013-14--final-/index.html Google ScholarPublic Health England (2015) PHE Weekly National Influenza Report Summary of UK surveillance of influenza and other seasonal respiratory illnesses 22 January 2015–Week 4 report (up to week 3 data). Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/397454/Weekly_report_current_week_4x.pdf Google Scholar FiguresReferencesRelatedDetails 2 December 2015Volume 21Issue 12ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 14 December 2015 Published in print 2 December 2015 Information© MA Healthcare LimitedPDF download

'Winter mortality, temperature and influenza' Revisiting Curwen and Devis after a quarter of a century

Objectives: to update the still quoted 25-year-old finding that a drop in winter temperature by 1 oC below its mean is associated with 8,000 excess winter deaths in England and Wales. Methods: time-series regression of excess winter deaths between 1950/1 and 2011/12 on mean outside temperature, influenza and pneumonia deaths and a secular trend. Results: we find that a 1 oC decrease in winter temperature below its mean is associated with 5,100 excess winter deaths. Excess winter mortality has been falling on average by approximately 580 deaths per year. Conclusions: Our revised estimates should supersede Curwen and Devis’s in academic and official publications. Notwithstanding there has been some mitigation in the effects of winter temperature on mortality over the last 60 years, excess winter mortality - given its magnitude- should still be a major source of public health concern in England and Wales. Jose IPARRAGUIRRE, Chief Economist, Age UK, London, United Kingdom, and Universidad de Moron, Buenos Aires, Argentina. London, United Kingdom. E-mail: jose.iparraguirre@ageuk.org.uk . James GOODWIN, Head of Research Department in Age UK, London, United Kingdom.

Why do more infants die in the UK than in Sweden? An intercountry comparison of birthweight-specific infant mortality

BackgroundThe UK has one of the highest infant mortality rates in western Europe, whereas Sweden has one of the lowest. A comparison of cohorts with similar characteristics at birth could show the origin of these disparities. This study aimed to compare birthweight-specific and age-at-death-specific mortality rates to assess which groups are most at risk in England and Wales relative to Sweden. MethodsWe used tabulated data on singleton live births and deaths in 2006 for England and Wales and in 2002–06 for Sweden. We examined mortality rates and rate differences per 1000 live births by birthweight (<1000 g, 1000–1499, 1500–2499, 2500–3499, ≥3500) and age-at-death categories (0–6 days, 7–27, 28–365). We calculated the number of excess deaths (deaths that could have been prevented if England and Wales had Sweden's mortality rates in 2006). FindingsThe study included 477 153 births and 1168 deaths in Sweden, and 649 421 births and 2828 deaths in England and Wales. The infant mortality rate in England and Wales was nearly double that in Sweden (4·36 deaths per 1000 live births, 95% CI 4·19–4·52 vs 2·45, 2·31–2·59), resulting in 1238 excess deaths (95% CI 1100–1377). If England and Wales had Sweden's birthweight-specific mortality rates, only 559 excess deaths would have occurred in 2006. The greatest disparities were observed for extremely low-birthweight babies (<1000 g), with 440 (95% CI 360–519) excess deaths (334 within the first week of life [265–404]). Babies with normal birthweights (2500–3499 g) had the second highest number of excess deaths (219, 95% CI 137–302), with 118 occurring in the postneonatal period (61–176). InterpretationThe number of excess deaths in England and Wales relative to Sweden declined substantially after accounting for differences in the birthweight distribution, suggesting that preventive policies in the UK should focus on reducing prenatal risk factors and improving maternal health before and during pregnancy. Differences in registration of live and stillbirths, resuscitation, or obstetric practices could explain some disparities in the early deaths among extremely low-birthweight babies. Excess postneonatal deaths among normal-birthweight babies suggests scope for reducing mortality by improving postnatal support for families. FundingAZ's PhD studentship is supported by awards to establish the Farr Institute of Health Informatics Research, from the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institute for Social Care and Health Research, and Wellcome Trust (grant MR/K006584/1). The authors' work was independent of their funders.

Future trends and inequalities in premature coronary deaths in England: Modelling study

BackgroundCoronary heart disease (CHD) is a major cause of premature mortality, particularly in deprived groups. Might recent declines in overall mortality obscure different rates of decline among social strata, creating potentially misleading views on inequalities? MethodsWe used a Bayesian analysis of an age–period–cohort model for the English population. We projected age-specific premature CHD mortality (ages 35–74) by gender and area-based deprivation status for the period 2007–2035, using 1982–2006 as the input. Deprivation status was measured by Index of Multiple Deprivation quintiles, which aggregate seven types of deprivation, including health and income.We analysed inequality in premature CHD mortality. We investigated the annual changes in inequality and the contributions of changes in each IMDQ to the overall annual changes, using both absolute (probability) and relative (logit) scales. We quantified inequality using the statistical variance in the probability of premature death among deprivation quintiles. ResultsThe overall premature CHD mortality trends conceal marked heterogeneities. Our models predict more rapid declines in premature CHD mortality for the most affluent quintiles than for the most deprived (annualized rate of decline 2006–2025, 7.5% [95% Credible Interval 4.3–10.5%] versus 5.4% [2.2–8.7%] for men, and 6.3% [3.0–9.9%] versus 5.9% [1.5–10.8%] for women). For men, the posterior probability that the rate of decline is greater for the most affluent was 82%.Variance in premature CHD mortality across deprivation quintiles was projected to decrease by approximately 81% [28–95%] among men and by 89% [30–99%] among women. This decrease was particularly driven by the most deprived groups due to their higher premature death rates. However, relative inequality was projected to rise by 93% among men [81–125%] and rise by 13% [−25–58%] among women. These increases are also mostly influenced by the most deprived, reflecting their slower declines in premature deaths. ConclusionsOverall, premature coronary death rates in England continue to decline steeply. Absolute inequalities are decreasing, reflecting declines in the high premature mortality in deprived groups. However, relative inequalities are projected to widen further, reflecting slower mortality declines in the most deprived groups. More aggressive and progressive prevention policies are urgently needed.

Rethinking pathways to completed suicide by female prisoners

Purpose – The purpose of this paper is to explore the role of trauma experience in pathways to self-harm or attempted suicide in female prisoners who died through self-inflicted death in England and Wales. Design/methodology/approach – Quantitative study using the Prison and Probation Ombudsmen’s independent reports on deaths in custody. In total, 32 cases of female self-inflicted death in custody were coded on the presence of direct or interpersonal trauma, presence of superficial self-harm (SSH), near-lethal self-harm (NLSH), suicide attempts and recent significant life event. The number of previous suicide attempts (PSAs) and age at time of death was recorded. Findings – Direct trauma is linked with repeated suicide attempts but recued the likelihood of SSH prior to suicide. Neither interpersonal trauma nor age increased likelihood of pre-suicide behaviours. NLSH was not predicted by either traumatic experience. Amongst these completed suicide cases, 56 per cent were not reported as having experienced trauma, 46 per cent had no recorded PSAs and 12 per cent also had no previous self-harm reported. Research limitations/implications – The small sample limited statistical power and specificity of classifications. Provides support for direct trauma in developing capacity for repeated suicidal behaviour as indicated in theoretical models of suicide (Joiner, 2005; O’Connor, 2011). Practical implications – Different pathways to suicide likely to exist for female prisoners and importance of trauma intervention services. Originality/value – Using cases of completed suicide in female prisoners to investigate the pathway to suicide from trauma through previous self-harm and attempted suicide.

Geographical Text Analysis: A new approach to understanding nineteenth-century mortality

This paper uses a combination of Geographic Information Systems (GIS) and corpus linguistic analysis to extract and analyse disease related keywords from the Registrar-General's Decennial Supplements. Combined with known mortality figures, this provides, for the first time, a spatial picture of the relationship between the Registrar-General's discussion of disease and deaths in England and Wales in the nineteenth and early twentieth centuries. Techniques such as collocation, density analysis, the Hierarchical Regional Settlement matrix and regression analysis are employed to extract and analyse the data resulting in new insight into the relationship between the Registrar-General's published texts and the changing mortality patterns during this time.

'Do I have to have cancer to get better care?' Improving palliative care provision for frail older people.

International Journal of Palliative NursingVol. 21, No. 8 Commentary‘Do I have to have cancer to get better care?’ Improving palliative care provision for frail older peopleMaggie KeebleMaggie KeebleSearch for more papers by this authorMaggie KeeblePublished Online:27 Aug 2015https://doi.org/10.12968/ijpn.2015.21.8.409AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Barnett K, Mercer SW, Norbury M et al. (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380(9836): 37–43 Crossref, Medline, Google ScholarBritish Geriatrics Society (2014) Fit for Frailty http://tinyurl.com/p7f85qo (accessed 2 July 2015) Google ScholarDixon J, King D, Matosevic T et al. (2015) Equity in Provision of Palliative Care in the UK: Review of Evidence http://tinyurl.com/ns73lgc (accessed 2 July 2015) Google ScholarGrande GE, Farquhar MC, Barclay SI et al. (2006) The influence of patient and carer age in access to palliative care services. Age and Ageing 35(3): 267–273 Crossref, Medline, Google ScholarGill TM, Gahbauer EA, Han L et al. (2010) Trajectories of disability in the last year of life. N Engl J Med 362(13): 1173–80 Crossref, Medline, Google ScholarOffice for National Statistics (2014) Deaths in England and Wales, 2013 http://tinyurl.com/o4ov8rb (accessed 2 July 2015) Google Scholar FiguresReferencesRelatedDetails 2 August 2015Volume 21Issue 8ISSN (print): 1357-6321ISSN (online): 2052-286X Metrics History Published online 27 August 2015 Published in print 2 August 2015 Information© MA Healthcare LimitedPDF download

Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour

ObjectivesReducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions...

Sex differentials in phthisis mortality in England and Wales, 1861–1870

In the mid-nineteenth century phthisis, or pulmonary tuberculosis, was the single most important cause of death in England and Wales. It was widely distributed geographically though some areas were worse affected than others. This paper explores aspects of the geography of phthisis mortality in England in the second half of the nineteenth century, with particular attention to the sex differential in mortality from this cause. Phthisis is often thought of as a disease of young women, and throughout much of England and Wales, especially in agricultural areas, women aged between 15 and 40 years were especially vulnerable. However the sex ratio of deaths from phthisis varied greatly from place to place and, in some places where phthisis was prevalent, men rather than young women were at the greatest risk of death. Phthisis mortality was sufficiently important that the geography of the overall sex differential in mortality was to a considerable extent determined by the geography of the sex differential in phthisis mortality. Where phthisis mortality disadvantaged females, the overall sex differential between male and female mortality was small or even negative; where phthisis mortality disadvantaged males, the overall sex differential was large. The paper then considers explanations of geographical variations in the sex differential in phthisis mortality. It is not clear that these are best explained by a ‘bargaining-nutrition’ account which holds that young women in poor households were especially vulnerable to mortality from phthisis because their weak intra-household bargaining position compromised their nutritional status. Other factors, such as the return migration to their native areas of out-migrants who became sick with the disease, and working conditions, especially for females, may have been more important. The final part of the paper considers the implications of the results for explanations of the decline of phthisis mortality between 1860 and 1900.

PTH-125 A national survey of palliative care in end stage liver disease in the UK

Introduction Liver disease is the third largest cause of premature death in the United Kingdom (UK) and currently accounts for 2% of deaths in England, but there is little strategy to improve care for those dying from it, as well as a lack of research in this area. Understanding of the views of health care professionals (HCP) on how care can be improved for patients dying from cirrhosis is poor. Aim To conduct a national survey of primary, secondary and tertiary care providers to explore current attitudes and practices, to identify future training needs, ideas for service improvement and research priorities. Method An online questionnaire survey was emailed to a maximum of 6,181 HCPs working in hepatology and gastroenterology (liver), general practice (GP) and specialist palliative care (SPC) across the UK. Results 517 HCP responded: 195 from liver, 46 from GPs and 273 from SPC (response rates 4%, 23% and 10% respectively; overall response rate 8%). Nearly all liver and SPC professionals felt that SPC had a role in the care of patients with cirrhosis. Liver professionals tended to refer to SPC whilst patients were in hospital but overall numbers were low, with only 14% (22/161) and 6% (9/61) of liver professionals referring more than 20 patients/year from in-patient and out-patient care respectively. Patients with cirrhosis only made up a median 1% of the SPC workload. All HCPs wanted further training in: managing liver-related symptoms (SPC), symptom control and end of life issues (liver and GP). Open responses were received from 221 participants. Two main research priorities were identified by all three health professional groups: better symptom control (in particular how best to manage recurrent ascites, opioid pharmacology in liver disease and optimal management of pruritus and encephalopathy), and prognostication. Conclusion Although all HCPs recognised the important role of SPC in caring for dying patients with cirrhosis, they all needed further training and uptake of skills to improve their confidence. We recommend a focus on improved understanding of the needs of patients with cirrhosis and their families, identification of better ways in communicating with patients at risk of death, smoother links across care boundaries, and enhanced training for all staff groups. Disclosure of interest None Declared.

A86 Comparative fatality risk for different travel modes of transport by age, sex, and deprivation

Abstract Background Cycling is widely perceived as an unsafe mode of transport in England and many other countries. However, numbers of road deaths in England have fallen sharply since 2007. We explored whether differences in fatality rates by age and mode persist, and the impact of deprivation on these. Methods Comparative fatality rates by distance (bn km) and time travelled (million hours’ use, mhu) were calculated by age, travel mode, and sex or area deprivation (Index of Multiple Deprivation of residence). Data for Travel-related deaths, including pedestrian falls, were drawn from the ONS mortality database (2007–2012). Data for distance and time travelled by age and sex or age and IMD quintile were drawn from National Travel Survey data 2007–2012. Results Fatality rates for walking, cycling and driving fell significantly between 2007–2009 and 2010–012, particularly among men. Male fatalities per bn km fell from 3.4 (95%CI 3.3–3.6) to 2.2 (2.1–2.4), for driving, 32.1 (28.5–36.0) to 20.8 (18.1–23.9) for cycling, and 51.4 (48.5–54.4) to 36.7 (34.3–39.3) for walking. Fatality rates varied by age, sex, and mode, ranging in males from 1.2–26.4/bnkm (0.05–1.01/mhu) for driving, 14.1–231.4/bnkm (0.22–2.59/mhu) for cycling, and 13.1–708.9/bnkm (0.05–2.55/mhu) for walking. For males aged 17–20, fatality rates were 25.9 (23.9–28.1)/bnkm; 1.01 (0.93–1.09)/mhu) for drivers and 22.5 (14.2–33.7)/bnkm; 0.28 (0.18–0.42)/mhu) for cyclists. Age-specific rates showed a J-shape for cycling, a U-shape for driving, and an exponential increase with age for walking. Fatality rates for adults aged 80+ were an order of magnitude higher in each mode than the all-age mean. For both f/bnkm or f/mhu, rates were significantly above mode-specific all-age rates (p Conclusions Fatality rates for walking, cycling and driving are higher for males than females at almost every age and vary more by age than by travel mode. Deprivation exacerbates the risks of walking for age groups >34 years old and driving for age groups

The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993–2012

Background: Studies in the United Kingdom and elsewhere have suggested inequality of hospice provision with respect to factors such as age, diagnosis and socio-economic position. How this has changed over time is unknown. Aim: To describe the factors associated with inpatient hospice death in England and examine how these have changed over time. Design: Population-based study. Multivariable Poisson regression compared 1998–2002, 2003–2007 and 2008–2012, with 1993–1997. Explanatory variables included individual factors (age, gender, marital status, underlying cause of death) and area-based measures of deprivation. Setting: Adults aged 25 years and over who died in inpatient hospice units in England between 1993 and 2002 (n = 446,615). Results: The annual number of hospice deaths increased from 17,440 in 1993 to 26,032 in 2012, accounting for 3.4% of all deaths in 1993 and 6.0% in 2012. A total of 50.6% of hospice decedents were men; the mean age was 69.9 (standard deviation: 12.4) years. The likelihood of hospice decedents being in the oldest age group (>85 years) increased over time (proportion ratio: 1.43, 95% confidence interval: 1.39 to 1.48 for 2008–2012 compared to 1993–1997). Just 5.2% of all hospice decedents had non-cancer diagnoses, though the likelihood of non-cancer conditions increased over time (proportion ratio: 1.41, 95% confidence interval: 1.37 to 1.46 for 2008–2012 compared to 1993–1997). The likelihood of hospice decedents being resident in the least deprived quintile increased over time (proportion ratio: 1.25, 95% confidence interval: 1.22 to 1.29 for 2008–2012 compared to 1993–1997). Conclusion: The increase in non-cancer conditions among hospice decedents is encouraging although absolute numbers remain very small. Deprivation trends are concerning and require further exploration.

Ignored Disease or Diagnostic Dustbin? Sudden Infant Death Syndrome in the British Context.

Sudden Infant Death Syndrome (SIDS) was defined in 1969 and incorporated into the International Classification of Diseases a decade later. To advocates of SIDS as a diagnosis, medical interest in sudden infant death was long overdue. However, the definition of SIDS lacked positive diagnostic criteria, provoking some to view it as a ‘diagnostic dustbin’ for the disposal of problematic cases where cause of death was unclear. This paper examines the development of medical interest in sudden infant death in Britain during the middle decades of the twentieth century. It highlights the importance of recognising the historicity of SIDS as a diagnosis facilitated by changes in law and medicine over the course of the nineteenth and twentieth centuries. It suggests that SIDS provides a definitive case study of the medicalisation of life and death, and a unique example of an officially recognised disease that had no symptoms, signs, pathology or patients.