Content area
Full Text
Manner of death (MOD) classification (i.e., natural, accident, suicide, homicide, or undetermined cause) affects mortality surveillance and public health research, policy, and practice. Determination of MOD in deaths caused by drug intoxication is challenging, with marked variability across states.
The Centers for Disease Control and Prevention hosted a multidisciplinary meeting to discuss drug intoxication deaths as they relate to suicide and other MOD. The meeting objectives were to identify individual-level, system-level, and place-based factors affecting MOD classification and identify potential solutions to classification barriers.
Suggested strategies included improved standardization in death scene investigation, toxicology, and autopsy practice; greater accountability; and creation of job aids for investigators. Continued collaboration and coordination of activities are needed among stakeholders to affect prevention efforts. (Am JPublic Health. 2017;107:1233-1239. doi:10.2105/AJPH.2017.303863)
Accurately classifying how someone died (by natural causes, accident, suicide, homicide, or an undetermined cause), called manner of death (MOD), is critical to public health. This information feeds directly into mortality surveillance systems that, in turn, drive prevention, research, policy, monitoring and evaluation, and allocation of resources.1 Since 1790, suicide rates have been considered to be substantially underestimated, both internationally and domestically, with variations across countries.2 6 In modern times, underestimation is thought to range from 10% to 30%.2-4,7,8
Undercounting may result from stigma avoidance; legal, religious, and political pressure; and underresourcing of medicolegal death investigation sys4,6,8,9 tems, among other reasons. In an effort to standardize MOD ascertainment, the National Association of Medical Examiners (NAME) developed A Guide for Manner of Death Classification in 2002.10 Although this document was considered a milestone in the field, death investigation systems and the authority to require guidance compliance are highly decentralized in the United States,11 and thus undercounting likely persists.
Research suggests that many suicides, defined typically as self-inflicted acts with the intent to die, may be hidden among accidental deaths12,13 (the term "accident" vs "unintentional death," which is preferred in the field of injury prevention, is the official label used in ascribing MOD and thus is used here out) and undetermined deaths (the manner ascribed when no single MOD is more compelling than another given the information available).3,14 Undetermined deaths are made up largely of drug intoxication deaths, also called "drug overdose" and "drug poisoning" deaths. (The term "drug intoxication" is...