Events Of Undetermined Intent Research Articles

The contributions of injury deaths to the gender gap in life expectancy and life disparity in Eastern Mediterranean Region

BackgroundInjury deaths constitute a major avoidable cause of death affecting life expectancy to a different degree in men and women. This study quantified the contributions of injury deaths to the gender gap in life expectancy (GGLE) and life disparity (GGLD) in nine Eastern Mediterranean Region (EMR) countries.MethodsWe retrieved annual data on age-sex specific causes of death from the World Health Organization mortality database for EMR countries with at least 2-year consecutive data during 2010–2019. The injury-related deaths were categorized into five groups: transport accidents, other accidental injuries, intentional self-harm, assault and events of undetermined intent. Considering women as the reference, the GGLE and GGLD were decomposed by age and causes of death, using a continuous-change model.ResultsThe largest and smallest GGLE were observed in Kuwait (5.2 years) and Qatar (− 1.2 years), respectively. Qatar (− 2.2 years) and Oman (0.2 years) had the highest and lowest GGLD. The highest contributions of injury deaths to the GGLE/GGLD were seen in Libya (1.8/− 1.2 years), followed by Iran (1.2/− 0.8 years). Among injury causes, transport accidents were the leading cause of GGLE in all countries but Libya and Morocco, with Iran having the greatest contributions (0.6 years). Injury deaths in men aged 15–29 years accounted for 33% [41%] (Kuwait) to 55% [65%] (Oman) of total GGLE [GGLD] attributable to injury deaths.ConclusionsHigh injury deaths, particularly transport accidents, among young men contributed substantially to the GGLE and GGLD across nine EMR countries in this study. This highlights the need for implementing preventing policies to reduce the burden of injury deaths specifically in young men.

Accuraatheid van de door de Vlaamse overheid gepubliceerde statistiek van de doodsoorzaken: een forensische benadering

A study into the accuracy of the published cause of death statistics by the government of Flanders, Belgium The cause of death (COD) stated on death certificates is the key component to compose COD statistics in Belgium. The aim of the study was to ascertain whether CODs of homicides as confirmed by autopsy by the Department of Forensic Sciences (DoFS) at the University of Leuven were reported as such in government statistics. Out of 455 autopsies performed by the DoFS between 01/01/2010 and 31/12/2013, 64 medicolegal homicides were retained, which in turn were cross-referenced with a provided list of all deaths in the same period by the government. Applying the ICD-10 (International Classification of Diseases, 10th revision) methodology to the study population, 97% of the attained codes fell under the section ‘Assault’. This concerned only 78% when coded by the government. The remaining were located under the less specific section ‘Event of undetermined intent’. One homicide was coded by the government as a death by natural causes and one death was not accounted for. Specific training for physicians on correctly filling out death certificates, a more user-friendly certificate and systematic feedback of autopsy findings to government agencies are proposed in order to increase the accuracy of COD statistics.

Comparing rates and patterns of male suicide and ''hidden suicide'' between nations and over time

Rates and age patterns of suicide differ between nations and population groups. The accuracy of data provided by national statistics offices has been questioned. This paper (1) compares recent high quality data regarding suicide rates in larger countries, and (2) explores differences between countries in proportions of male deaths coded as ''undetermined''. Data were obtained from the WHO Mortality Database regarding deaths in ten larger nations in 2015, coded (using ICD-10) as due to suicide, Event of Undetermined Intent (EUI), ill-defined or unknown cause (R99), or accidental poisoning or drowning. Numbers in 5-year age groups were recorded and rates calculated using population figures. Male suicide rates per 100,000 in the ten nations were found to vary between 8.40 (Mexico) and 37.52 (Korea). Most Western nations had bimodal male age patterns, US and Japan trimodal, and Korea's was upward-sloping. Male EUI rates varied: those in Mexico and Japan progressively increased across the age-range. The UK's male R99 cross-age rate was nearly zero; the other 9 countries had high rates, largely with exponential rises in late life. England & Wales publish combined suicide and EUI rates as their ''official'' suicide figures. Other countries, too, have been shown to code many suicides as ''undetermined deaths''. Partly this could be because of lack of resources to adequately investigate deaths. Accuracy of data would be improved by increased use of verbal autopsies. Comparisons of male age patterns of suicide, examining associations between period effects and sociocultural differences, could help identify reversible causative factors.

Spain’s suicide statistics: do we believe them?

There is a widespread belief that suicides around the world are under-counted. A substantial proportion of suicides may have been inappropriately registered as accidental or of undetermined cause or intent. There is reason to explore to what extent low suicide rates in some nations could be partly attributable to under-counting. Mortality statistics of most countries are available on-line. Numbers of suicide deaths in Spain, and in England and Wales (E & W), in male and female 5-year age groups, in each year between 2014 and 2018, were documented, along with deaths coded to ICD-10 accident or 'undetermined death' categories. Crude mortality rates were calculated using official population figures. Single year suicide, undetermined death, and non-transport accidental death rates of 12 other nations were calculated. Spain's crude suicide rate per 100,000 remains low (7.89) compared to other nations; its event of undetermined intent (EUI) death rate was 0.09 (contrasting with E & W's 1.74). Its accidental poisoning rate is much lower than that of E & W. The study showed much higher rates of ill-defined/unknown cause deaths in late life in Spain (both genders) than in E & W, and age-associated increases in accidental drowning rates parallel with increased suicide by drowning. Reportedly low suicide rates in Spain could be partly attributable to increased rates of 'hidden suicide' (accidental drowning, male accidental poisoning, and possibly ill-defined/unknown cause deaths, but not EUIs). It would be appropriate (and not just in Spain) to increase numbers of verbal and/or forensic autopsies in questionable 'undetermined' cases.

Mortality among the Russian working-age population from suicide: official and actual rates

Abstract Purpose of the study is to assess suicide-related loss of the Russian working-age population in the 2000s and extent of its possible under-reporting. Analysis is based on Rosstat data on deaths among the Russian working-age population (15-59 years) calculated in FAISS-Potential, as well as data on mortality from suicide in the “old” and “new” European Union (EU) (before and after May 2004) from the European mortality database. Officially, mortality from suicide among the working-age population decreased at 3.4 fold in males and 2.9 in females, far exceeding the rate of decline in the overall mortality from external causes which equaled to 2.6 times in males and 2.5 in females in 2000-2018. Currently, the Russian mortality from suicide is multifold higher than the “old” EU one across all working ages and higher than the “new” EU one among population aged up to 45 years only. The rate of decline in mortality from event of undetermined intent among working-age population was lower compared to suicide, adding up to 14.2% and 11.6% vs 3.4 and 2.9-fold. And the Russia's such loss compared to the “new” EU one was about 10-fold in both males and females across all working ages. With a high degree of probability, “events of undetermined intent” are likely to be latent suicides. Conclusions Official mortality from suicide among working-age population decreased at extremely high rate with linear trends. A significant share of suicide mortality is latent and is counted as events of undetermined intent. With a high degree of probability, latent suicides cover hanging, jumping/falling from a high place, and drug poisoning of undetermined intent. The trend in loss due to latent suicide is negative. The share of latent events among actual suicide-related loss in 2010s steadily increased, exceeding one third in males and reaching 50% in females in 2018. Currently, mortality from suicide is likely to exceed the Rosstat indicators by 60% in males and over 2-fold in females. Key messages In the 2000s, the official mortality from suicide among the Russian working-age population decreased at an extremely high rate with linear trends. The share of latent events among the actual suicide-related loss in the 2010s steadily increased, exceeding one third in males in 2018 and reaching 50% in females.

Undercounting of suicides: Where suicide data lie hidden

ABSTRACT The suicide rates officially reported by most countries are widely believed to be lower than actual rates, attributable partly to inaccuracy of registration of deaths and misclassification of cause of death. In this review paper, we discuss under-counting of deaths and of suicides, referring to findings from international research. We then describe the three main ICD-10 cause of death categories that possibly harbour ‘hidden suicides’: ill-defined or unknown causes of death, events of undetermined intent (EUI), and accidental deaths. We used the 2017 Australian mortality statistics to illustrate these three categories. The World Health Organization (WHO) data and international research show (1) that mortality data provided to the WHO by a large number of its Member States are of questionable quality and not timely; and (2) substantial variations among countries in rates of suicide, ill-defined or unknown deaths, EUIs, and accidental deaths (notably, poisoning). Accurate reporting of suicides is needed to advance research on suicide prevention and develop more effective suicide prevention programmes. Nations should endeavor to obtain, publish and analyse data regarding annual rates of deaths coded as of ill-defined/unknown cause, EUI, and accidental poisoning and other relevant types of accident.

Hidden deaths: corrected estimates of homicides in Bahia, Brazil, 1996- 2015.

The objective of this study was to correct and estimate five-year homicide rates in Bahia, Brazil, for the 1996-2015 period. An ecological study of the homicides was carried out using official data from the Mortality Information System of the Ministry of Health. Deaths due to assault are classified in the codes X85-Y09 of the International Classification of Disease 10th Revision (ICD-10). A proportional redistribution of deaths classified as events of undetermined intent (Y10-Y34) was carried out and mortality correction factors were applied. In the analyzed period, 67,599 homicides were registered in the Mortality Information System; after the second correction, 88,429 homicide deaths were estimated. Comparing the official and adjusted figures, there was an underreporting of 30.8%. The highest corrected homicide rates were observed in the eastern region, in Pojuca (129.8 homicides per 100,000 inhabitants), Lauro de Freitas (117.7) and Simões Filho (114.3); in the southern region, in Santa Luzia (121.4), Valença (87.6) and Itabuna (86.5); and in the far south, Santa Cruz Cabrália (128.2), Itabela (113.3) and Porto Seguro (106.8). After correction, there was an increase in homicides in all of the five-year periods in the municipalities analyzed, which resulted in an even higher mortality rate.

Trend of ill-defined causes of death in Egypt (2000-2013) in comparison to selected Eastern Mediterranean Countries

Introduction: The morbidity statistics are considered more adequate to understand the health and disease process in the population, especially the incidence measures, as they reflect the dynamics of diseases/health injuries. it is one of the most valuable sources of information in PH, being useful for the assessment of the population health status, allowing the identification of higher-risk groups andmore important causes of death. Objectives: Identify the trend of ill-defined death rates in Egypt from 2000 to 2013; compare ill-defined causes of death for Egypt 2013 with KSA and Kuwait the same year. Methods: Secondary data; Egypt cause-specific mortality data as well as the data from other countries of Eastern Mediterranean region for the years 2000-2013.The ill-defined causes, and the level over time will be presented and compared with other countries. The ill-defined causes of death are defined as; deaths coded symptoms, signs and event of undetermined intent from the ICD-10. Results: Percentage of ill-defined causes of deaths (COD) in Egypt ranges 47 to 49 % during the period of 2000—2013. By conducting analytical study of Egypt mortality data 2013 we found that deaths diagnosed as symptoms and signs is 23 % followed by the mode of dying heart failure in 10%, higher rates among age groups 20-59 and 60+. There is a significant relationship between percentage of ill-defined causes of death and years; p value < 0.01 (95% CI: 0.986, 0.987). Ill-defined COD, 2013 in KSA and Kuwait are 11% and 2.5% respectively compared to 47% in Egypt with statistical significant relationship p value < 0.01 (95% CI: 0.56, 0.57). Conclusion and Recommendation: Egypt is one of the countries regularly report mortality data using ICD-10 coding system to WHO heath statistics department since 2000, with high level of completeness up to 100% however the data is of low usability due high percentage of garbage codes up to 50%Egypt, mortality data, ill-defined causes of death.

Violence deaths and its impact on life expectancy: a comparison between Mexico and Brazil.

Using official data, this study analyzed violent deaths (homicide, suicide, events of undetermined intent and deaths due to legal intervention) in Brazil and Mexico in the three-year periods 2002-2004 and 2012-14, the impact of these causes of death on life expectancy in both countries and the role of the different age groups in years of life expectancy lost (YLEL). Abridged life tables were constructed for both countries for both periods. Temporary life expectancy and YLEL between zero and 80 years by selected causes and age groups were calculated for each triennium. The leading cause of YLEL among men was homicide in both periods in Brazil (1.5 years) and in the second period in Mexico (one year). Violent deaths (VD) accounted for around 16% of YLEL in Brazil and 13% in Mexico in 2012-2014. Among women, YLEL due to homicides and suicides showed the greatest relative increase in both countries, although VD accounted for barely 3% of total YLEL. The highest percentage of YLEL due to VDwas found among the 15 to 29 year age groups in both countries and for both sexes. The increase in rates of VD in Mexico, above all among young people, has curbed further increases in life expectancy in recent years, especially among men. Likewise, the high rates of VD in Brazil in both periods have hindered the growth of life expectancy.

Unexpected variations in official UK statistics related to rates of suicide and those of undetermined intent: An exploration of causes

BackgroundOfficial rates of suicide are perhaps the most important and enduring measures of population mental health. They are however prone to variations in reporting usually relating to deaths where the intention was uncertain, though most official statistics circumvent this by including ‘events of undetermined intent’ (ICD10 Y10-34 and Y87.2) along with ‘intentional self-harm’ in their official statistics. It is however unclear how successful this strategy has been and whether significant sources of bias still persist.AimTo systematically examine the dramatic change in rates of death from suicide (and undetermined intent) in Northern Ireland, that coincided with a major overhaul and reorganisation of the Coroners Service in 2005/6, to understand the extent to which the initial investigation by the coroners’ office, legal processing, registration and coding practices can influence official suicide statistics.MethodsIn the space of one year, Northern Ireland went from having a standardised rate of suicide (incl undetermined intent) of 12.6/100,000 in 2004 to 26.6/100,000 in 2006 (a 111% increase) and in doing so went from having consistently the lowest to consistently the highest registered rate of suicide in the UK.ResultsInitial analyses rules out changes in the police service, pathology service or registration coding practices as causative and suggest that the introduction of a coroner's liaison officer (with a formal data gathering role) was the most likely factor. The centralisation of the coroners’ service also reduced variations according to age, sex, geography and coding.ConclusionsThe process underpinning official statistics need to be routinely scrutinised.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Differing Procedures for Recording Mortality Statistics in Scandinavia.

There may be various reasons for differences in suicide rates between countries and over time within a country. One reason can be different registration practices. The purpose of this study was to describe and compare the present procedures for mortality and suicide registration in the three Scandinavian countries and to illustrate potential sources of error in the registration of suicide. Information about registration practices and classification procedures was obtained from the cause of death registers in Norway, Sweden, and Denmark. In addition, we received information from experts in the field in each country. Sweden uses event of undetermined intent more frequently than Denmark does, and Denmark more frequently than Norway. There seems to be somewhat more uncertainty among deaths classified as ill-defined and unknown cause of mortality in Norway, compared with the other two countries. Sweden performs more forensic autopsies than Norway, and Norway more than Denmark. In Denmark, in cases of a suspected unnatural manner of death, a thorough external examination of the deceased is performed. Differences in the classification of causes of death and in postmortem examinations exist in Scandinavian countries. These differences might influence the suicide statistics in Scandinavia.

Mortality from undetermined causes of death in Russia and in selected countries

Deaths due to injuries and poisoning which experts cannot identify, such as homicide, suicide or accident, are registered in statistical databases as deaths due to an event of undetermined intent. The proportion of such deaths can indicate the quality of statistics on causes of death, above all of statistics on intentional self-harm and assaults. In Russia, the proportion of deaths due to events of undetermined intent among other external causes has been growing for almost four decades. Such a trend was observed in the past during periods of growing mortality from external causes. Yet the steady and long decline in mortality from external causes in Russia that began in 2003 has not stopped the trend. The displacement of other external causes continues, though mortality from events of undetermined intent has exceeded both suicide and homicide mortality, and its proportion has increased tenfold, reaching very high levels relative to those of other countries. In several studies done in Russia over the past decade, scholars have argued that such a high proportion essentially results from the manipulation of statistics on mortality from external causes, the so-called conversion of socially important causes of death to a latent form.
 The factors behind the persistent rise of the proportion of deaths due to events of undetermined intent (EUI) are analysed on the basis of a review of relevant research and long-term trends in mortality from external causes in Russia and selected developed countries. This makes it possible to expand the contextual framework of the discussion about the factors of the persistent growth of this “technical” indicator and about the hypothesis of the “natural” character of such dynamics.

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.

Suicide and external mortality pattern in a cohort of migrants from the former Soviet Union to Germany

BackgroundMental health consequences of migration are manifold. Where some migrants experience migration as liberation from life threatening conditions, others suffer from hostility and social descent in the target country. This study investigates deaths due to external causes, suicides, and events of undetermined intent in German repatriates from the Former Soviet Union. The relation between age at migration and suicide mortality is also explored. MethodsA cohort of German repatriates who migrated between 1990 and 1999 was followed-up until 2010. Each individual accumulated time at risk, expressed in person years (PY). Standardized mortality ratios (SMR) were calculated, supplemented by subgroup analyses for age and calendar year strata, and immigration period. Multivariate Poisson models were used to investigate the influence of age, sex, calendar year, number of moves, and final move distance. ResultsA total of 6378 German repatriates (3031 men, 3347 women) accumulated 92 149 PY. Median age at immigration was 30 years in women and 27 years in men. Women's all-cause mortality was significantly lower (SMR = 0.85 [0.75; 0.97]). Men more often died from external causes (SMR = 1.58 [1.09; 2.23]), intentional self-harm (SMR = 1.68 [0.90; 2.88]), and events of undetermined intent such as poisoning by drugs (SMR = 8.07 [4.02; 14.44]). External cause mortality was significantly increased after 1995 (SMR = 1.87). In particular, men who migrated when they were 11–20 years old were at strongly increased risk of committing suicide (SMR = 3.84) or dying due to events of undetermined intent (SMR = 14.75). ConclusionThe most endangered subgroup is men who migrated at teenage age. Protective factors such as strong family bounds formerly present in the FSU failed in Germany, the higher population density caused intense friction. The changes in the families' ethnical composition from mostly ethnic German members in the early 90s' towards predominantly Russian members around the turn of the millennium complicated integration. Setting-oriented prevention measures should consider the families' migration history, their link to culture and religion, and the different concepts of mental health.

Survival of patients with alcohol use disorders discharged from an emergency department: a population-based cohort study

ObjectivesThe aim was to study the cause-specific mortality of users of the emergency department (ED) who received a diagnosis of alcohol use disorder (AUD) in comparison with mortality of other...

Adolescent mortality in South Africa: An analysis of unnatural causes of deaths by sex, 2000-2009

Despite South Africa being a peaceful democracy for the past 18 years, mortality due to unnatural and violent causes still occur among the youth, who are aged between 15 and 34 years old (Presidency of the Republic of South Africa 2009). However, this is not specific to South Africa; with developed countries experiencing the same trend. In developed countries, Christoffe (1994) found that death due to unnatural causes, specifically related to violence, had increased especially among the youth. South Africa is now moving towards the same transition that is currently experienced by developed nations in the world: violent deaths as a major cause of death amongst the youth which includes some adolescents (10-19 years old) (Norman, et al, 2007). With this in mind, this paper aims to examine the different levels of male and female adolescent mortality due to five unnatural causes of death. Data from South African Death Notification Forms is analysed for the years 2000-2009. Cause-specific mortality rates and proportional mortality ratios are produced. Results show adolescents are dying from events of undetermined intent, transport accidents’ and self- harm, especially males. The selected causes of death are contributing up to 27% of all adolescent male mortality and almost 12% of all female mortality in 2009. The results of this paper allude to crime, violence and safety issues in South Africa.

Em busca de melhores informações sobre a causa básica do óbito por meio de linkage: um recorte sobre as causas externas em idosos - Estado do Rio de Janeiro, Brasil, 2006

Objective: to improve data regarding the underlying cause of deaths due to external causes, among the elderly (60 years and older) in the state of Rio de Janeiro, Brazil, in 2006. Methods: exploratory study based on probabilistic record linkage between Mortality Information System and Hospital Information System/National Unified Health System, databases, using Reclink method. Results: 15,804 pairs of records were identified as possible matches; concerning the distribution of specific categories of external causes, at first, events of undetermined intent were the main cause of deaths (55.9%); after record linkage, proportional mortalities due to transport accidents (21.5%; previously, 7.0%) and due to falls (27.4%; previously, 11.7%) represented un increase of almost three fold. Conclusion: the results indicate the possibility of improving information on mortality by means of a feasible methodology.

Child death reviews, an audit in wales: suicides and events of undetermined intent in children and young people: the role of deprivation and abuse

AimAs part of the Child Death Review Pilot in Wales, we aimed to analyse the theme of suicides and events of undetermined intent in children and young people. We aimed...

FC08-03 - Increased risk of amputation of lower limbs and mortality in patients with diabetes and comorbid mental illness

IntroductionThere are concerns that people with mental disorders may not receive proper somatic care within health care systems, and face the risk of poor physical health outcomes and premature death.ObjectiveTo study whether patients with diabetes and comorbid mental illness are at higher risk of amputation of the lower limbs and mortality than diabetic patients without mental illness.AimTo pinpoint possible disparities in physical health outcomes and mortality in diabetic patients with or without mental disorders.MethodNational Swedish registers; Prescribed Drug Register, Patient Register and Cause of Death Register. All subjects that were prescribed antidiabetics during 2006, at age 35–79, were included (n = 229,956). Subjects with at least 2 hospital inpatient stays during 1996–2005 for psychotic disorders, i.e. schizophrenia/affective psychosis (n = 2,791), or non-psychotic disorders, i.e. depression/anxiety (n = 2,327) were identified. The study population was followed from 2007–2009. A Poisson regression model estimated the effect of mental illness on the likelihood of amputation or death. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated.ResultsDiabetic patients with comorbid psychotic and non-psychotic illness were more likely to die than patients without mental illness, also when suicides and events of undetermined intent were excluded (IRR = 2.44, CI 2.18–2.72 and IRR = 2.43, CI 2.17–2.71, respectively). The risk of amputation was particularly enhanced in diabetic patients with depression or anxiety (IRR = 4.39, CI 2.58-7.49).ConclusionIn diabetic patients there exist unsettling disparities in physical health outcomes and mortality that are associated with whether a person is mentally ill or not.

Narrative verdicts and their impact on mortality statistics in England and Wales

Annually, there are around 30,000 coroner's inquests held in England and Wales that conclude with a verdict. 'Short form' verdicts such as accident or misadventure; natural causes; suicide; and homicide make up the majority of all verdict conclusions. 'Narrative' verdicts can be used by a coroner or jury, instead of a short form verdict, to express their conclusions as to the cause of death following an inquest. Since 2001 narrative verdicts have been more widely used, with over 3,000 narrative verdicts returned in 2009. In some cases, it can be difficult to code the underlying cause of death from the information provided in the narrative. For some time, the Office for National Statistics (ONS) and other organisations have been concerned about the impact of narrative verdicts on the quality of the statistics on cause of death. Our research investigated the impact of narrative verdicts on trends for deaths attributed to injury and poisoning in England and Wales. The research considered narrative verdicts received by ONS between 2001 and 2009. All available information provided by the coroner from the narrative verdict, together with the underlying cause of death, was used in the analysis. All causes of death where a narrative verdict was returned were investigated. More in-depth analysis of accidental deaths was undertaken, as classification of these deaths by intent is more difficult when the information from the coroner is imprecise. A sensitivity analysis of suicide rates (intentional self-harm and event of undetermined intent) was carried out. This involved using two different scenarios of reclassifying selected proportions of accidental hanging and poisoning deaths, where a narrative verdict was returned, as intentional self-harm. An exercise to measure the consistency of coding cause of death from narrative verdicts was also undertaken. The increasing proportion of narrative verdicts involving injury and poisoning has not significantly affected published mortality rates for suicide (intentional self-harm and injury or poisoning of undetermined intent). However, if the rise in narrative verdicts continues at the same rate, the accurate reporting of injury and poisoning deaths, including suicides, is likely to be affected. The exercise to establish the consistency of coding the cause of death by ONS cause coders showed that the current coding rules were being applied uniformly. The increase in the use of narrative verdicts by coroners has not had a statistically significant impact on published suicide rates in England and Wales and so no revision to these rates is needed. A review of current coding practices and the handling of narrative verdicts will be undertaken by ONS with particular reference to deaths from intentional self-harm. A recommendation has been made to coroners to consider ways of recording narrative verdicts to allow more accurate coding of cause of death. This will ensure that mortality statistics are maintained to the highest standards.List of Tables, 83.