Hill Chris, Cook Lois
Office for National Statistics.
Health Stat Q. 2011 Spring(49):81-100. doi: 10.1057/hsq.2011.4.
Annually, there are around 30,000 coroner's inquests held in England and Wales that conclude with a verdict. 'Short form' verdicts such as accident or misadventure; natural causes; suicide; and homicide make up the majority of all verdict conclusions. 'Narrative' verdicts can be used by a coroner or jury, instead of a short form verdict, to express their conclusions as to the cause of death following an inquest. Since 2001 narrative verdicts have been more widely used, with over 3,000 narrative verdicts returned in 2009. In some cases, it can be difficult to code the underlying cause of death from the information provided in the narrative. For some time, the Office for National Statistics (ONS) and other organisations have been concerned about the impact of narrative verdicts on the quality of the statistics on cause of death. Our research investigated the impact of narrative verdicts on trends for deaths attributed to injury and poisoning in England and Wales.
The research considered narrative verdicts received by ONS between 2001 and 2009. All available information provided by the coroner from the narrative verdict, together with the underlying cause of death, was used in the analysis. All causes of death where a narrative verdict was returned were investigated. More in-depth analysis of accidental deaths was undertaken, as classification of these deaths by intent is more difficult when the information from the coroner is imprecise. A sensitivity analysis of suicide rates (intentional self-harm and event of undetermined intent) was carried out. This involved using two different scenarios of reclassifying selected proportions of accidental hanging and poisoning deaths, where a narrative verdict was returned, as intentional self-harm. An exercise to measure the consistency of coding cause of death from narrative verdicts was also undertaken.
The increasing proportion of narrative verdicts involving injury and poisoning has not significantly affected published mortality rates for suicide (intentional self-harm and injury or poisoning of undetermined intent). However, if the rise in narrative verdicts continues at the same rate, the accurate reporting of injury and poisoning deaths, including suicides, is likely to be affected. The exercise to establish the consistency of coding the cause of death by ONS cause coders showed that the current coding rules were being applied uniformly.
The increase in the use of narrative verdicts by coroners has not had a statistically significant impact on published suicide rates in England and Wales and so no revision to these rates is needed. A review of current coding practices and the handling of narrative verdicts will be undertaken by ONS with particular reference to deaths from intentional self-harm. A recommendation has been made to coroners to consider ways of recording narrative verdicts to allow more accurate coding of cause of death. This will ensure that mortality statistics are maintained to the highest standards.List of Tables, 83.
在英格兰和威尔士，每年约有30000例死因裁判法庭的死因调查得出裁决结果。“简短形式”的裁决，如意外事故或不幸事故、自然原因、自杀和他杀，构成了所有裁决结果的大部分。死因裁判官或陪审团可以使用“叙述性”裁决，而不是简短形式的裁决，来表达他们在死因调查后对死亡原因的结论。自2001年以来，叙述性裁决的使用更为广泛，2009年有超过3000例叙述性裁决。在某些情况下，根据叙述中提供的信息对根本死因进行编码可能会很困难。一段时间以来，国家统计局（ONS）和其他组织一直担心叙述性裁决对死亡原因统计质量的影响。我们的研究调查了叙述性裁决对英格兰和威尔士因伤害和中毒导致的死亡趋势的影响。
该研究考虑了国家统计局在2001年至2009年期间收到的叙述性裁决。分析中使用了死因裁判官从叙述性裁决中提供的所有可用信息以及根本死因。对所有返回叙述性裁决的死亡原因进行了调查。对意外死亡进行了更深入的分析，因为当死因裁判官提供的信息不准确时，按意图对这些死亡进行分类会更加困难。对自杀率（故意自我伤害和意图不明的事件）进行了敏感性分析。这涉及使用两种不同的情景，将选定比例的意外上吊和中毒死亡（返回叙述性裁决）重新分类为故意自我伤害。还进行了一项衡量从叙述性裁决中编码死亡原因的一致性的工作。
涉及伤害和中毒的叙述性裁决比例的增加并未对公布的自杀死亡率（故意自我伤害以及意图不明的伤害或中毒）产生显著影响。然而，如果叙述性裁决继续以相同的速度上升，包括自杀在内的伤害和中毒死亡的准确报告可能会受到影响。国家统计局死因编码人员确定编码死亡原因一致性的工作表明，当前的编码规则正在统一应用。
死因裁判官使用叙述性裁决的增加对英格兰和威尔士公布的自杀率没有统计学上的显著影响，因此无需对这些比率进行修订。国家统计局将对当前的编码做法和叙述性裁决的处理进行审查，特别提及故意自我伤害导致的死亡。已向死因裁判官提出建议，考虑记录叙述性裁决的方式，以便更准确地编码死亡原因。这将确保死亡率统计保持在最高标准。表格列表，83。
