58 Medical examiner/coroner systems and state variability in reporting suicide and "unintentional" drug-intoxication deaths: distorting reality and impeding prevention. (9th June 2015)

• Record Type: Journal Article
• Authors: Rockett, Ian; Hobbs, Gerald; Zhejiang, Dan Wu; Jia, Haomiao; Nolte, Kurt B; Smith, Gordon S; Caine, Eric D
• Is Part Of: Injury prevention. Volume 21(2015)Supplement 2
• Page Start: A21
• Page End: A21
• Publication Date: 2015-06-09
• Subjects: Children's accidents -- Prevention -- Periodicals; Accidents -- Prevention -- Periodicals; 617.1
• DOI: 10.1136/injuryprev-2015-041654.58
• Languages: English
• ISSNs: 1353-8047

Abstract

Abstract : Statement of purpose: The 21st-century surge in national drug-intoxication deaths has been associated with a growing problem of suicide misclassification. Prevention of suicide and lethal drug intoxications depends upon accurate classification of manner of death. This study evaluated interstate variation in reporting drug-intoxication suicides and their potential misclassification according to type of medicolegal death investigation system. Methods/approach: An observational mortality study of all 111, 583 drug-intoxication decedents from the 50 states for the period 2008–2010, whose manner of death was suicide, accident, or undetermined intent. Data derived from CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). The main outcome measure was the rate ratio of combined accident plus undetermined intent to suicide drug-intoxication deaths (indexing potential suicide misclassification), and percentage of intoxication deaths specifying at least one drug (indexing fastidiousness of the death investigation process). Results: Drug-intoxication suicide rates ranged from a high of 3.68 deaths per 100, 000 persons in New Mexico to 0.65 per 100, 000 in North Dakota. The rate ratio of combined accident and undetermined intent to suicide drug-intoxication deaths ranged from 16.11 in Louisiana (drug-intoxication suicide rate = 0.79 per 100, 000) to 2.49 in South Dakota (drug-intoxication suicide rate = 1.74 per 100, 000). Adjusting for drug-specification, states with a decentralised coroner system were 46 times more likely to have a high rate ratio (>7.00) of the combined accident plus undetermined intent to suicide drug-intoxication deaths as states with a centralised medical examiner system (95% CI, 3.14–1750.22). Conclusions: Results suggest that the numerous jurisdictions not meeting rigorous standards for conducting medicolegal death investigations are excessively prone to differentially undercounting drug-intoxication suicides. Significance and contributions: There is a national urgency to have uniform state and local death investigation and reporting systems that meet high standards in ascertaining manner of death and providing appropriate surveillance data for evidence-based interventions.