Unreported Deaths Research Articles

Morte materna mascarada: um caminho para sua identificação

OBJETIVO: verificar a presença de mortes maternas mascaradas ou presumíveis a partir de procedimentos obstétricos e diagnósticos secundários registrados no Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS), nos Estados de São Paulo, Paraná, Pará, Ceará e Mato Grosso, nos anos de 1999 e 2000. MÉTODOS: utilizamos dados secundários dos CD-ROMs Movimento de Autorização de Internação Hospitalar (AIH) do Sistema Único de Saúde, por meio de formulários das Autorização (AIHs). RESULTADOS: identificamos 651 mortes maternas declaradas pelo sistema e 55 foram mortes maternas mascaradas ou presumíveis, obtidas a partir de procedimentos obstétricos e diagnósticos secundários pertencentes ao Capítulo XV da CID 10 - Gravidez, parto e puerpério, registrados no SIH-SUS. CONCLUSÃO: o presente estudo revelou que tal sistema de informação pode ser utilizado como medida complementar para a identificação de mortes maternas não informadas.

Pregnancy-related deaths in four regions of Europe and the United States in 1999–2000: Characterisation of unreported deaths

Objective We compared official maternal mortality statistics with those from a special study covering all pregnancy-associated deaths in two European countries (Finland and France) and in two US states (Massachusetts and North Carolina) in 1999–2000 to characterize pregnancy-related deaths that are not included in official statistics. Study design We linked the official ICD-10-based maternal mortality data for 84 deaths with study data on 404 pregnancy-associated deaths. Results Of the pregnancy-associated deaths, 151 were pregnancy-related. We found 69 pregnancy-related deaths that had not been included as maternal deaths, and two deaths coded as maternal deaths that did not meet our definition for a pregnancy-related death. In total, 58 of these 69 deaths were from medical causes and 11 were from external causes or injuries (10 postpartum depression-related suicides and one accidental drug poisoning). The unreported deaths due to medical causes included 27 direct, 15 indirect, and two direct/indirect pregnancy-related deaths and 14 possibly pregnancy-related deaths. The most common causes of the unreported deaths due to medical causes were intracerebral hemorrhage (7 deaths), peripartum cardiomyopathy (4), pulmonary embolism (4) and pregnancy-induced hypertension (4). Conclusions The collection of data on pregnancy-related and pregnancy-associated deaths is useful for countries with low maternal mortality figures. The use of various data-collection methods may substantially increase the quality of maternal mortality statistics.

Documented deaths of hepatic lobe donors for living donor liver transplantation

The actual risk of death in hepatic lobe donors for living donor liver transplantation (LDLT) is unknown because of the lack of a comprehensive database. In the absence of a definitive estimate of the risk of donor death, the medical literature has become replete with anecdotal reports of donor deaths, many of which cannot be substantiated. Because donor death is one of the most important outcomes of LDLT, we performed a comprehensive survey of the medical and lay literature to provide a referenced source of worldwide donor deaths. We reviewed all published articles from the medical literature on LDLT and searched the lay literature for donor deaths from 1989 to February 2006. We classified each death as "definitely," "possibly," or "unlikely" related to donor surgery. We identified 19 donor deaths (and one additional donor in a chronic vegetative state). Thirteen deaths and the vegetative donor were "definitely," 2 were "possibly," and 4 were "unlikely" related to donor surgery. The estimated rate of donor death "definitely" related to donor surgery is 0.15%. The rate of donor death which is "definitely" or "possibly" related to the donor surgery is 0.20%. This analysis provides a source document of all identifiable living liver donor deaths, provides a better estimate of donor death rate, and may provide an impetus for centers with unreported deaths to submit these outcomes to the liver transplantation community.

Mortality of the Extreme Aged in the United States in the 1990S, Based on Improved Medicare Data

The most extensive mortality experience of very old persons in North America is the experience reflected in the master records of Medicare enrollment. Furthermore, the data are of high quality; for example, the age in the record generally is not a mere allegation, but rather is supported by documentation. Indeed, this experience is used for the older ages in the construction of the decennial U.S. life tables. Even the best data, however, are not free of error, and the Medicare data contain errors of duplicate information, incorrect ages, and unreported deaths. These errors understandably are most serious at the oldest ages, when the true experience is least extensive. We have undertaken several initiatives at the microdata level to improve the quality of the information, and we report those initiatives and the mortality probabilities that were obtained in this paper.‡

Unreported Deaths Underplay Importance of Thromboembolism

Unreported Deaths Underplay Importance of Thromboembolism

Unreported Deaths Underplay Importance of Thromboembolism

Unreported Deaths Underplay Importance of Thromboembolism

Suicide rates in China, 1995–99

A wide range of suicide rates are reported for China because official mortality data are based on an unrepresentative sample and because different reports adjust crude rates in different ways. We aimed to present an accurate picture of the current pattern of suicide in China on the basis of conservative estimates of suicide rates in different population cohorts. Suicide rates by sex, 5-year age-group, and region (urban or rural) reported in mortality data for 1995-99 provided by the Chinese Ministry of Health were adjusted according to an estimated rate of unreported deaths and projected to the corresponding population. We estimated a mean annual suicide rate of 23 per 100,000 and a total of 287,000 suicide deaths per year. Suicide accounted for 3(.)6% of all deaths in China and was the fifth most important cause of death. Among young adults 15-34 years of age, suicide was the leading cause of death, accounting for 19% of all deaths. The rate in women was 25% higher than in men, mainly because of the large number of suicides in young rural women. Rural rates were three times higher than urban rates-a difference that remained true for both sexes, for all age-groups, and over time. Suicide is a major public-health problem for China that is only gradually being recognised. The unique pattern of suicides in China is widely acknowledged, so controversy about the overall suicide rate should not delay the development and testing of China-specific suicide-prevention programmes.

Undiagnosed and Unreported AIDS Deaths: Results From the San Francisco Medical Examiner

Undiagnosed and Unreported AIDS Deaths: Results From the San Francisco Medical Examiner

Undiagnosed and unreported AIDS deaths: results from the San Francisco Medical Examiner.

To determine whether AIDS surveillance misses a substantial number of persons who die with unreported AIDS, we conducted a cross-sectional survey of decedents examined by the San Francisco (SF) Medical Examiner. Decedents who received toxicology screening were tested for HIV antibody and examined for evidence of AIDS. Names of decedents with positive or indeterminate HIV antibody test results were cross-referenced against the SF AIDS registry to identify previously reported AIDS cases. Medical records of unreported cases were reviewed to determine whether AIDS had been diagnosed prior to death. Of 1959 decedents tested, 176 (9%) were HIV positive; 105 (60%) were identified as having AIDS by the Medical Examiner. Of the 105 AIDS cases, 101 (96%) had been previously diagnosed; 98 (97%) had been previously reported. Overall, diagnosis and reporting were 93% complete. HIV-infected decedents were more likely than those uninfected to be men and <45 years old, and less likely to be Asian/Pacific Islander or Native American (p <.001). They were more likely to have died of suicide (p <.05) or drug abuse/overdose (p <.001). In SF, AIDS case reporting is highly complete. Current surveillance activities, which identify cases from health care settings, are appropriate. To decrease deaths among HIV-infected persons, suicide prevention and substance abuse treatment programs are needed.

Interpreting the collapse of the northern cod stock from survey and catch data

Sequential population analysis reconstructions of the northern cod (Gadus morhus) stock using survey and catch data formed the basis for the scientific advice for substantial reductions in catch quotas in the late 1980s. However, the model failed to provide acceptable reconstructions of the population in subsequent stock assessments when data for the 1990s were added. The model assumes constant age-independent instantaneous rate of natural mortality, accurate catch reporting, and a constant linear relationship between the survey index at age and the population size at age. It seems likely that one or more of these assumptions failed to hold around the time of the collapse. Diagnostic studies were carried out to determine the magnitude of the departure from the assumptions required to allow the model to fit the data. Information related to changes in natural mortality, fishing activity, and survey catchability is reviewed to evaluate the plausibility of departures from model assumptions of the magnitude estimated. It is concluded that unreported deaths caused by the offshore fishery may be most plausible as the main contributing factor to lack of model fit but that factors such as increased natural mortality, and possibly changes in survey catchability, also played a role.

Antilymphoblastic Globulin in Renal Transplant Patients: No Allergic Reactions: A Correction

To the Editor. —The University of Minnesota wishes to correct the public record. An article appearing in the October 11, 1976, issue ofJAMAentitled Antilymphoblastic Globulin in Renal Transplant Patients: No Allergic Reactions1incorrectly referred to Richard Condie as Richard Condie, PhD. Mr Condie did not possess, and to our best knowledge does not possess, a PhD degree or any degree beyond the baccalaureate. A recent federal indictment has named Mr Condie and others regarding unreported deaths of patients associated with administration of antilymphoblast globulin.2I can say that none of the unreported deaths occurred in the 50 patients reported in theJAMAarticle. This letter was shown to Mr Condie, who declined to reply. At the time this request was made, Dr Chou was interim dean of the University of Minnesota Medical School.—Ed.

Antilymphoblastic globulin in renal transplant patients: no allergic reactions: a correction

<h3>To the Editor.</h3> —The University of Minnesota wishes to correct the public record. An article appearing in the October 11, 1976, issue of<i>JAMA</i>entitled "Antilymphoblastic Globulin in Renal Transplant Patients: No Allergic Reactions"¹incorrectly referred to Richard Condie as Richard Condie, PhD. Mr Condie did not possess, and to our best knowledge does not possess, a PhD degree or any degree beyond the baccalaureate. A recent federal indictment has named Mr Condie and others regarding unreported deaths of patients associated with administration of antilymphoblast globulin.²I can say that none of the unreported deaths occurred in the 50 patients reported in the<i>JAMA</i>article. <i>This letter was shown to Mr Condie, who declined to reply. At the time this request was made, Dr Chou was interim dean of the University of Minnesota Medical School</i>.—Ed.

Application of two secondary documentary sources to identify the underreporting of fatal occupational injuries in Cape Town, South Africa.

We reviewed 8,502 deaths registered at the Salt River state mortuary, Cape Town (medical examiner records) for an 18-month period (1/1/90-6/30/91). When fatal occupational injuries located from this data source were matched with the records of the occupational safety inspectorate of the Department of Manpower, it was found that 28% had not been reported in terms of statutory regulations. Unreported deaths accounted for 25% of all fatal occupational injuries in the construction industry. None of the fatal occupational injuries in agriculture and fishing had been reported. Falls constituted 45% of the unreported fatalities. High levels of unreported fatal occupational injury indicate deficiencies in current occupational safety surveillance and enforcement in South Africa.

The AIDS Epidemic: Estimating Survival After AIDS Diagnosis From Surveillance Data

Survival analysis based on reported acquired immune deficiency syndrome (AIDS) cases from the surveillance data maintained by the Centers for Disease Control (CDC) leads to severe bias because of a sizable fraction of unreported deaths. One approach to this problem is to condition the analysis on reported deaths, but this approach presents several difficulties. First, only the individuals who die within a chronologic time interval defined by the analysis may be observed. Second, this right-truncated sampling process is complicated by the delay in reporting death to the surveillance system, and as a result, only a proportion of those who die within the defined time interval are reported. Third, the time each death is reported to the surveillance system, which is essential for the construction of a joint likelihood of survival and reporting delay, may not be available. Fourth, deaths that occurred before 1984 all had unknown times of death. As a consequence, the direct implementation of the joint likelihood...