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Hiam L, Estrin-Serlui T, Dorling D, McKee M, Minton J. A deathly silence: why has the number of people found decomposed in England and Wales been rising? J R Soc Med 2024; 117:172-181. [PMID: 37989250 DOI: 10.1177/01410768231209001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES The number of deaths occurring in private homes in England and Wales had been rising for years, increasingly rapidly from 2020. Media stories and research linked decomposing bodies found in private homes with pandemic-related social isolation. We aim to explore whether these incidents are one-offs or part of a wider trend. DESIGN Descriptive analysis of publicly available Office for National Statistics (ONS) data. SETTING England and Wales. PARTICIPANTS All residents of England and Wales, 1979 to 2020. MAIN OUTCOME MEASURES Using data from the Office for National Statistics, we calculate European Age Standardised Rates for deaths coded as R98 ('unattended death') and R99 ('other ill-defined and unknown causes of mortality') in the 10th version of the International Classification of Diseases (ICD-10), and the corresponding codes in ICD-9, by sex and age group from 1979 (when ICD-9 began) to 2020. These are proxy markers for deaths where decomposition precludes attribution of a specific cause at postmortem. RESULTS While mortality from all other causes decreased from 1979 to 2020, the opposite was seen for deaths from R98 and R99 (or 'undefined deaths'), with men more affected than women. There was a sharp rise in these deaths in both sexes but in men particularly in the 1990s and 2000s, coinciding with a time when overall mortality was rapidly improving. CONCLUSIONS The increase in people found dead from unknown causes suggests wider societal breakdowns of both formal and informal social support networks. They are concerning and warrant urgent further investigation. We call on national and international authorities to consider measures that would make it possible to identify these deaths more easily in routine data.
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Affiliation(s)
- Lucinda Hiam
- School of Geography and the Environment, University of Oxford, Oxford OX1 3QY, UK
| | | | - Danny Dorling
- School of Geography and the Environment, University of Oxford, Oxford OX1 3QY, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London WC1E 7HT, UK
| | - Jon Minton
- Public Health Scotland, Gyle Square, 1 S Gyle Cres, Edinburgh EH12 9EB, UK
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Kruckow L, Basit S, Nordentoft M, Banner J, Boyd HA. Factors associated with medico-legal autopsy of decedents with psychiatric disorders. Forensic Sci Int 2024; 355:111940. [PMID: 38290227 DOI: 10.1016/j.forsciint.2024.111940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/01/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Autopsy rates are declining worldwide, resulting in increasing selectivity in referral for forensic autopsy and increased uncertainty about the validity of assigned causes of death. Persons with psychiatric disorders have high rates of premature death but not all are referred for forensic autopsies. Knowledge is needed on which decedents with psychiatric disorders are chosen for forensic autopsy to determine whether causes of death are at risk of being misclassified among certain subgroups of decedents. METHODS We conducted a nationwide register-based case-control study including all decedents with psychiatric disorders in Denmark in the period 1998-2015. Using multivariate logistic regression, we examined associations between demographic and socioeconomic factors, comorbidities, healthcare utilization, and referral for forensic autopsy, overall and stratified by age at death (<45, 45-64, ≥65 years). RESULTS Of the 152,799 decedents in the study population, 7043 (4.61 %) had a forensic autopsy. Decedents referred for forensic autopsy were more likely to be young, have a history of substance use, and have schizophrenia or an affective disorder (factors listed in diminishing order of strength of association). Increasing severity of comorbidities as measured by the Charlson comorbidity index was associated with decreasing likelihood of being autopsied. Patterns of association with sex, alcohol use, habitation and education did not vary by age at death. Schizophrenia and drug use were most strongly associated with forensic autopsy in decedents < 45 years of age, whereas death early in the study period was more strongly associated with autopsy in the oldest age groups. DISCUSSION The decision to refer a decedent for forensic autopsy was predominantly based on the decedent's age, history of drug use, and the absence of non-psychiatric comorbidities. Causes of death in decedents with comorbidities or recent contact with the healthcare system and decedents > 65 years may be more likely to be inaccurate, particularly in drug users.
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Affiliation(s)
- Line Kruckow
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen, Denmark.
| | - Saima Basit
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Heather Allison Boyd
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
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Dudukina E, Horváth-Puhó E, Sørensen HT, Ehrenstein V. Association between pregnancy affected by vaginal bleeding and women's mortality: A cohort study. BJOG 2024; 131:175-188. [PMID: 37519289 DOI: 10.1111/1471-0528.17623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To investigate the association between vaginal bleeding (VB) in pregnancy and women's mortality, using VB-unaffected pregnancies, terminations and miscarriages as comparators. DESIGN Observational cohort study. SETTING Nationwide registries of Denmark linked at an individual level. POPULATION OR SAMPLE 1 354 181 women and their 3 162 317 pregnancies (1979-2017), including 70 835 VB-affected pregnancies and comparators: 2 236 359 VB-unaffected pregnancies ending in childbirth; 589 697 terminations; and 265 426 miscarriages. METHODS We followed pregnancies until the earliest date of woman's death, emigration or end of data. MAIN OUTCOME MEASURES All-cause and cause-specific mortality rates per 10 000 person-years (PY) and hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted using Cox proportional hazards regression for age, calendar year, pre-existing chronic conditions and socio-economic factors. RESULTS There were 2320 deaths from any cause among women following VB-affected pregnancy (mortality rate 15.2, 95% CI 14.6-15.9 per 10 000 PY); 55 030 deaths following VB-unaffected pregnancy (mortality rate 12.7, 95% CI 12.6-12.8); 27 500 deaths following a termination (mortality rate 21.9, 95% CI 21.6-22.1), and 10 865 deaths following a miscarriage (mortality rate 19.2, 95% CI 18.8-19.6). For comparison of VB-affected versus VB-unaffected pregnancies, associations with all-cause (HR 1.14, 95% CI 1.09-1.19), natural causes (HR 1.15, 95% CI 1.09-1.22) and non-natural causes (HR 1.27, 95% CI 1.08-1.48) mortality were attenuated in a sensitivity analysis of pregnancies recorded in 1994-2017 (HR 1.00, 95% CI 0.90-1.12, HR 0.98, 95% CI 0.85-1.14 and HR 1.04, 95% CI 0.72-1.51, respectively). Contrasts with remaining comparators did not suggest increased risks of all-cause, natural or non-natural mortality causes. CONCLUSION We found no evidence of an increased risk of women's mortality following VB-affected versus VB-unaffected pregnancy, termination or miscarriage.
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Affiliation(s)
- Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Plana-Ripoll O, Dreier JW, Momen NC, Prior A, Weye N, Mortensen PB, Pedersen CB, Iburg KM, Christensen MK, Laursen TM, Agerbo E, Pedersen MG, Brandt J, Frohn LM, Geels C, Christensen JH, McGrath JJ. Analysis of mortality metrics associated with a comprehensive range of disorders in Denmark, 2000 to 2018: A population-based cohort study. PLoS Med 2022; 19:e1004023. [PMID: 35709252 PMCID: PMC9202944 DOI: 10.1371/journal.pmed.1004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The provision of different types of mortality metrics (e.g., mortality rate ratios [MRRs] and life expectancy) allows the research community to access a more informative set of health metrics. The aim of this study was to provide a panel of mortality metrics associated with a comprehensive range of disorders and to design a web page to visualize all results. METHODS AND FINDINGS In a population-based cohort of all 7,378,598 persons living in Denmark at some point between 2000 and 2018, we identified individuals diagnosed at hospitals with 1,803 specific categories of disorders through the International Classification of Diseases-10th Revision (ICD-10) in the National Patient Register. Information on date and cause of death was obtained from the Registry of Causes of Death. For each of the disorders, a panel of epidemiological and mortality metrics was estimated, including incidence rates, age-of-onset distributions, MRRs, and differences in life expectancy (estimated as life years lost [LYLs]). Additionally, we examined models that adjusted for measures of air pollution to explore potential associations with MRRs. We focus on 39 general medical conditions to simplify the presentation of results, which cover 10 broad categories: circulatory, endocrine, pulmonary, gastrointestinal, urogenital, musculoskeletal, hematologic, mental, and neurologic conditions and cancer. A total of 3,676,694 males and 3,701,904 females were followed up for 101.7 million person-years. During the 19-year follow-up period, 1,034,273 persons (14.0%) died. For 37 of the 39 selected medical conditions, mortality rates were larger and life expectancy shorter compared to the Danish general population. For these 37 disorders, MRRs ranged from 1.09 (95% confidence interval [CI]: 1.09 to 1.10) for vision problems to 7.85 (7.77 to 7.93) for chronic liver disease, while LYLs ranged from 0.31 (0.14 to 0.47) years (approximately 16 weeks) for allergy to 17.05 (16.95 to 17.15) years for chronic liver disease. Adjustment for air pollution had very little impact on the estimates; however, a limitation of the study is the possibility that the association between the different disorders and mortality could be explained by other underlying factors associated with both the disorder and mortality. CONCLUSIONS In this study, we show estimates of incidence, age of onset, age of death, and mortality metrics (both MRRs and LYLs) for a comprehensive range of disorders. The interactive data visualization site (https://nbepi.com/atlas) allows more fine-grained analysis of the link between a range of disorders and key mortality estimates.
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Affiliation(s)
- Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Julie W. Dreier
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, University of Bergen, Norway
| | - Natalie C. Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Nanna Weye
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Carsten B. Pedersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
- Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
| | | | - Maria Klitgaard Christensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Marianne G. Pedersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate, Interdisciplinary Centre of Climate Change, Aarhus University, Roskilde, Denmark
| | - Lise Marie Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - John J. McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
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5
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Korhonen K, Moustgaard H, Tarkiainen L, Östergren O, Costa G, Urhoj SK, Martikainen P. Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy. J Affect Disord 2021; 295:831-838. [PMID: 34706453 DOI: 10.1016/j.jad.2021.08.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/12/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The reasons for the shorter life expectancy of people with depression may vary by age. We quantified the contributions of specific causes of death by age to the life-expectancy gap in four European countries. METHODS Using register-based cohort data, we calculated annual mortality rates in between 1993 and 2007 for psychiatric inpatients with depression identified from hospital-care registers in Denmark, Finland and Sweden, and between 2000 and 2007 for antidepressant-treated outpatients identified from medication registers in Finland and Turin, Italy. We decomposed the life-expectancy gap at age 15 years by age and cause of death. RESULTS The life-expectancy gap was especially large for psychiatric inpatients (12.1 to 21.0 years) but substantial also for antidepressant-treated outpatients (6.3 to 14.2 years). Among psychiatric inpatients, the gap was largely attributable to unnatural deaths below age 55 years. The overall contribution was largest for suicide in Sweden (43 to 45%) and Finland (37 to 40%). In Denmark, 'other diseases' (25 to 34%) and alcohol-attributable causes (10 to 18%) had especially large contributions. Among antidepressant-treated outpatients, largest contributions were observed for suicide (18% for men) and circulatory deaths (23% for women) in Finland, and cancer deaths in Turin (29 to 36%). Natural deaths were concentrated at ages above 65 years. LIMITATIONS The indication of antidepressant prescription could not be ascertained from the medication registers. CONCLUSIONS Interventions should be directed to self-harm and substance use problems among younger psychiatric inpatients and antidepressant-treated young men. Rigorous monitoring and treatment of comorbid somatic conditions and disease risk factors may increase life expectancy for antidepressant-treated outpatients, especially women.
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Affiliation(s)
- Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland, P.O. Box 18, 00014 Helsinki, Finland.
| | - Heta Moustgaard
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland, P.O. Box 18, 00014 Helsinki, Finland; Helsinki Institute of Urban and Regional Studies (URBARIA), University of Helsinki, Helsinki, Finland, Yliopistonkatu 3, 00100 Helsinki, Finland
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland, P.O. Box 18, 00014 Helsinki, Finland; Helsinki Institute of Urban and Regional Studies (URBARIA), University of Helsinki, Helsinki, Finland, Yliopistonkatu 3, 00100 Helsinki, Finland
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden, SE - 106 91 Stockholm, Sweden; Aging Research Center, Karolinska Institutet, Solna, Sweden, Tomtebodavägen 18a, SE-171 65 Solna, Sweden
| | - Giuseppe Costa
- Epidemiology Unit, Regional Health Service ASL TO3, Turin, Italy, Via Sabaudia 164, Grugliasco (TO), Italy
| | - Stine Kjaer Urhoj
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark, Oster Farimagsgade 5, P.O. Box 2099, 1014 København K, Denmark
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland, P.O. Box 18, 00014 Helsinki, Finland; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden, SE - 106 91 Stockholm, Sweden; Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany, Konrad-Zuse-Str. 1, 18057 Rostock, Germany
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Rosendahl A, Mjörnheim B, Eriksson LC. Autopsies and quality of cause of death diagnoses. SAGE Open Med 2021; 9:20503121211037169. [PMID: 34394931 PMCID: PMC8351029 DOI: 10.1177/20503121211037169] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The consequences of a low autopsy rate are not considered in determining the cause of death. Method: We have analyzed the Cause of Death Register of the Swedish National Board of Health and Welfare since it started 1969 to and including 2016 to visualize the decline in the frequency of clinical autopsies over time and evaluated the effect on the quality of the cause of death diagnoses. Results: Over the five decades studied, the frequency of clinical autopsies declined from almost 40% to less than 5%. The rate of decline was not even. Political decisions and changes of healthcare organization in Sweden affected the slope of decline of autopsies superimposed on a linear decline over time reflecting changes in clinical routines. A request of clinical autopsies was highly dependent on the level of care at the time of death, with the lowest number of requests for persons who died in nursing homes. The age at the time of death was a major factor affecting the number of autopsies, resulting in an autopsy rate of less than 1% in the ages where most persons die. Although men were autopsied more often than women, a gender-specific difference was not seen after correction for the age of death. We also found a higher rate of unspecific and irrelevant diagnosis in the cases not autopsied and we know from earlier studies by us and other authors that the cause of death diagnoses were missed in between 30% and 50% of the cases not autopsied. Conclusion: The decline in the clinical autopsy rate reduced the value of the death certificate register. An increase in the number of autopsies performed will improve the understanding of disease and cause of death, as well as to better inform next of kin.
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Affiliation(s)
- Anders Rosendahl
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Berit Mjörnheim
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lennart C Eriksson
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Snowdon J. Spain's suicide statistics: do we believe them? Soc Psychiatry Psychiatr Epidemiol 2021; 56:721-729. [PMID: 32918553 DOI: 10.1007/s00127-020-01948-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/01/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a widespread belief that suicides around the world are under-counted. A substantial proportion of suicides may have been inappropriately registered as accidental or of undetermined cause or intent. There is reason to explore to what extent low suicide rates in some nations could be partly attributable to under-counting. METHODS Mortality statistics of most countries are available on-line. Numbers of suicide deaths in Spain, and in England and Wales (E & W), in male and female 5-year age groups, in each year between 2014 and 2018, were documented, along with deaths coded to ICD-10 accident or 'undetermined death' categories. Crude mortality rates were calculated using official population figures. Single year suicide, undetermined death, and non-transport accidental death rates of 12 other nations were calculated. RESULTS Spain's crude suicide rate per 100,000 remains low (7.89) compared to other nations; its event of undetermined intent (EUI) death rate was 0.09 (contrasting with E & W's 1.74). Its accidental poisoning rate is much lower than that of E & W. The study showed much higher rates of ill-defined/unknown cause deaths in late life in Spain (both genders) than in E & W, and age-associated increases in accidental drowning rates parallel with increased suicide by drowning. CONCLUSIONS Reportedly low suicide rates in Spain could be partly attributable to increased rates of 'hidden suicide' (accidental drowning, male accidental poisoning, and possibly ill-defined/unknown cause deaths, but not EUIs). It would be appropriate (and not just in Spain) to increase numbers of verbal and/or forensic autopsies in questionable 'undetermined' cases.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Sydney, Australia. .,Centre for Mental Health, Concord Hospital, Sydney, Australia.
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8
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Lycke Ellingsen C, Alfsen GC, Braut GS. Forensic autopsies in Norway 1996-2017: A retrospective study of factors associated with deaths undergoing forensic autopsy. Scand J Public Health 2021; 50:424-431. [PMID: 33685312 PMCID: PMC9152604 DOI: 10.1177/1403494821997208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Forensic autopsies are important for the investigation of deaths with a legal
or public-health interest, as well as being a source for cause-of-death
statistics. The aim of this study was to investigate the use of forensic
autopsies in Norway, with a special emphasis on geographical variation. Methods: Data from the Norwegian Cause of Death Registry for the years 1996–2017
included 920,232 deaths and 37,398 forensic autopsies. We used logistic
regression to identify factors that were associated with the proportion of
forensic autopsies, grouped according to the registered cause of death.
Explanatory variables were age and sex, place of death, police district,
population size and urbanity level of the municipality and distance to the
autopsy facility. Results: The proportion of deaths undergoing forensic autopsy was 4.1%, with the
highest being homicides (96.6%) and the lowest being deaths from natural
causes (1.7%). Variation between police districts was 0.9–7.8%, and the span
persisted during the study period. The most important explanatory variables
across the strata were place of death (there were few autopsies of deaths in
health-care facilities), police district and age of the deceased. Distance
to the autopsy facility, sex, population size and the level of urbanity had
only a minor influence. The variation between police districts was not fully
accounted for by the other investigated factors. Conclusions: Unjustified differences in the frequency of autopsies may lead to
insufficient investigation of possible unnatural deaths. In worst-case
scenarios, homicides or other criminal cases might remain undetected. It
may also introduce spurious shifts in the cause-of-death
statistics.
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Affiliation(s)
- Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - G Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, Norway.,Faculty of Medicine, University of Oslo, Norway
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Paalanen L, Reinikainen J, Härkänen T, Mattila T, Laatikainen T, Jousilahti P, Tolonen H. Comparing data sources in estimating disability-adjusted life years (DALYs) for ischemic heart disease and chronic obstructive pulmonary disease in a cross-sectional setting in Finland. Arch Public Health 2020; 78:58. [PMID: 32566225 PMCID: PMC7302348 DOI: 10.1186/s13690-020-00439-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background The disability-adjusted life years (DALYs) summarize the burden of years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Our aim was to estimate the burden of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in Finland in 2012, and to examine, how much the YLD are affected by the use of different data sources. Methods The YLL were calculated using mortality data for the Finnish 25–74-year-old population in 2012. The YLD were calculated using data from the FINRISK 2012 survey (3041 males, 3383 females aged 25–74 years) and then directly adjusted to the corresponding population. Different administrative registers on 1) hospital inpatient episodes and specialist outpatient visits, 2) entitlement to specially reimbursed medicines, and 3) purchases of prescribed medicines were used for estimation of the YLD in addition to self-reported data. The DALYs were calculated without age-weighting. Results The YLL for IHD were 37.5 for males and 9.1 for females per 1000 population among 25–74-year-old people in Finland in 2012. The YLD for IHD varied markedly depending on which data sources were used. All data sources combined, the YLD per 1000 were 5.3 for males and 2.5 for females resulting in estimated 42.8 and 11.6 DALYs per 1000 due to IHD among males and females, respectively. For COPD, the YLL were 4.7 for males and 2.0 for females per 1000. Also for COPD, the YLD varied markedly depending on data sources used. The YLD per 1000 based on all data sources combined were 2.0 for males and 1.6 for females. As a result, estimated 6.7 and 3.6 DALYs per 1000 were due to COPD among males and females, respectively. Conclusions Especially for COPD, all mild disease cases could probably not be identified from the included registers. Thereby, including survey data improved the coverage of the data. The YLD of IHD and COPD varied markedly between the data sources used in the calculations. However, as YLL constituted a major part of DALYs for these diseases, the variation in YLD did not lead to substantial variation in DALYs.
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10
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Snowdon J, Choi NG. Undercounting of suicides: Where suicide data lie hidden. Glob Public Health 2020; 15:1894-1901. [DOI: 10.1080/17441692.2020.1801789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney University, Concord, Australia
| | - Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Abstract
AIMS Widowed people have increased mortality compared to married people of the same age. Although most widowed people are of older age, few studies include the oldest old. As life expectancy is increasing, knowledge of widowhood into older age is needed. This study aimed to examine mortality and widowhood in older age by comparing mortality in widowed and married people by sex, age, time since spousal loss and cause of death. METHODS A Danish register-based matched cohort study of 10% of widowed persons ⩾65 years in the years 2000-2009. For each randomly drawn widowed person, five married persons were matched on sex and age. Mortality rate ratios (MRR) were calculated using Poisson regression, and stratified according to sex and 5-year age intervals. MRRs were furthermore calculated by time since spousal loss and by specific cause of death. RESULTS The study included 82 130 persons contributing with 642 914.8 person-years. The overall MRR between widowed and married persons with up to 16 years of follow-up was 1.25 (95% CI 1.23-1.28). At age ⩾95 years for men, and ⩾90 years for women, no differences in mortality rates were seen between widowed and married persons. Mortality in widowed persons was increased for most specific causes of death, with the highest MRR from external causes (MRR 1.53 [1.35-1.74]) and endocrine diseases (MRR 1.51 [1.34-1.70]). CONCLUSIONS Widowhood was associated with increased mortality in older age for both men and women until age ⩾95 and ⩾90 years, respectively. Increased mortality was observed for almost all causes of death.
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Svendsen MT, Bøggild H, Skals RK, Mortensen RN, Kragholm K, Hansen SM, Riddersholm SJ, Nielsen G, Torp-Pedersen C. Uncertainty in classification of death from fatal myocardial infarction: A nationwide analysis of regional variation in incidence and diagnostic support. PLoS One 2020; 15:e0236322. [PMID: 32716962 PMCID: PMC7384617 DOI: 10.1371/journal.pone.0236322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/02/2020] [Indexed: 11/04/2022] Open
Abstract
AIMS The usefulness of mortality statistics relies on the validity of death certificate diagnosis. However, diagnosing the causal sequence of conditions leading to death is not simple. We examined diagnostic support for fatal acute myocardial infarction (AMI) and investigated its association with regional variation. METHODS AND RESULTS From Danish nationwide registers, we identified the study population (N = 3,244,051) of whom 36,669 individuals were recorded with AMI as the underlying cause-of-death between 2002 and 2015. We included clinical diagnoses, procedures, and claimed prescriptions related to atherosclerotic disease to evaluate the level of diagnostic support for fatal AMI in three diagnostic groups (Definite; Plausible; Uncertain). Adjusted mortality rates, rate ratios, and odds ratios were estimated for each AMI category, stratified by hospital region using multivariable regression models. More than one-third (N = 12,827, 35%) of deaths reported as fatal AMI had uncertain diagnostic support. The largest regional variation in AMI mortality rate ratios, varying from 1.16 (95%CI:1.02;1.31) to 1.62 (95%CI:1.43;1.83), was found among cases with uncertain diagnostic supportive data. Substantial inter-regional differences in the degree to which death occurs outside hospital [OR: 1.01 (95%CI:0.92;1.12) - 1.49 (95%CI:1.36;1.63)] and general practitioners determining the cause-of-death at home were present. Minor regional differences [OR: 0.96 (95%CI:0.85;1.07) - 1.16 (95%CI:1.04;1.29)] in in-hospital AMI mortality were observed. CONCLUSION There is significant regional variation associated with recording AMI as a cause-of-death. This variation is predominately based on death certificate diagnoses without diagnostic supportive evidence. Studies of fatal AMI should include a stratification on supportive evidence of the diagnosis.
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Affiliation(s)
- Majbritt Tang Svendsen
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Henrik Bøggild
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Regitze Kuhr Skals
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Steen Møller Hansen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Juel Riddersholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Anesthesia and Intensive care, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Nielsen
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
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13
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Aagaard SK, Dreier JW, Sun Y, Laursen TM, Christensen J. Accidental deaths in young people with epilepsy and psychiatric comorbidity—A Danish nationwide cohort study. Epilepsia 2020; 61:479-488. [DOI: 10.1111/epi.16453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Sissel K. Aagaard
- Department of Neurology Aarhus University Hospital Aarhus Denmark
- Department of Economics and Business Economics, Business and Social Science The National Center for Register‐based Research Aarhus University Aarhus Denmark
| | - Julie W. Dreier
- Department of Economics and Business Economics, Business and Social Science The National Center for Register‐based Research Aarhus University Aarhus Denmark
| | - Yuelian Sun
- Department of Neurology Aarhus University Hospital Aarhus Denmark
- Department of Economics and Business Economics, Business and Social Science The National Center for Register‐based Research Aarhus University Aarhus Denmark
| | - Thomas M. Laursen
- Department of Economics and Business Economics, Business and Social Science The National Center for Register‐based Research Aarhus University Aarhus Denmark
| | - Jakob Christensen
- Department of Neurology Aarhus University Hospital Aarhus Denmark
- Department of Economics and Business Economics, Business and Social Science The National Center for Register‐based Research Aarhus University Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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Geneviève LD, Martani A, Mallet MC, Wangmo T, Elger BS. Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One 2019; 14:e0226015. [PMID: 31830124 PMCID: PMC6907832 DOI: 10.1371/journal.pone.0226015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. OBJECTIVE This systematic review aims to identify barriers and facilitators to health data harmonization-including data sharing and linkage-by a comparative analysis of studies from Denmark and Switzerland. METHODS Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. RESULTS Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. CONCLUSION This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.
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Affiliation(s)
| | - Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Center of Legal Medicine, University of Geneva, Geneva, Switzerland
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Plana-Ripoll O, Pedersen CB, Agerbo E, Holtz Y, Erlangsen A, Canudas-Romo V, Andersen PK, Charlson FJ, Christensen MK, Erskine HE, Ferrari AJ, Iburg KM, Momen N, Mortensen PB, Nordentoft M, Santomauro DF, Scott JG, Whiteford HA, Weye N, McGrath JJ, Laursen TM. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet 2019; 394:1827-1835. [PMID: 31668728 DOI: 10.1016/s0140-6736(19)32316-5] [Citation(s) in RCA: 304] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/07/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder. METHODS In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death. FINDINGS 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher. INTERPRETATION Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death. FUNDING Danish National Research Foundation.
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Affiliation(s)
| | - Carsten Bøcker Pedersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Yan Holtz
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Annette Erlangsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Vladimir Canudas-Romo
- School of Demography, ANU College of Arts & Social Sciences, Australian National University, Canberra, ACT, Australia
| | | | - Fiona J Charlson
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Maria K Christensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Holly E Erskine
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alize J Ferrari
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Natalie Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Damian F Santomauro
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Harvey A Whiteford
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nanna Weye
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - John J McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.
| | - Thomas M Laursen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
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Bogdanović MD, Marić GD, Pekmezović TD, Alempijević ĐM. Evaluation of coding ill-defined and unknown causes of death in the Republic of Serbia. J Forensic Leg Med 2019; 62:34-39. [PMID: 30639853 DOI: 10.1016/j.jflm.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/25/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Milenko D Bogdanović
- Institute of Forensic Medicine "Milovan Milovanović", School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gorica D Marić
- Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana D Pekmezović
- Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Đorđe M Alempijević
- Institute of Forensic Medicine "Milovan Milovanović", School of Medicine, University of Belgrade, Belgrade, Serbia.
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Rockett IRH, Caine ED, Stack S, Connery HS, Nolte KB, Lilly CL, Miller TR, Nelson LS, Putnam SL, Nestadt PS, Jia H. Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel National Violent Death Reporting System analysis. PLoS One 2018; 13:e0197805. [PMID: 29787584 PMCID: PMC5963755 DOI: 10.1371/journal.pone.0197805] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/09/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. METHODS This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011-2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. RESULTS An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. CONCLUSIONS Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.
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Affiliation(s)
- Ian R. H. Rockett
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, United States of America
- Injury Control Research Center, West Virginia University, Morgantown, West Virginia, United States of America
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
- Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Steven Stack
- Department of Criminal Justice, Wayne State University, Detroit, Michigan, United States of America
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Michigan, United States of America
| | - Hilary S. Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kurt B. Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Christa L. Lilly
- Department of Biostatistics, West Virginia University, Morgantown, West Virginia, United States of America
| | - Ted R. Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States of America
- Curtin University School of Public Health, Perth, Australia
| | - Lewis S. Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Sandra L. Putnam
- Injury Control Research Center, West Virginia University, Morgantown, West Virginia, United States of America
| | - Paul S. Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Haomiao Jia
- School of Nursing, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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18
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Dunwoodie Stirton F, Heslop P. Medical Certificates of Cause of Death for people with intellectual disabilities: A systematic literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:659-668. [DOI: 10.1111/jar.12448] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Fred Dunwoodie Stirton
- The Learning Disabilities Mortality Review (LeDeR) Programme; School for Policy Studies; University of Bristol; Bristol UK
| | - Pauline Heslop
- The Learning Disabilities Mortality Review (LeDeR) Programme; School for Policy Studies; University of Bristol; Bristol UK
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19
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Lehti V, Gissler M, Markkula N, Suvisaari J. Mortality and causes of death among the migrant population of Finland in 2011-13. Eur J Public Health 2018; 27:117-123. [PMID: 28177440 DOI: 10.1093/eurpub/ckw196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Lower mortality among migrants than in the general population has been found in many, but not in all, previous studies. The mortality of migrants has not been studied in Finland, which has a relatively small and recent migrant population. Methods People who were born abroad and whose mother tongue is not Finnish were identified from the Finnish Central Population Register (n = 185 605). A Finnish-born control matched by age, sex and place of residence was identified for each case (n = 185 605). Information about deaths was collected from the Finnish Causes of Death Register. Cox proportional hazards model was used for assessing the association between migrant status and death in 2011–13. Results The mortality risk was found to be significantly lower for migrants than for Finnish controls (adjusted hazard ratio 0.77, 95% CI 0.72–0.84), both for migrant men (aHR 0.80, 95% CI 0.73–0.89) and women (aHR 0.78, 95% CI 0.70–0.88). The difference was statistically significant only among people who were not married and among people who were not in employment. There was variation by country of birth, but no migrant group had higher mortality than Finnish controls. No differences in mortality were found by duration of residence in Finland. The higher mortality of Finnish controls was largely explained by alcohol-related conditions and external causes of death. Conclusions The mortality risk of migrants is lower than of people who were born in Finland. Possible explanations include selection and differences in substance use and other health behaviour.
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Affiliation(s)
- Venla Lehti
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,University of Turku, Research Centre for Child Psychiatry, Turku, Finland
| | - Mika Gissler
- University of Turku, Research Centre for Child Psychiatry, Turku, Finland.,National Institute for Health and Welfare, Information Services Department, Helsinki, Finland.,Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - Niina Markkula
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland.,Universidad del Desarrollo, Santiago, Chile
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
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Wunsch G, Gourbin C. Mortality, morbidity and health in developed societies: a review of data sources. GENUS 2018; 74:2. [PMID: 29398718 PMCID: PMC5787574 DOI: 10.1186/s41118-018-0027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/11/2018] [Indexed: 12/26/2022] Open
Abstract
The purpose of this paper is to review the major sources of data on mortality, morbidity and health in Europe and in other developed regions in order to examine their potential for analysing mortality and morbidity levels and trends. The review is primarily focused on routinely collected information covering a whole country. No attempt is made to draw up an inventory of sources by country; the paper deals instead with the pros and cons of each source for mortality and morbidity studies in demography. While each source considered separately can already yield useful, though partial, results, record linkage among data sources can significantly improve the analysis. Record linkage can also lead to the detection of possible causal associations that could eventually be confirmed. More generally, Big Data can reveal changing mortality and morbidity trends and patterns that could lead to preventive measures being taken rather than more costly curative ones.
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Affiliation(s)
- Guillaume Wunsch
- Centre for Demographic Research, Catholic University of Louvain, Place Montesquieu 1/L2.08.03, B-1348 Louvain-la-Neuve, Belgium
| | - Catherine Gourbin
- Centre for Demographic Research, Catholic University of Louvain, Place Montesquieu 1/L2.08.03, B-1348 Louvain-la-Neuve, Belgium
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21
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Milner GR, Boldsen JL. Life not death: Epidemiology from skeletons. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 17:26-39. [PMID: 28521910 DOI: 10.1016/j.ijpp.2017.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 03/07/2017] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
Analytically sophisticated paleoepidemiology is a relatively new development in the characterization of past life experiences. It is based on sound paleopathological observations, accurate age-at-death estimates, an explicit engagement with the nature of mortality samples, and analytical procedures that owe much to epidemiology. Of foremost importance is an emphasis on people, not skeletons. Transforming information gleaned from the dead, a biased sample of individuals who were once alive at each age, into a form that is informative about past life experiences has been a major challenge for bioarchaeologists, but recent work shows it can be done. The further development of paleoepidemiology includes essential contributions from paleopathology, archaeology or history (as appropriate), and epidemiology.
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Affiliation(s)
- George R Milner
- Department of Anthropology, 409 Carpenter Building, Pennsylvania State University, University Park, PA 16802, USA.
| | - Jesper L Boldsen
- Unit of Anthropology [ADBOU], Department of Forensic Medicine, University of Southern Denmark, Lucernemarken 20, DK 5260 Odense S, Denmark.
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22
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Danilova I, Shkolnikov VM, Jdanov DA, Meslé F, Vallin J. Identifying potential differences in cause-of-death coding practices across Russian regions. Popul Health Metr 2016; 14:8. [PMID: 27006644 PMCID: PMC4802884 DOI: 10.1186/s12963-016-0078-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/15/2016] [Indexed: 10/27/2022] Open
Abstract
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 inter-regional 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.
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Affiliation(s)
- Inna Danilova
- />Max Planck Institute for Demographic Research, Konrad-Zuse-Strasse 1, 18057 Rostock, Germany
- />National Research University Higher School of Economics, Myasnitskaya St. 20, 101000 Moscow, Russia
| | - Vladimir M. Shkolnikov
- />Max Planck Institute for Demographic Research, Konrad-Zuse-Strasse 1, 18057 Rostock, Germany
- />New Economic School, Novaya St. 100, Skolkovo, 143026 Moscow, Russia
| | - Dmitri A. Jdanov
- />Max Planck Institute for Demographic Research, Konrad-Zuse-Strasse 1, 18057 Rostock, Germany
- />New Economic School, Novaya St. 100, Skolkovo, 143026 Moscow, Russia
| | - France Meslé
- />Institut national d’études démographiques, Blvd. Davout 133, 75020 Paris, France
| | - Jacques Vallin
- />Institut national d’études démographiques, Blvd. Davout 133, 75020 Paris, France
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23
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Kulhánová I, Menvielle G, Bopp M, Borrell C, Deboosere P, Eikemo TA, Hoffmann R, Leinsalu M, Martikainen P, Regidor E, Rodríguez-Sanz M, Rychtaříková J, Wojtyniak B, Mackenbach JP. Socioeconomic differences in the use of ill-defined causes of death in 16 European countries. BMC Public Health 2014; 14:1295. [PMID: 25518912 PMCID: PMC4302075 DOI: 10.1186/1471-2458-14-1295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/08/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries. The proportion of deaths from ill-defined conditions is one of the indicators of the quality of cause-of-death data. We investigated educational differences in the use of ill-defined causes of death in official mortality statistics. METHODS Using age-standardized mortality rates from 16 European countries, we calculated the proportion of all deaths in each educational group that were classified as due to "Symptoms, signs and ill-defined conditions". We tested if this proportion differed across educational groups using Chi-square tests. RESULTS The proportion of ill-defined causes of death was lower than 6.5% among men and 4.5% among women in all European countries, without any clear geographical pattern. This proportion statistically significantly differed by educational groups in several countries with in most cases a higher proportion among less than secondary educated people compared with tertiary educated people. CONCLUSIONS We found evidence for educational differences in the distribution of ill-defined causes of death. However, the differences between educational groups were small suggesting that socioeconomic inequalities in cause-specific mortality in Europe are not likely to be biased.
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Affiliation(s)
- Ivana Kulhánová
- Department of Public Health, Erasmus Medical Center, P,O, Box 2040, 3000 CA Rotterdam, The Netherlands.
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24
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Ylijoki-Sørensen S, Boldsen JL, Lalu K, Sajantila A, Baandrup U, Boel LWT, Ehlers LH, Bøggild H. Cost-consequence analysis of cause of death investigation in Finland and in Denmark. Forensic Sci Int 2014; 245:133-42. [PMID: 25447186 DOI: 10.1016/j.forsciint.2014.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
The 1990s 12-16% total autopsy rate in Denmark has until now declined to 4%, while in Finland, it has remained between 25 and 30%. The decision to proceed with a forensic autopsy is based on national legislation, but it can be assumed that the financing of autopsies influences the decision process. Only little is known about the possible differences between health economics of Finnish and Danish cause of death investigation systems. The aims of this article were to analyse costs and consequences of Finnish and Danish cause of death investigations, and to develop an alternative autopsy practice in Denmark with another cost profile. Data on cause of death investigation systems and costs were derived from Departments of Forensic Medicine, Departments of Pathology, and the National Police. Finnish and Danish autopsy rates were calculated in unnatural (accident, suicide, homicide and undetermined intent) and natural (disease) deaths, and used to develop an alternative autopsy practice in Denmark. Consequences for society were analysed. The estimated unit cost (€) for one forensic autopsy is 3.2 times lower in Finland than in Denmark (€1400 versus €4420), but in Finland the salaries for forensic pathologists working at the National Institute for Health and Welfare are not included in the unit cost. The unit cost for one medical autopsy is also lower in Finland than in Denmark; €700 versus €1070. In our alternative practice in Denmark, the forensic autopsy rate was increased from 2.2% to 8.5%, and the medical autopsy rate from 2.4% to 5.8%. Costs per 10,000 deaths were estimated to be 50% (±25%) higher than now; i.e. €3,678,724 (2,759,112-4,598,336), but would result in a lower unit cost for forensic autopsies €3,094 (2,320-3,868) and for medical autopsies €749 (562-936). This practice would produce a higher accuracy of national mortality statistics, which, consequently, would entail higher quality in public health, an accurate basis for decision-making in health politics, and better legislative safety in society. The implementation of this alternative practice in Denmark requires that legislation demands that forensic autopsy be performed if causality between unnatural death and cause of death cannot be clarified or if cause of death remains unknown. The Danish Health and Medicines Authority should provide guidelines that request a medical autopsy in natural deaths where more information about disease as a cause of death is needed. Our study results warrant similar health economic analyses of different cause of death investigations in other countries.
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Affiliation(s)
- Seija Ylijoki-Sørensen
- Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
| | - Jesper Lier Boldsen
- ADBOU, Institute of Forensic Medicine, University of Southern Denmark, Lucernemarken 20, 5260 Odense S, Denmark.
| | - Kaisa Lalu
- National Institute for Health and Welfare, Forensic Medicine Unit, Helsinki Kytösuontie 11, 00300 Helsinki, Finland.
| | - Antti Sajantila
- Department of Forensic Medicine, Hjelt Institute, Helsinki University, Kytösuontie 11, 00014 Helsinki, Finland, and Institute of Applied Genetics, Department of Molecular and Medical Genetics, University of North Texas Health Science Center, Ft. Worth, Texas, USA.
| | - Ulrik Baandrup
- Centre for Clinical Research, Vendsyssel Hospital/Faculty of Medicine, Aalborg University, Bispensgade 37, 9800 Hjørring, Denmark.
| | - Lene Warner Thorup Boel
- Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
| | - Lars Holger Ehlers
- Department of Business and Management, Danish Center for Healthcare Improvements, Faculty of Social Sciences, Aalborg University, Fibigerstræde 11, Room 73, 9220 Aalborg, Denmark.
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 3-209, 9220 Aalborg, Denmark.
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