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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries

Authors: Ingvild Maria Tøllefsen, Ingemar Thiblin, Karin Helweg-Larsen, Erlend Hem, Marianne Kastrup, Ullakarin Nyberg, Sidsel Rogde, Per-Henrik Zahl, Gunvor Østevold, Øivind Ekeberg

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

National mortality statistics should be comparable between countries that use the World Health Organization’s International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences.

Methods

The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports.

Results

In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts reclassified 22 and 51 %, respectively, to accidents.

Conclusion

There was moderate agreement in reclassification of accidents between the official mortality statistics and the experts. In the majority of cases where there was disagreement, accidents were reclassified as undetermined manner of death, and only a small proportion as suicides.
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Metadata
Title
Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries
Authors
Ingvild Maria Tøllefsen
Ingemar Thiblin
Karin Helweg-Larsen
Erlend Hem
Marianne Kastrup
Ullakarin Nyberg
Sidsel Rogde
Per-Henrik Zahl
Gunvor Østevold
Øivind Ekeberg
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3135-5

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