Ylijoki-Sørensen Seija, Sajantila Antti, Lalu Kaisa, Bøggild Henrik, Boldsen Jesper Lier, Boel Lene Warner Thorup
Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
Department of Forensic Medicine, Hjelt Institute, Helsinki University, Kytösuontie 11, 00014 Helsinki, Finland; Institute of Applied Genetics, Department of Molecular and Medical Genetics, University of North Texas Health Science Center, Fort Worth, TX, USA.
Forensic Sci Int. 2014 Nov;244:289-94. doi: 10.1016/j.forsciint.2014.09.016. Epub 2014 Sep 28.
Exact cause and manner of death determination improves legislative safety for the individual and for society and guides aspects of national public health. In the International Classification of Diseases, codes R00-R99 are used for "symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified" designated as "ill-defined" or "with unknown etiology". The World Health Organisation recommends avoiding the use of ill-defined and unknown causes of death in the death certificate as this terminology does not give any information concerning the possible conditions that led to the death. Thus, the aim of the study was, firstly, to analyse the frequencies of R00-R99-coded deaths in mortality statistics in Finland and in Denmark and, secondly, to compare these and the methods used to investigate the cause of death. To do so, we extracted a random 90% sample of the Finnish death certificates and 100% of the Danish certificates from the national mortality registries for 2000, 2005 and 2010. Subsequently, we analysed the frequencies of forensic and medical autopsies and external clinical examinations of the bodies in R00-R99-coded deaths. The use of R00-R99 codes was significantly higher in Denmark than in Finland; OR 18.6 (95% CI 15.3-22.4; p<0.001) for 2000, OR 9.5 (95% CI 8.0-11.3; p<0.001) for 2005 and OR 13.2 (95% CI 11.1-15.7; p<0.001) for 2010. More than 80% of Danish deaths with R00-R99 codes were over 70 years of age at the time of death. Forensic autopsy was performed in 88.3% of Finnish R00-R99-coded deaths, whereas only 3.5% of Danish R00-R99-coded deaths were investigated with forensic or medical autopsy. The codes that were most used in both countries were R96-R99, meaning "unknown cause of death". In Finland, all of these deaths were investigated with a forensic autopsy. Our study suggests that if all deaths in all age groups with unclear cause of death were systematically investigated with a forensic autopsy, only 2-3/1000 deaths per year would be coded as an ill-defined and unknown cause of death in national mortality statistics. At the same time the risk to overlook unnatural deaths is decreased to a minimum. To achieve this in Denmark requires that the existing legislation on cause of death investigation would need to be changed to ensure that all deaths with unknown cause of death are investigated with a forensic autopsy.
准确判定死亡原因和方式可提高个人及社会的立法安全性，并指导国家公共卫生的相关方面。在《国际疾病分类》中，编码R00 - R99用于“未在其他处分类的症状、体征以及异常临床和实验室检查结果”，被指定为“定义不明确”或“病因不明”。世界卫生组织建议避免在死亡证明中使用定义不明确和死因不明的表述，因为这种术语并未提供任何关于可能导致死亡的状况的信息。因此，本研究的目的，首先是分析芬兰和丹麦死亡率统计中编码为R00 - R99的死亡频率，其次是比较这些频率以及用于调查死因的方法。为此，我们从2000年、2005年和2010年的国家死亡率登记处随机抽取了90%的芬兰死亡证明样本和100%的丹麦死亡证明样本。随后，我们分析了编码为R00 - R99的死亡案例中法医解剖、医学解剖以及尸体外部临床检查的频率。丹麦使用R00 - R99编码的比例显著高于芬兰；2000年的比值比为18.6（95%置信区间15.3 - 22.4；p<0.001），2005年为9.5（95%置信区间8.0 - 11.3；p<0.001），2010年为13.2（95%置信区间11.1 - 15.7；p<0.001）。丹麦编码为R00 - R99的死亡案例中，超过80%的死者死亡时年龄超过70岁。芬兰编码为R00 - R99的死亡案例中，88.3%进行了法医解剖，而丹麦编码为R00 - R99的死亡案例中，只有3.5%进行了法医或医学解剖。两国最常使用的编码是R96 - R99，意思是“死因不明”。在芬兰，所有这些死亡案例都进行了法医解剖。我们的研究表明，如果对所有年龄组死因不明的所有死亡案例都系统地进行法医解剖，那么在国家死亡率统计中，每年只有2 - 3/1000的死亡案例会被编码为定义不明确和死因不明。同时，忽视非自然死亡的风险可降至最低。在丹麦要实现这一点，需要更改现有的死因调查立法，以确保对所有死因不明的死亡案例都进行法医解剖。
