Certifying Death in the United States

Ruiz, Leah; Posey, Brianne M.; Neuilly, Melanie-Angela; Stohr, Mary K.; Hemmens, Craig

doi:10.1111/1556-4029.13689

Cited by 24 publications

(25 citation statements)

References 21 publications

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“…However, our analysis is limited by our focus on only a single state and healthcare system. As such, these ndings may not represent patterns in other states' NVDRS systems or among all decedents, an especially notable limitation given the broad variability across states in medicolegal investigations (Oregon being among the states with a centralized medical examiner system; Hickman et al, 2004;Ruiz et al, 2018; US Department of Justice, 2019). Our analyses were also limited by a relatively small numbers of observations for analysis, making some of the estimated ORs unstable (i.e., wide con dence intervals) in our examination of patterns of sensitivity by decedent characteristics.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Carlson

Gilbert

DeFrancesco

et al. 2022

Preprint

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Background The National Violent Death Reporting System (NVDRS) collects data on the circumstances of violent deaths, and all firearm-related deaths, across states and territories in the United States. This surveillance system is critical to understanding patterns and risk factors for these fatalities, thereby informing targets for prevention. NVDRS variables include behavioral health conditions among decedents, but the validity of the reported behavioral health data is unknown. Using Department of Veterans Affairs (VA) healthcare records as a criterion standard, we examined the accuracy of NVDRS-reported behavioral health variables for veteran decedents in a sample state (Oregon) between 2003 and 2017. Methods We linked Oregon NVDRS data to VA healthcare data to identify veteran decedents who used VA services within two years of death. Veterans’ VA diagnoses within this time frame, including depression, post-traumatic stress disorder (PTSD), anxiety, and substance use disorders, were compared to behavioral health variables identified in the Oregon NVDRS. Concordance, sensitivity, and correlates of sensitivity were examined over time and by decedent characteristics. Results We identified 791 VA-using veterans with fatal injuries documented in the Oregon NVDRS between 2003 and 2017. In this cohort, the Oregon NVDRS accurately identified only 49% of decedents who were diagnosed with depression, 45% of those diagnosed with PTSD, and 17% of those diagnosed with anxiety by the VA. Among 211 veterans diagnosed by the VA with a substance use disorder, the Oregon NVDRS coded only 56% as having a substance use problem. In general, the sensitivity of behavioral health variables in the Oregon NVDRS remained the same or decreased over the study period; however, the sensitivity of PTSD diagnoses increased from 21% in 2003–2005 to 54% in 2015–2017. Sensitivity varied by some decedent characteristics, but not consistently across behavioral health variables. Conclusions NVDRS data from one state missed more than half of behavioral health diagnoses among VA-using veterans who died from violence or from firearm injuries. This suggests that reports of behavioral health conditions among decedents nationally may be severely undercounted. Efforts to improve validity of these variables in state NVDRS data are needed.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Carlson

Gilbert

DeFrancesco

et al. 2022

Preprint

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“…A study in Vermont revealed that 51% of death certificates completed by non-medical examiners had major errors, and that certificates for hospital deaths were more error prone than those completed for residential deaths (59% vs. 39% errors) [25]. A nationally representative sample of older Americans who died while hospitalized found that there was significant disagreement between Medicare records and the assigned cause of death on certificates, and that the contributing nature of infections was under-reported [26]. Systems for certifying death vary by state – there are few standards, with official examiners sometimes having little or no medical expertise or training [27].…”

Section: Discussionmentioning

confidence: 99%

Differences in Race and Ethnicity in Muscular Dystrophy Mortality Rates for Males under 40 Years of Age, 2006–2015

2018

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Background/Aims: Duchenne Muscular Dystrophy (DMD) has childhood onset, primarily affects males, and is usually fatal before the age of 40 years. Previous studies have indicated that this X-linked condition is more prevalent in whites than in blacks, but those were based on active surveillance, and limited to smaller populations and younger ages. Methods: US death data were used to calculate mortality rates by race and ethnicity, with MD as either the underlying or multiple cause of death (MCD). Poisson approximation was used for confidence intervals; chi-square was used to compare rates. Results: From 2006 to 2015, there were 3,256 deaths in males <40 years with MD as MCD, and 71% of these were aged 15–29 years. For whites, the average annual death rate was 0.43/100,000, which was significantly higher (p < 0.0001) that that of blacks (0.28), American Indian/Alaska Natives (0.20), and Asian/Pacific Islanders (0.21). The rate for non-Hispanic whites (0.46) was significantly higher (p < 0.0001) than the rates for Hispanic whites (0.31), Hispanic blacks (0.07), and non-Hispanic blacks (0.29). Conclusion: Since DMD is the primary cause of deaths in young males with MD, mortality rates are a reasonable proxy for the relative difference in racial prevalence. It appears that DMD is significantly more common in white males than in males of other races.

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“…In FARS, toxicological testing was conducted by the respective medico-legal office such as the medical examiner or coroner [46,47]. Currently, 21 states and the District of Columbia have medical examiner systems, 9 have coroner systems, and 20 have mixed medical examiner and coroner systems responsible for certifying deaths [47,48]. The FARS database records up to three nonalcohol drugs per driver [42,49].…”

Section: Drug and Alcohol Testingmentioning

confidence: 99%

Is marijuana use associated with decreased use of prescription opioids? Toxicological findings from two US national samples of drivers

Chihuri

2020

Subst Abuse Treat Prev Policy

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Background: State governments in the United States are increasingly viewing marijuana legalization as a policy option for controlling the opioid epidemic under the premise that marijuana is a less harmful substitute for opioids. The purpose of this study is to assess whether marijuana use is associated with decreased odds of prescription opioid use. Methods: A cross-sectional study design was applied to toxicological testing data from two national samples of drivers: 1) the 2011-2016 Fatality Analysis Reporting System (FARS) and 2) the 2013-2014 National Roadside Survey of Alcohol and Drug Use by Drivers (NRS). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) estimated from multivariable logistic regression models were used to assess the associations of marijuana use with prescription opioid use and alcohol use. Results: Among the 47,602 drivers from the FARS, 15.7% tested positive for marijuana and 6.9% positive for prescription opioids. Compared with drivers testing negative for marijuana, those testing positive for marijuana were 28% more likely to test positive for prescription opioids (adjusted OR = 1.28, 95% CI = 1.15-1.42). Among the 7881 drivers from the NRS, 7.9% tested positive for marijuana and 4.5% positive for prescription opioids. Relative to drivers testing negative for marijuana, those testing positive for marijuana were twice as likely to test positive for prescription opioids (adjusted OR = 2.03, 95% CI = 1.29-3.20). In both study samples, marijuana use was associated with significantly increased odds of alcohol positivity. Conclusions: Drivers who test positive for marijuana are significantly more likely to test positive for prescription opioids. Longitudinal studies with rigorous designs and toxicological testing data are needed to further address the substitution hypothesis between marijuana and prescription opioids.

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Certifying Death in the United States

Cited by 24 publications

References 21 publications

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Differences in Race and Ethnicity in Muscular Dystrophy Mortality Rates for Males under 40 Years of Age, 2006–2015

Is marijuana use associated with decreased use of prescription opioids? Toxicological findings from two US national samples of drivers

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