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Despite efforts to reduce stillbirths and neonatal deaths, inconsistent definitions and reporting practices continue to hamper global progress. Existing data frequently being limited in terms of quality and comparability across countries. This paper addresses this critical issue by outlining the new International Classification of Disease (ICD‐11) recommendations for standardized recording and reporting of perinatal deaths to improve data accuracy and international comparison. Key advancements in ICD‐11 include using gestational age as the primary threshold to for reporting, clearer guidance on measurement and recording of gestational age, and reporting mortality rates by gestational age subgroups to enable country comparisons to include similar populations (e.g., all births from 154 days [22+0 weeks] or from 196 days [28+0 weeks]). Furthermore, the revised ICD‐11 guidance provides further clarification around the exclusion of terminations of pregnancy (induced abortions) from perinatal mortality statistics. Implementing standardized recording and reporting methods laid out in ICD‐11 will be crucial for accurate global data on stillbirths and perinatal deaths. Such high‐quality data would both allow appropriate regional and international comparisons to be made and serve as a resource to improve clinical practice and epidemiological and health surveillance, enabling focusing of limited programmatic and research funds towards ending preventable deaths and improving outcomes for every woman and every baby, everywhere. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of revision of Australian mortality statistics every year since 2007 on numbers and rates of suicide and 'hidden suicide'. Method: Nine months after the end of each year, the Australian Bureau of Statistics releases preliminary statistics concerning deaths registered in that year, together with revised and finalised data regarding previous years. Numbers and rates of suicide and of deaths coded to selected categories of accidental, undetermined and unknown cause deaths were tabled. Results: Upward revision of suicide and accidental drug poisoning death numbers, three years after first release, show that true rates are substantially higher than initially released data suggested. Concomitant downward revision of rates of undetermined and unknown cause deaths supports evidence that at first release some suicides are coded to these categories. Conclusions: Australia's finalised suicide data are likely to be more accurate than equivalent data from nations that do not revise mortality data. More comprehensive investigation (including verbal or psychological autopsy) in doubtful cases in Australia and elsewhere would probably lead to reported suicide rates being higher. [ABSTRACT FROM AUTHOR]

This article describes patterns in the homicides committed in Estonia since the 1990s. The overall decreasing trend in mortality is first described using mortality statistics. Based on a dataset of court verdicts spanning the 2016−2023 period, we extend previous research in this domain by describing current homicide patterns. To reflect on changes, we compare the results yielded by our investigation with those obtained in prior key studies. According to our analyses, mortality due to homicide exhibited a relatively stable trend over the last decade, with alcohol as a major contributor to most of these incidents. At the same time, there has been a decrease in economically motivated cases, as well as in homicides committed with firearms. Guided by these results, we provide suggestions for future research aimed at contributing to the European Homicide Monitor (EHM) database. [ABSTRACT FROM AUTHOR]

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The article examines the 1918-1920 excess mortality data from Spanish flu epidemic in Florence, Italy. Two local documentary sources (the statistical abstracts published by the town administration and the admission registers of the Florence main hospital) provide empirical evidence for a revision of the national mortality data. The Italian case-study shows a pronounced excess mortality among women, as it happened even in England and India. Specific social and epidemiological explanations are debated. The Spanish flu was not socially-neutral; it did not change the traditional nexus between economic poverty and sanitary vulnerability. [ABSTRACT FROM AUTHOR]

Aim. To assess the dynamics and structure of coronary artery disease (CAD) mortality rates in the Russian Federation (RF) and a number of regions.Material and methods. The study analyzed the dynamics of the mortality structure and the reliability of CAD mortality rates in the Russian Federation and a number of regions before and during the coronavirus disease 2019 (COVID-19) pandemic. For the analysis, statistical data of the Russian Ministry of Health and Rosstat C52 tables for 2019-2022 were used. The study used statistical and analytical methods. MSOffice Excel 2019 was used for data processing. The correct coding of death causes was determined by expert analysis.Results. In the Russian Federation and the regions studied in 2019-2022, there was no general trend due to territorial differences in the dynamics of CAD mortality rates and the proportion of acute and chronic CAD forms. An expert assessment in the studied Russian regions revealed errors in the preparation of medical certificate of cause of death. A decrease in the proportion of acute CAD types was noted in the Russian Federation as a whole, as well as in the Samara, Kaliningrad, and Tula regions, and an increase in the Belgorod and Tomsk regions. A decrease in the proportion of chronic CAD forms was noted in the Tula region, and an increase in the Russian Federation as a whole, Samara, Kaliningrad, Tomsk and Belgorod regions. An expert assessment in the studied regions revealed the following peculiarities in death certificates: the proportion of certificates with three completed lines of part 1 of paragraph 22 ranges from 11,1 to 30,3%.Conclusion. The high CAD mortality rate in the studied regions is associated mainly with errors in the selection of chronic CAD forms as the initial cause of death. Differences in mortality rates from CAD in a number of regions are associated with the incorrect selection, most often, of chronic forms as the initial cause of death before and after the COVID-19 pandemic.

Mortality statistics are the basis for analysing and conducting epidemiological studies focusing on the leading causes of death categorised by age, sex and other demographic parameters. These studies are the foundation for analyzing disease etiology and evaluating diagnostic practices, leading to improved disease prevention and patient care. It is therefore essential that professionals responsible for mortality registration ensure that accurate, comprehensive, reliable and timely information is provided. The aim of this article is to present an analysis of the current status of mortality reporting in Bulgaria and the advantages of reporting deaths by cause with the new revision of the International Classification of Diseases (ICD-11) compared to the previous ICD-10, focusing on the effective adoption of modern technologies for more accurate and automated methods of coding deaths by cause. [ABSTRACT FROM AUTHOR]

Increasing the life expectancy of the Russian population is the most important goal of the country’s national policy. Due to the COVID-19 pandemic, this indicator has decreased in most countries worldwide, including Russia, which necessitates research in this domain. Life expectancy levels greatly vary across Russian regions. The goal of this study is to evaluate the extent to which the targeted life expectancy goals have been attained in the Arctic regions of the Russian Federation. The study relies on the systems approach, the critical approach, content analysis, and demographic analysis. The novelty of the study lies in the conclusion that the life expectancy target outlined in the Strategy for the Development of the Arctic Zone of the Russian Federation and Provision of National Security for the Period up to 2035, aimed at reaching the level of 78 years by 2024, will not be met. This assertion is substantiated by an analysis of long-term trends. The Arctic regions are categorized based on their progress toward the strategic life expectancy goal: the Yamalo-Nenets Autonomous District has come closest to achieving it, while the Krasnoyarsk Territory, the Republic of Karelia, and the Arkhangelsk Region face the most challenging circumstances. We have identified key avenues for increasing life expectancy in each Arctic region, with measures to prevent mortality from external causes showing significant potential for reducing premature deaths. A comparative analysis shows that at the current state of healthcare infrastructure development in Russia, regional differences do not exert a decisive impact on life expectancy. Therefore, it is recommended to strengthen efforts to encourage regular medical check-ups, making them an annual practice for all age groups. This approach would facilitate the early diagnosis of critical illnesses and reduce premature mortality. As a rule, the availability of medical services in the Russian Arctic is higher than the average around the country, as evidenced by statistical data on the development of a network of medical institutions and their medical staffing. Also, most Arctic regions have a lower proportion of the rural population than the national average, with the exception of the Republic of Sakha (Yakutia) and the Chukotka Autonomous Okrug. Telemedicine and mobile healthcare services should be used more actively, particularly in locations such as remote settlements, onshore and offshore oil platforms, and nomadic routes. There is a need for an effective mechanism of government support for corporate employee wellness programs that make a real contribution to reducing the loss of work time due to sick leaves. It is also vital to promote a healthy lifestyle, engaging the population in physical activities and sports, as the Russian Arctic already has the necessary facilities and conditions.

The system to collect information on mortality statistics in Lao PDR is not well established, accurate and timely death information is therefore not available. This article reports the system and process to make the mortality statistical data of Lao PDR. The country has a paper-based resident registration system, using a death notification document, a death certificate, and a family census book. The death notification document is important as it provides the cause of death, which is issued from a health facility and the village office. In the event of a death occurring at home, the family representative needs to report to the village office verbally to obtain a death notification document. On the other hand, if the death occurred in a medical facility, a death notification document from a health facility is provided. The family representative should bring the death notification document to the district Home Affairs office to register the death and obtain a death certificate. After that, the family representative needs to bring the death certificate to the district Public Security office for an amendment in the family census book. ICD-10 is under development regarding death notification from health facilities under the Ministry of Health. However, it is unclear how death notification from village offices can adopt ICD-10 as the majority of deaths occur outside health facilities. A comprehensive and integrated mortality reporting system is necessary in order to create a holistic health policy and welfare for the country. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the profile of hospital morbidity and mortality due to COPD in Brazil between 2011 and 2021, in order to understand the evolution of related health indicators and identify the need for improvement in public policies for prevention and treatment strategies. for the disease. From the processed information, a significant decrease in the prevalence of hospitalizations for COPD was evidenced. The age groups that represented the highest numbers of hospitalizations were "50 years or older" and "under 5 years". Proportional mortality declined, while COPD-specific mortality did not change statistically significantly over the entire decade. Mortality showed an increasing pattern according to age group, with more than 40% of deaths occurring in individuals aged 80 years or older. The highest numbers of hospitalizations and deaths occurred in the Southeast, South and Northeast regions, with a predominance of males. COPD is a problem that requires greater attention from health services, because despite the decrease in hospitalizations due to exacerbations, severe forms of the disease are still frequent, which highlights weaknesses in the primary and secondary prevention of the disease. Thus, new studies that extensively investigate the factors that determine the epidemiological behavior of the disease are fundamental, because only in this way can strategies and interventions be developed to improve trends in hospitalization and mortality due to COPD in Brazil. [ABSTRACT FROM AUTHOR]

Quantitative evidence and metrics play a central role in contemporary global health. Mortality statistics, for example, are considered essential for improving health in the global South. Yet, many observers lament that reliable cause of death data is not available for many low- and middle-income countries. The Million Death Study (MDS) in India forms an effort to address this issue, seeking to reduce ignorance around mortality by generating representative statistics by combining an existing, representative demographic sample with an innovative diagnostic method called verbal autopsy. Yet, ignorance is more than the absence of reliable mortality statistics in this study. Social science perspectives on institutionalized ignorance can help unpack how certain paradoxes of evidence-based global health manifest through three different articulations of ignorance in the MDS. First, the study's simultaneously national and global ambitions intersect in arguments that present ignorance as legitimation for the study. Second, ignorance is presented as instrumental in balancing the need for expertise with the risk of bias in diagnosing causes of death. Third, MDS researchers dismiss remaining ignorance or uncertainty about diagnoses, by claiming it is relative compared to the 'actionability' of study results for improving public health. In exploring these various manifestations of institutionalized ignorance, several paradoxes of the MDS as an evidence-based global health project become visible. By exploring these paradoxes, this analysis suggests that studies of institutionalized ignorance can provide novel perspectives on how deliberate articulations and mobilization of ignorance helps constitute evidence-based global health. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to understand the information architecture and degree of integration of mortality surveillance systems in Ghana and Peru.Methods: We conducted a cross-sectional study using a combination of document review and unstructured interviews to describe and analyse the sub-systems collecting mortality data.Results: We identified 18 and 16 information subsystems with independent databases capturing death events in Peru and Ghana respectively. The mortality information architecture was highly fragmented with a multiplicity of unconnected data silos and with formal and informal data collection systems.Conclusion: Reliable and timely information about who dies where and from what underlying cause is essential to reporting progress on Sustainable Development Goals, ensuring policies are responding to population health dynamics, and understanding the impact of threats and events like the COVID-19 pandemic. Integrating systems hosted in different parts of government remains a challenge for countries and limits the ability of statistics systems to produce accurate and timely information. Our study exposes multiple opportunities to improve the design of mortality surveillance systems by integrating existing subsystems currently operating in silos.

In order to understand the dimensions and consequences of the Spanish flu, the great influenza pandemic of 1918-1920, it is necessary to carry out analytical research at the local and regional level, in order to compare the results with similar research carried out in other national and international contexts. The Glocal Spanish Influenza project focuses on the case of Tuscany and aims to reconstruct both the number of deaths and the number of sick peoplemortality and morbidity figures, as well as the institutional responses to the crisis, the political consequences, collective behaviour, memories and displacements. Here we present two contributions by Roberto Bianchi, who compares the Spanish flu and Covid-19, and by Giovanni Gozzini, who analyses the numbers of the Spanish flu. [ABSTRACT FROM AUTHOR]

Abstract Background In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh. Methods Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool. Results Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates. Conclusions Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems.

Objectives: Inaccuracies in cause-of-death information in death certificates can reduce the validity of national death statistics and result in poor targeting of resources to reduce morbidity and mortality in people with HIV. Our objective was to measure the sensitivity, specificity, and agreement between multiple causes of deaths from death certificates obtained from the National Death Index (NDI) and causes determined by expert physician review. Methods: Physician specialists determined the cause of death using information collected from the medical records of 50 randomly selected HIV-infected people who died in San Francisco from July 1, 2016, through May 31, 2017. Using expert review as the gold standard, we measured sensitivity, specificity, and agreement. Results: The NDI had a sensitivity of 53.9% and a specificity of 66.7% for HIV deaths. The NDI had a moderate sensitivity for non–AIDS-related infectious diseases and non–AIDS-related cancers (70.6% and 75.0%, respectively) and high specificity for these causes (100.0% and 94.7%, respectively). The NDI had low sensitivity and high specificity for substance abuse (27.3% and 100.0%, respectively), heart disease (58.3% and 86.8%, respectively), hepatitis B/C (33.3% and 97.7%, respectively), and mental illness (50.0% and 97.8%, respectively). The measure of agreement between expert review and the NDI was lowest for HIV (κ = 0.20); moderate for heart disease (κ = 0.45) and hepatitis B/C (κ = 0.40); high for non–AIDS-related infectious diseases (κ = 0.76) and non–AIDS-related cancers (κ = 0.72); and low for all other causes of death (κ < 0.35). Conclusions: Our findings support education and training of health care providers to improve the accuracy of cause-of-death information on death certificates. [ABSTRACT FROM AUTHOR]

Abstract Background The vital registration system is universally recognized as the main source of mortality data which is essential for policy formulation, proper interventions and resource allocation to address priority health challenges. To improve availability and quality of mortality statistics by strengthening the vital registration system, understanding the current vital registration system is essential. This study identified challenges in generating reliable mortality statistics in the vital registration system of Myanmar. Methods Qualitative methods were used to collect data in two selected townships of Mandalay Region. Grey literature related to the management of mortality registration was reviewed; in-depth interviews of sixteen key informants and fourteen focus group discussions were conducted with those involved in death registration at the local level, such as healthcare providers, local administrators and knowledgeable adults in households where deaths occurred during the past three years. Thematic analysis was performed to identify system barriers in the death registration process. Results Weaknesses in the death registration system are classified in three areas: a) administrative which includes the lack of enforcement of mandatory death registration, limited issuance of death certificates and no formal mandatory notification of death events by households and; b) technical which includes absence of proper and regular on-the-job trainings, ineffective cause-of-death certification practice for deaths in the communities and the absence of routine data plausibility checks at the local level; and c) societal which includes poor community awareness and inadequate participation in death registration. Conclusion The study highlighted challenges in the death registration system at the operational level, which undermines the achievement of a satisfactory level of completeness and accuracy of mortality data. We recommend establishing a strong legal framework, improving technical capacities and raising public awareness and cooperation to strengthen the system that can generate reliable mortality statistics.

Background: In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh.Methods: Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool.Results: Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates.Conclusions: Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems. [ABSTRACT FROM AUTHOR]

Introduction Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk. Objective To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015. Methods Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography. Results There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Moran’s I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors. Conclusions The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.

Simone de Vries,1 Michael Schaapveld,1 Jan WPF Kardaun,2,3 Kim H de Bruin,2 Augustinus DG Krol,4 Pieternella J Lugtenburg,5 Judy N Jacobse,1 Berthe MP Aleman,6 Flora E van Leeuwen1 1Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; 2Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands; 3Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands; 4Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands; 5Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; 6Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands Objective: Obtaining accurate data about causes of death may be difficult in patients with a complicated disease history, including cancer survivors. This study compared causes of death derived from medical records (CODMR) with causes of death derived from death certificates (CODDC) as processed by Statistics Netherlands of patients primarily treated for Hodgkin lymphoma (HL) or breast cancer (BC).Methods: Two hospital-based cohorts comprising 1,215 HL patients who died in the period 1980–2013 and 714 BC patients who died in the period 2000–2013 were linked with cause-of-death statistics files. The level of agreement was assessed for common underlying causes of death using Cohen’s kappa, and original death certificates were reviewed when CODDC and CODMR showed discrepancies. We examined the influence of using CODDC or CODMR on standardized mortality ratio (SMR) estimates.Results: Agreement for the most common causes of death, including selected malignant neoplasms and circulatory and respiratory diseases, was 81% for HL patients and 97% for BC patients. HL was more often reported as CODDC (CODDC=33.1% vs. CODMR=23.2%), whereas circulatory disease (CODDC=15.6% vs. CODMR=20.9%) or other diseases potentially related to HL treatment were more often reported as CODMR. Compared to SMRs based on CODDC, SMRs based on CODMR complemented with CODDC were lower for HL and higher for circulatory disease.Conclusion: Overall, we observed high levels of agreement between CODMR and CODDC for common causes of death in HL and BC patients. Observed discrepancies between CODMR and CODDC frequently occurred in the presence of late effects of treatment for HL. Keywords: cause of death, Hodgkin lymphoma, breast cancer, mortality statistics

Abstract For our master thesis in medicine, we aimed to determine how many deaths were caused by and with dementia in 2014 and we compared our results with figures from abroad. The mortality rates of 2014 in Flanders were used to determine the amount of deaths related to dementia. These figures are collected by Vlaams Agentschap Zorg & Gezondheid (VAZG) and coded per ICD-10 classification. Of all deaths in Flanders in 2014, 6.60% were caused by dementia and 4.29% were caused by another condition, while also suffering from dementia. Data from abroad are ambiguous. While working on our thesis about “death & dementia”, we questioned the reliability of mortality statistics. Possible explanations could be; the complexity of completing death certificates correctly and the challenges involved in properly constructing a chain of causes of death. The accuracy of mortality data can be improved by training and redrafting death certificates.

Objectives: Cause-of-death information, reported by frontline clinicians after a patient's death, is an irreplaceable source of public health data. However, systematic bias in cause-of-death reporting can lead to over- or underestimation of deaths attributable to different causes. New York City consistently reports higher rates of deaths attributable to pneumonia and influenza than many other US cities and the country. We investigated systematic erroneous reporting as a possible explanation for this phenomenon. Methods: We reviewed all deaths from 2 New York City hospitals during 2013-2014 in which pneumonia or influenza was reported as the underlying cause of death (n = 188), and we examined the association between erroneous reporting and multiple extrinsic factors that may influence cause-of-death reporting (patient demographic characteristics and medical comorbidities, time and hospital location of death, type of medical provider reporting the death, and availability of certain diagnostic information). Results: Pneumonia was erroneously reported as the underlying cause of death in 163 (86.7%) reports. We identified heart disease and dementia as the more likely underlying cause of death in 21% and 17% of erroneously reported deaths attributable to pneumonia, respectively. We found no significant association between erroneous reporting and the multiple extrinsic factors examined. Conclusions: Our results underscore how erroneous reporting of 1 condition can lead to underreporting of other causes of death. Misapplication or misunderstanding of procedures by medical providers, rather than extrinsic factors influencing the reporting process, are key drivers of erroneous cause-of-death reporting. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate cause of death reporting is vital in the pandemic circumstance for effective planning of the control measures. Accurate reporting and registration of the reason for death are crucial in planning of health programs in turn contributing for the national development. Background: All births and deaths occurring across India should be mandatorily registered per the Registration of Births and Deaths Act passed in the year 1969. The act also requires the issuance of cause of death certificate by the doctor attending the departed during his last illness. Data obtained from the cause of death certificate provides cause-specific mortality profile, which is required to analyze the health trends of the population. Review results: This article discusses the available guidelines on the appropriate documentation of cause of death in the confirmed or suspected coronavirus disease-2019 (COVID-19) infection resulting into death. Conclusion: Proper certification of the cause of death leads to better epidemic surveillance. Scrutiny of the clinical sequences from the cause of death certificate is useful to prioritize the allocation of resources for critical care management and to augment our knowledge about underlying causes resulting in mortality from COVID-19. Clinical significance: Dissemination of available guidelines on proper documentation of the cause of death in confirmed/suspected COVID-19 cases will reduce the errors in cause of death reporting. [ABSTRACT FROM AUTHOR]

• The COVID-19 pandemic had a significant impact on violent deaths in the Šumadija region (Central Serbia). • There is an overall increase in the number of violent deaths and a major impact on deaths due to domestic violence. • Policies to address domestic violence should be prioritized during the pandemic and beyond. • Strategies should be developed to mitigate the effects of future pandemics or lockdowns. The COVID-19 pandemic has had a significant impact on various aspects of society, including crime rates. In Serbia, it is important to examine the changes in violent deaths before and during the pandemic to inform public health and safety policies. We conducted a retrospective, epidemiological, cross-sectional analytical study of medico-legal autopsies in the Department of Forensic Medicine and Toxicology at the University Clinical Center of Kragujevac. Our study sample comprises all forensic autopsy cases examined from January 2017 to December 2019 (151 cases), labeled as "Before," and from January 2020 to December 2022 (192 cases), labeled as "During" the pandemic period. Natural deaths, skeletal remains, and undetermined cases were excluded from our sample. The data show an increase in the total number of incidents reported from 152 in the "Before" period to 191 in the "During" period. The proportion of incidents involving males remained relatively stable at around 70%, while the proportion of incidents involving females increased. There was no statistically significant change in the proportion of incidents classified as accidental, while the proportion of incidents classified as homicide and suicide increased. The results show a statistically significant association between gender and incident type for both the "Before" and "During" periods. Deaths due to domestic violence have increased by 22.2% during the pandemic, which is cause for concern. In terms of demographic characteristics, males and younger individuals were more likely to be victims of violent deaths both before and during the pandemic. The COVID-19 pandemic had a significant impact on violent deaths in the Šumadija region (Central Serbia), with an overall increase in the number of violent deaths and a major impact on deaths due to domestic violence. Policies to address domestic violence should be prioritized during the pandemic and beyond, and strategies should be developed to mitigate the effects of future pandemics or lockdowns. [ABSTRACT FROM AUTHOR]

A lawful disposal of human dead body is only possible after establishment of proper and valid cause of death. If the cause is obscure, autopsy is the only mean of search. Inadequacy and unavailability of health care facility often makes this situation more complicated in developing countries where many deaths remain unexplained and proper mortality statistics is missing, especially for infant and children. Tissue sampling by needle autopsy or use of various imaging technique in virtopsy have been tried globally to find out an easier alternative. An exclusive and unique initiative, by limited autopsy through tissue biopsy and body fluid analysis, has been taken to meet this dire need in African and some of Asian developing countries, as worldwide accepted institutional data are even missing or conflicting at times. Traditional autopsy has changed little in last century, consisting of external examination and evisceration, dissection of organs with identification of macroscopic pathologies and injuries, followed by histopathology. As some population groups have religious objections to autopsy, demand for minimally invasive alternative has increased of late. But assessment of cause of death is most important for medico-legal, epidemiological and research purposes. Thus minimally invasive technique is of high importance in primary care settings too. In this article, we have made a journey through different autopsy methods, their relevance and applicability in modern day perspective considering scientific research articles, textbooks and interviews.

This study seeks to establish whether medico-legal practitioners differ in their autopsy conclusions within and across medico-legal institutions. Data include 459 violent deaths (homicides, suicides, and accidents) autopsy reports written by more than 20 death certifiers from four medico-legal institutions in two countries (France and the United States). Multinomial models show that compared with accidental deaths, weapon use and decedents' characteristics both influence a homicide verdict, but not a suicide one. In addition, French practitioners are more likely than Americans to reach a conclusion of homicide or suicide compared with accident, and homicides are more likely to be certified by male practitioners. [ABSTRACT FROM AUTHOR]

One of the most frequently used indicators for the quality of mortality statistics is the use of R-codes as the cause of death (COD) in death certificates. The aim of this study was to analyse the coding of ill-defined and unknown causes of death in the Republic of Serbia (RS). The data for this descriptive study, covering a ten-year period (2006-2015), were obtained from the National Mortality Register. Since population and economic features differ widely between regions in RS, we compared the Belgrade region (BR) with other regions (Or). We estimated the frequency of certain types of death investigation methods regarding R00-99-coded deaths. The frequency of R-codes, by subcategories, and code-specific mortality rates were calculated by region for each year. The use of R-codes was significantly lower in BR than in Or (OR 0.85; 95% CI, 0.84-0.66; p < 0.001). The most frequent method of determining COD was external examination of the body, both in BR and Or (60.7% and 85.5%, respectively). The rate of forensic autopsies in BR was 38.1% while in Or it was only 3.6%. Clinical autopsies were performed in 1% of deaths in BR, compared to 0.5% in Or. Our results suggest that in BR the use of R-codes compared to other CODs has decreased over the past years while there has been an increasing trend in autopsy proportions; in Or the frequency of R-codes, as well as of autopsy proportions, has remained unchanged. [ABSTRACT FROM AUTHOR]

We believe that forensic medicine should play a significant role in the COVID-19 pandemic. Forensic pathologists should ask and answer various questions through autopsy cases during the COVID-19 period, thus providing a significant contribution to science. Some of the potential roles of forensic medicine in this issue include: determining the exact cause of death among the deceased who were SARS-CoV-2 positive, contribution to the accuracy of mortality statistics, understanding pathological mechanisms of COVID-19, tracking the presence of the virus over time, survival of the virus after death as well as dealing with medicolegal issues. A detailed multidisciplinary analysis of autopsy samples would undoubtedly help understand this new illness and its clinical management. Therefore, autopsies during the COVID-19 pandemic should not be an exception, but certainly a rule. [ABSTRACT FROM AUTHOR]

A descriptive and cross-sectional study of the 9 211 dead patients due to all causes was carried out in Santiago de Cuba province during 2017, with the aim of describing the mortality profile in that period. In the series an increment of the general mortality was observed when compared to 2016; also, as main causes of death there were heart diseases, malignant tumors and cerebrovascular diseases. The municipalities that prevailed in the mortality profile were Contramaestre, San Luis, Songo-La Maya, Santiago de Cuba and III Frente, mainly due to heart diseases. On the other hand, the greatest risk of dying due to malignant tumors in the female patients obeyed to the localization in lung, breast and intestine, except in the rectum; in the men, in prostate, lung and colon, respectively. It is recommended to direct the efforts in health according to the stratified risk in this province. [ABSTRACT FROM AUTHOR]

An index of fatal toxicity for new psychoactive substances has been developed based solely on information provided on death certificates. An updated index of fatal toxicity (Tf), as first described in 2010, was calculated based on the ratio of deaths to prevalence and seizures for the original five substances (amphetamine, cannabis, cocaine/crack, heroin and 3,4-methylenedioxymethylamphetamine)*. These correlated well with the 2010 index. Deaths were then examined for cases both where the substance was and was not found in association with other substances. This ratio (sole to all mentions; S/A) was then calculated for deaths in the period 1993 to 2016. This new measure of fatal toxicity, expressed by S/A, was well-correlated with the index Ln (Tf) of the original reference compounds. The calculation of S/A was then extended to a group of new psychoactive substances where insufficient prevalence or seizure data were available to directly determine a value of Tf by interpolation of a graph of Tf versus S/A. Benzodiazepine analogues had particularly low values of S/A and hence Tf. By contrast, γ-hydroxybutyrate/γ-butyrolactone, α-methyltryptamine, synthetic cannabinoid receptor agonists and benzofurans had a higher fatal toxicity. [ABSTRACT FROM AUTHOR]

The cause-of-death (COD) statement on the standard US death certificate is a valuable tool for public health practice, but its utility is impaired by reporting inaccuracies. To assess the quality of CODs reported in New York City, we developed and applied a quality measure to 3 leading CODs: cancer, pneumonia, and diabetes. The COD quality measure characterized 5 common issues with COD completion: nonspecific conditions as the underlying COD (UCOD); UCOD discrepancies; the presence of only 1 informative cause on the entire certificate; competing causes listed together on 1 line; and clinically improbable sequences. COD statements with more than 1 quality issue were defined as statements of "limited" quality. Of 82,116 deaths with cancer, diabetes, or pneumonia assigned as the UCOD in New York City from 2010 to 2014, 66.8% of pneumonia certificates were classified as "limited" quality as compared with 45.6% of cancer certificates and 32.3% of diabetes certificates. Forty percent of cancer certificates listed only 1 informative condition on the death certificate. Almost half of pneumonia certificates (45.9%) contained only enough information to assign International Classification of Diseases, Tenth Revision, code J18.9 ("unspecified pneumonia") as the UCOD, whereas most diabetes certificates contained UCOD discrepancies (25.2%). These limitations affect the quality of mortality data but may be reduced through quality improvement efforts. [ABSTRACT FROM AUTHOR]

Diseases of the musculoskeletal system (DMSS) are a topical social, medical, and economic problem. They are widespread and account for about 10% of the overall morbidity and primary disability of population, about 5% of primary morbidity, and about 0.1% of mortality. The reliable statistics are important to analyze the situation and make necessary adjustments to the organization of medical care.Objective. To examine the accuracy of the data on morbidity and mortality from DMSS in the Tula region.Materials and Methods. Data from statistical reports, reference documents, and databases of Tula region residents (including those who died in 2000–2011) were used.Results. The inequality in growth rates of general and primary morbidity were revealed, which is indicative of incorrect coding and underestimation of DMSS in medical organizations of the Tula region.A comprehensive phased statistical study was carried out to assess validity of the mortality data, including the following: verification of databases for errors using an automated system; control of postmortal diagnosis quality using the four-digit subcategory code in accordance with the WHO recommendations; analysis according to the initial and multiple causes of death. Underestimation of mortality from rheumatoid arthritis by about 25% was revealed. Attention was paid to the implementation and use of automated systems.

Objective: Errors in cause and manner of death on death certificates are common and affect families, mortality statistics, and public health research. The primary objective of this study was to characterize errors in the cause and manner of death on death certificates completed by non-Medical Examiners. A secondary objective was to determine the effects of errors on national mortality statistics. Methods: We retrospectively compared 601 death certificates completed between July 1, 2015, and January 31, 2016, from the Vermont Electronic Death Registration System with clinical summaries from medical records. Medical Examiners, blinded to original certificates, reviewed summaries, generated mock certificates, and compared mock certificates with original certificates. They then graded errors using a scale from 1 to 4 (higher numbers indicated increased impact on interpretation of the cause) to determine the prevalence of minor and major errors. They also compared International Classification of Diseases, 10th Revision (ICD-10) codes on original certificates with those on mock certificates. Results: Of 601 original death certificates, 319 (53%) had errors; 305 (51%) had major errors; and 59 (10%) had minor errors. We found no significant differences by certifier type (physician vs nonphysician). We did find significant differences in major errors in place of death ( P < .001). Certificates for deaths occurring in hospitals were more likely to have major errors than certificates for deaths occurring at a private residence (59% vs 39%, P < .001). A total of 580 (93%) death certificates had a change in ICD-10 codes between the original and mock certificates, of which 348 (60%) had a change in the underlying cause-of-death code. Conclusions: Error rates on death certificates in Vermont are high and extend to ICD-10 coding, thereby affecting national mortality statistics. Surveillance and certifier education must expand beyond local and state efforts. Simplifying and standardizing underlying literal text for cause of death may improve accuracy, decrease coding errors, and improve national mortality statistics. [ABSTRACT FROM AUTHOR]

A lawful disposal of human dead body is only possible after establishment of proper and valid cause of death. If the cause is obscure, autopsy is the only mean of search. Inadequacy and unavailability of health care facility often makes this situation more complicated in developing countries where many deaths remain unexplained and proper mortality statistics is missing, especially for infant and children. Tissue sampling by needle autopsy or use of various imaging technique in virtopsy have been tried globally to find out an easier alternative. An exclusive and unique initiative, by limited autopsy through tissue biopsy and body fluid analysis, has been taken to meet this dire need in African and some of Asian developing countries, as worldwide accepted institutional data are even missing or conflicting at times. Traditional autopsy has changed little in last century, consisting of external examination and evisceration, dissection of organs with identification of macroscopic pathologies and injuries, followed by histopathology. As some population groups have religious objections to autopsy, demand for minimally invasive alternative has increased of late. But assessment of cause of death is most important for medico-legal, epidemiological and research purposes. Thus minimally invasive technique is of high importance in primary care settings too. In this article, we have made a journey through different autopsy methods, their relevance and applicability in modern day perspective considering scientific research articles, textbooks and interviews. [ABSTRACT FROM AUTHOR]

Objetivo: Evaluar la diferencia en muertes perinatales (MP) ocurridas en Cataluña y su evolución según 2 fuentes de información sanitaria. Métodos: Los datos proceden de la estadística de mortalidad (Departament de Salut e Institut d'Estadística de Catalunya) y del Conjunto Mínimo Básico de Datos de Altas Hospitalarias (CMBDAH) del Servei Català de la Salut del período 2000-2003. Se describen las frecuencias totales de MP según si cumplen o no criterio legal de declaración. Resultados: La estadística de mortalidad registró un 27,2% menos de MP, un 44,77% menos de muertes fetales y un 13,5% más de muertes neonatales precoces que el CMBDAH. Estos porcentajes son menores considerando sólo los casos con criterios legales de declaración. Conclusión: Las diferencias de casos entre ambas fuentes están relacionadas con características del recién nacido: bajo peso al nacer, prematuridad y lugar en que se produjo. Los datos hospitalarios podrían mejorar la estadística de mortalidad perinatal.Objective: To evaluate differences in the number of cases of perinatal mortality in Catalonia (Spain) recorded in 2 health information systems, as well as trends in this phenomenon. Methods: Data were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics) and the minimum data set (MDS) for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteria for reporting. Results: The mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered. Conclusion: The differences between the two sources were related to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal mortality statistics.

Background: Reliable and comparable data on causes of death are crucial for public health analysis, but the usefulness of these data can be markedly diminished when the approach to coding is not standardized across territories and/or over time. Because the Russian system of producing information on causes of death is highly decentralized, there may be discrepancies in the coding practices employed across the country. In this study, we evaluate the uniformity of cause-of-death coding practices across Russian regions using an indirect method. Methods: Based on 2002-2012 mortality data, we estimate the prevalence of the major causes of death (70 causes) in the mortality structures of 52 Russian regions. For each region-cause combination we measured the degree to which the share of a certain cause in the mortality structure of a certain region deviates from the respective interregional average share. We use heat map visualization and a regression model to determine whether there is regularity in the causes and the regions that is more likely to deviate from the average level across all regions. In addition to analyzing the comparability of cause-specific mortality structures in a spatial dimension, we examine the regional cause-of-death time series to identify the causes with temporal trends that vary greatly across regions. Results: A high level of consistency was found both across regions and over time for transport accidents, most of the neoplasms, congenital malformations, and perinatal conditions. However, a high degree of inconsistency was found for mental and behavioral disorders, diseases of the nervous system, endocrine disorders, ill-defined causes of death, and certain cardiovascular diseases. This finding suggests that the coding practices for these causes of death are not uniform across regions. The level of consistency improves when causes of death can be grouped into broader diagnostic categories. Conclusion: This systematic analysis allows us to present a broader picture of the quality of cause-of-death coding at the regional level. For some causes of death, there is a high degree of variance across regions in the likelihood that these causes will be chosen as the underlying causes. In addition, for some causes of death the mortality statistics reflect the coding practices, rather than the real epidemiological situation. [ABSTRACT FROM AUTHOR]

Uma das possibilidades permitidas pelo avanço tecnológico é o estudo da mortalidade por causas múltiplas em contraposição à estatística feita por uma única causa, a chamada causa básica de morte. O conhecimento das várias doenças que contribuem para uma morte permite que seja avaliada a importância das causas que normalmente não estariam privilegiadas nas estatísticas porque são doenças não caracterizadas como causa básica. Um exemplo é a mortalidade por infarto do miocárdio em pessoas com diabetes mellitus. Este último, neste caso e em outros semelhantes, poderá não ser considerado nas estatísticas, enquanto o infarto o será. Desta forma, no exemplo citado, analisando apenas a causa básica, perde-se a informação sobre a magnitude do diabetes e sua relação com as complicações que levam à morte. A idéia da elaboração de estatísticas de mortalidade segundo causas múltiplas não é nova. No entanto não é realizada de forma sistemática, ainda que vários estudos mostrem suas vantagens. Entre essas vantagens estão a possibilidade de descobrir novas associações de doenças; conhecer informações sobre a natureza das lesões em casos de morte por causas externas (acidentes e violências), entre outras. A existência de computadores e de programas específicos para a elaboração das estatísticas de mortalidade, atualmente em uso, deve permitir que essa idéia seja colocada em prática e que, a partir das estatísticas de mortalidade por causas múltiplas, possibilite melhores e mais específicas ações de saúde.The introduction of new technology has made it possible to study multiple causes of death as opposed to mortality statistics based only on the underlying cause of death. The knowledge of all diseases that contribute to one death allows the assessment of the importance of causes that frequently do not appear in mortality statistics, because of those diseases that are not characterized as the underlying cause. An example is the death by myocardial infarction of a person that also has diabetes mellitus. The idea of producing mortality statistics according to multiple causes is not new. However, it is not a routine, although several studies have demonstrated its advantages. Among the advantages is the possibility of finding new associations of diseases and to know the nature of the injury according to the type of accident or violence. The utilization of computers and specific programs for producing mortality statistics enables multiple-cause statistical calculations, a practice that should be stimulated.

Dematerialization of death certificates is an emerging issue worldwide. In Portugal through SICO system, electronic certification has been a reality since 2012. However, with the evolution of technology, there are new needs, that force us to explore a new option: mobile dematerialization for death certificates. With this pioneering project - Mobile SICO – we intend to address the issue of electronic certification through a solution architecture that is close to the needs of users. [ABSTRACT FROM AUTHOR]

Background: In Austria, mortality from diseases of the circulatory system and malignant neoplasms is high and varies among the federal states. Lower mortality in some states indicates a preventive potential in those states with higher mortality.Methods: We computed the number of premature deaths, for women and men separately, from the two leading causes of death, diseases of the circulatory system (ICD-10: I00-I09) and cancer (ICD-10: C00-C97), in the nine Austrian federal states between 2010-2012. The potentially preventable deaths per federal state and sex were calculated by subtracting expected deaths from observed deaths.Results: The western federal states had the lowest death rates, and thus the smallest preventive potential. In death from circulatory diseases and from cancer the differences between women and men varied remarkably between the federal states. For circulatory diseases among all federal states the highest difference in percent was given in Vorarlberg (6.2%) with more potentially preventable deaths for men. For cancer, Burgenland had the highest difference (8.6%) in comparison with the other federal states, again with the higher preventive potential for men.Conclusions: Intervention programs as lifestyle modification interventions as well as improvements in health care services provision, should focus on the characteristics of the specific federal state, which are setting-oriented and account for social determinants including sex/gender differences and economic factors. Relevant data gathering is therefore, urgently needed. [ABSTRACT FROM AUTHOR]

In recent years, increasing attention has been paid to the issue of (fatal) child abuse and neglect, largely due to the media attention garnered by some headline-grabbing cases. If media statements are to be believed, such cases may be an increasing phenomenon. With these published accounts in mind, publicly available statistics should be analysed with respect to the question of whether reliable statements can be formulated based on these figures. It is hypothesised that certain data, e.g., the Innocenti report published by UNICEF in 2003, may be based on unreliable data sources. For this reason, the generation of such data, and the reliability of the data itself, should also be discussed. Our focus was on publicly available German mortality and police crime statistics ( Polizeiliche Kriminalstatistik). These data were classified with respect to child age, data origin, and cause of death (murder, culpable homicide, etc.). In our opinion, the available data could not be considered in formulating reliable scientific statements about fatal child abuse and neglect, given the lack of detail and the flawed nature of the basic data. Increasing the number of autopsies of children 0-3 years of age should be considered as a means to ensure the capture of valid, practical, and reliable data. This could bring about some enlightenment and assist in the development of preemptive strategies to decrease the incidence of (fatal) child abuse and neglect. [ABSTRACT FROM AUTHOR]

Background: The Turkish government has implemented several reforms to improve the Turkish Statistical Institute Death Reporting System (TURKSTAT-DRS) since 2009. However, there has been no assessment to evaluate the impact of these reforms on causes of death statistics. This study attempted to analyse the impact of these reforms on the TURKSTAT-DRS for Turkey, and in the case of Izmir, one of the most developed provinces in Turkey. Methods: The evaluation framework comprised three main components each with specific criteria. Firstly, data from TURKSTAT for Turkey and Izmir for the periods 2001-2008 and 2009-2013 were assessed in terms of the following dimensions that represent quality of mortality statistics (a. completeness of death registration, b. trends in proportions of deaths with ill-defined causes). Secondly, the quality of information recorded on individual death certificates from Izmir in 2010 was analysed for a. missing information, b. timeliness of death notifications and c. characteristics of deaths with ill-defined causes. Finally, TURKSTAT data were analysed to estimate life tables and summary mortality indicators for Turkey and Izmir, as well as the leading causes-of-death in Turkey in 2013. Results: Registration of adult deaths in Izmir as well as at the national level for Turkey has considerably improved since the introduction of reforms in 2009, along with marked decline in the proportions of deaths assigned illdefined causes. Death certificates from Izmir indicated significant gaps in recorded information for demographic as well as epidemiological variables, particularly for infant deaths, and in the detailed recording of causes of death. Life expectancy at birth estimated from local data is 3-4 years higher than similar estimates for Turkey from international studies, and this requires further investigation and confirmation. Conclusion: The TURKSTAT-DRS is now an improved source of mortality and cause of death statistics for Turkey. The reliability and validity of TURKSTAT data needs to be established through a detailed research program to evaluate completeness of death registration and validity of registered causes of death. Similar evaluation and data analysis of mortality indicators is required at regular intervals at national and sub-national level, to increase confidence in their utility as primary data for epidemiology and health policy. [ABSTRACT FROM AUTHOR]

Introduction An adequate certification of causes of death is essential for Public Health. The objective of this work is to improve the professional competence of medicine students and family doctors with regard to the certification of causes of death according to the international regulations of the WHO. Methods Intervention-formation , before and after design, addressed to students of Medicine in their last year (6th year), and Family Doctors and Interns. The blended learning or b-learning program consisted in an on-site seminar-workshop, plus basic information/documentation stored in an on-line platform, together with the preparation of Certificates of Causes of Death based on Clinical Histories of real cases. Results 308 students participated in the program. We observed an individual improvement in the professional competence in all certifications of death, which was significant in 3 out of 5 cases (it was not significant in a medical-legal case of violent death and the case of a pluripathological chronic patient). The intermediate causes improved in all cases. Most formal aspects of the certification improved with significant changes. In the group of 62 Family Doctors and interns who took part in the program there were improvements in the basic or underlying causes in 4 of the 5 cases and improvements in the formal quality of the assessment, although less significantly than in students, because they started with better basal indexes in their certificates in the Before stage of the study. Conclusions Blended learning training has shown to be effective in improving the professional competence, both in students of the Degree of Medicine and in practicing Family Doctors and Interns. [ABSTRACT FROM AUTHOR]

In Africa, mortality statistics are not reliable due to the low performance of the death registering systems. Our aim is to implement an efficient system. In this article we make a comparison between the existing system model and the new system that will be set up. Method: UML has been used as the modeling language based on the 2TUP analysis methods. Results: the new system for registering deaths and their causes was conceived and represented through activities, utilization cases and data model diagrams. Discussion: We have developed a tool for death registration taking into account African hospitals characteristics. The progressive deployment of this system at the CHUSS of Bobo- Dioulasso enables users and actors to appropriate it. [ABSTRACT FROM AUTHOR]

Exact cause and manner of death determination improves legislative safety for the individual and for society and guides aspects of national public health. In the International Classification of Diseases, codes R00-R99 are used for ''symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified" designated as ''ill-defined'' or ''with unknown etiology''. The World Health Organisation recommends avoiding the use of ill-defined and unknown causes of death in the death certificate as this terminology does not give any information concerning the possible conditions that led to the death. Thus, the aim of the study was, firstly, to analyse the frequencies of R00-R99-coded deaths in mortality statistics in Finland and in Denmark and, secondly, to compare these and the methods used to investigate the cause of death. To do so, we extracted a random 90% sample of the Finnish death certificates and 100% of the Danish certificates from the national mortality registries for 2000, 2005 and 2010. Subsequently, we analysed the frequencies of forensic and medical autopsies and external clinical examinations of the bodies in R00-R99-coded deaths. The use of R00-R99 codes was significantly higher in Denmark than in Finland; OR 18.6 (95% CI 15.3-22.4; p < 0.001) for 2000, OR 9.5 (95% CI 8.0-11.3; p < 0.001) for 2005 and OR 13.2 (95% CI 11.1-15.7; p < 0.001) for 2010. More than 80% of Danish deaths with R00-R99 codes were over 70 years of age at the time of death. Forensic autopsy was performed in 88.3% of Finnish R00-R99-coded deaths, whereas only 3.5% of Danish R00-R99-coded deaths were investigated with forensic or medical autopsy. The codes that were most used in both countries were R96-R99, meaning ''unknown cause of death''. In Finland, all of these deaths were investigated with a forensic autopsy. Our study suggests that if all deaths in all age groups with unclear cause of death were systematically investigated with a forensic autopsy, only 2-3/1000 deaths per year would be coded as an ill-defined and unknown cause of death in national mortality statistics. At the same time the risk to overlook unnatural deaths is decreased to a minimum. To achieve this in Denmark requires that the existing legislation on cause of death investigation would need to be changed to ensure that all deaths with unknown cause of death are investigated with a forensic autopsy. [ABSTRACT FROM AUTHOR]

Despite their relative importance in terms of human mortality, extreme heat events have not attracted the same level of study compared with other natural hazards in regards to vulnerability and implications for emergency management and policy change. Definitional confusion and inconsistencies in defining heat related deaths over time have made it difficult to determine an absolute death toll. Notwithstanding these issues, this study employs PerilAUS - Risk Frontiers' database of natural hazard event impacts - in combination with official sources in an attempt to provide a lower-bound estimate of heat-associated deaths in Australia since European settlement. From 1844 to 2010, extreme heat events have been responsible for at least 5332 fatalities in Australia and, since 1900, 4555: more than the combined total of deaths from all other natural hazards. Over 30% of those deaths occurred in just nine events. Both deaths and death rates (per unit of population) fluctuate widely but show an overall decrease with time. The male to female death-rate ratio has fluctuated and approaches but does not reach equality in more recent times. In line with other studies, seniors have been the most vulnerable age group overall, with infants also over-represented. Policy implications in view of a warming climate and an ageing population are discussed. [ABSTRACT FROM AUTHOR]

The study was conducted to find out errors in the medical certification of cause of death during July 2011 at a new teaching hospital in Vadodara. All certificates of in-hospital deaths in medical record department, from May 2010 to June 2011, were assessed for major and minor errors. Data were analyzed with SPSS 17 version software. The results revealed that out of 40 death certificates, not a single was free from any error. Major errors occurred in 23(57.5%) cases with improper sequencing (55%) as most frequent. Most common minor error was the absence of time interval between the onset of disease and death (92.5%). No significant association was found between major errors and factors like age, sex, ward and underlying cause of death. This study concluded that educational intervention is necessary to increase physicians' awareness regarding importance of medical certificate of cause of death and accuracy of death certificates.

Abstract: Background: Recently, the number of homeless persons in Japan has steadily decreased. However, it is not certain whether unexpected death of the homeless have actually decreased in proportion to decrease in total number of cases. Methods: The documentation of medicolegal deaths among homeless persons handled in the Tokyo Medical Examiner’s Office during 1999–2010 were reviewed, and we compared the number and manner/cause of death between cases occurring before 2004 and those occurring after 2004. In addition, we compared manner/cause of death between homeless and non-homeless persons. Results: The number of medicolegal deaths of homeless persons remained almost the same during the study period in spite of a marked decrease in the total number of homeless persons after 2004. Age distribution shifted to older after 2004, and a higher proportion of the deceased had longer postmortem periods after 2004. Comparison between the manners/causes of death of the cases occurring before 2004 and those occurring after 2004 showed little difference. Disease constituted about 70% of all cases, and causes of death from disease were more various than those of non-homeless persons. Certain specific patterns included a higher proportion of death from circulatory disease in elderly homeless persons and a higher proportion of death from alcohol-related digestive disease and tuberculosis among younger homeless persons. Regarding accidental death, hypothermia was a leading cause of death irrespective of age group. Conclusion: Aging and isolation among homeless persons might contribute to an unchanged number of medicolegal death of them. In addition to measures to address frequent causes of death in each age group, better intervention for isolated homeless persons might be a key factor to prevent unexpected deaths of homeless persons in the future. [Copyright &y& Elsevier]

This cohort study examines trends in pneumonia mortality in Finland and the effects of a WHO recommendation restricting the registering of pneumonia as the underlying cause of death (COD) for several chronic diseases. All cases having pneumonia in any COD fields in 2000–2008 were extracted from the COD statistics. We examined trends in underlying-cause pneumonia mortality where pneumonia was also the immediate COD. Results are presented as age-specific and age-standardized rates. In the study period 2000–2008, there were 90 626 deaths with pneumonia in COD fields, while the underlying-cause pneumonia mortality rate decreased from 32 to 6/100 000 person-years. Immediate-cause pneumonia was less often chosen as underlying-cause towards 2008 suggesting an effect from changing coding practices. Changes in coding practices need to be considered when comparing different countries or time periods in pneumonia mortality. [ABSTRACT FROM AUTHOR]