Ill-defined and unspecified causes of death in Russia
Abstract
More than half of all deaths in Russia in 2011-2014 were subjected to pathologic or forensic autopsy, as a result of which the cause of death was not identified for 3.8 percent of the cases. More than 147,000 unproductive autopsies which left the cause of death unknown were carried out. Such a large number of cases cannot be explained by the state of the cadavers at the moment of the autopsy. Another 161,000 deaths (4.1% of autopsies) were classified as events of undetermined intent. This paper attempts to find a rational explanation for such a high proportion of uncertain autopsy conclusions concerning the cause of death.
The methods applied include an analysis at the macro-level (regions), with the help of factor analysis and clustering techniques, and multinomial logistic regression at the micro-level, using anonymous individual records. The study is based entirely on Russian state statistics data.
There are large interregional differences in the practices of determining the cause of death based on autopsy. Practices of diagnosing external causes also vary greatly by region. In regions where the proportion of unspecified causes is higher, the share of events of undetermined intent is also higher. These differences are not connected with the peculiarities of mortality in each region.
The analysis suggests that the large number of cases in which the cause of death remains unknown after an autopsy is due to the lack of incentives to clarify the cause of death after the issuance of the preliminary medical death certificate.
Moreover, the existing system of relations between forensic bureaus and law-enforcement agencies makes no provision for apprising forensics experts of the final conclusions concerning the external causes of death.
From 2011 to 2014 the number of forensic autopsies of persons who had died from disease increased by 20 percent, but there are doubts that the information obtained as a result of the autopsies is effectively used by the health care system.
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References
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