Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries
2016 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, 449Article in journal (Refereed) PublishedText
Tøllefsen, Ingvild Maria
Oslo Univ Hosp Ullevaal, Dept Acute Med, Box 4950, N-0424 Oslo, Norway.;Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Dept Acute Med, Div Med, Box 4950, N-0424 Oslo, Norway..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
Univ Copenhagen, Dept Social Med & Publ Hlth Res, Norregade 10, DK-1165 Copenhagen K, Denmark..
Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4950, N-0424 Oslo, Norway..
Background: National mortality statistics should be comparable between countries that use the World Health Organization's International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences. Methods: The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports. Results: In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts reclassified 22 and 51 %, respectively, to accidents. Conclusion: There was moderate agreement in reclassification of accidents between the official mortality statistics and the experts. In the majority of cases where there was disagreement, accidents were reclassified as undetermined manner of death, and only a small proportion as suicides.
Place, publisher, year, edition, pages
2016. Vol. 16, 449
Accidents, Autopsy, Reclassification, Suicide statistics, Undetermined deaths
Forensic Science Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:uu:diva-298875DOI: 10.1186/s12889-016-3135-5ISI: 000377166900001PubMedID: 27229154OAI: oai:DiVA.org:uu-298875DiVA: diva2:948278