Postcode lottery plays out in death as well as life

We can’t cheat death, but can it cheat us? MTSOfan

Whether your death is reported to the coroner or not depends hugely on where you live (or died) and whether you are a man or a woman, as does the verdict on the cause of your death.

These were the preliminary findings of a study we conducted into death reporting to, and decision making by, coroners in England and Wales between 2001-2010.

Reporting deaths to Coroners

Not all deaths are reported to a coroner by a doctor. But there are a number of reasons when they are. These include when the cause of death is unknown; the death was violent, unnatural, sudden or explained; or if the person who died wasn’t seen by the doctor who signed the medical certificate within 14 days before or after they died.

In the 1950’s, fewer than 20% of registered deaths were reported to a coroner. This figure is now 46%. And it varies significantly between regions. We found reporting rates ranged from 12% of registered deaths in one jurisdiction to 87% in another.

Differences between jurisdictions

Reporting rates were stable over the 10-year period we studied and there weren’t obvious geographical or demographic explanations for the variation. This means that differences must come down to a combination of local demography, a high number of suicides in a particular area for example, or local practice, where a coroner might favour a particular verdict over another.

Three quarters of the 114 coroner jurisdictions in England and Wales had death reporting rates of between 33% and 57%; 11 had less than 33% and 17 had reporting rates of 57% and above.

When these findings were placed on a map, there was an inverse relationship between geographically larger jurisdiction areas and lower reporting rates - so if you live in a larger urban area, rather than a more rural one, your death is more likely to be reported.

It’s unsurprising that highly populated areas should report more deaths, but population size doesn’t seem to make a difference to the rate (percentage) of reporting. For example, the two coroner jurisdictions with the highest populations - Essex & Thurrock and North London - had reporting rates of 36% to 59% respectively.

But the more deprived an area is, the higher the rate of reporting. This potentially throws up an interesting insight into health inequalities - this demographic is likely to be less well known to GPs, who are then less able to certify a death.

But it’s still not the full picture: significant differences were found between Blackburn and Manchester North, areas with similar levels of deprivation.

Potential links with crime rates are a current focus, such as whether reporting rates and the levels of gang violence and gun crime in an area are related.

Inquest verdicts

Inquest verdicts are another area with wide variation. The average post mortem rate for 2010 was 46%, but varied locally from 20% to 66%. What’s surprising is that in areas where a greater proportion of registered deaths were reported there were proportionately less post mortems.

Verdict types - for example, accident/misadventure or natural causes - also vary. For unnatural deaths, men were statistically over-represented in industrial disease and suicide verdicts while women were over-represented in narrative verdicts (where the coroner doesn’t reach a verdict but lays out the facts of the case) and accidents.

The variation suggests that verdict patterns are more a product of an individual coroner’s decision-making style than local patterns of death.

Even jurisdictions with similar overall case loads reported very different verdict profiles. Of course, there’s a link with reporting patterns. For example, a coroner who records fewer natural causes verdicts may be one whose guidance influences decisions by local doctors when certifying a death.

Share of the six main coroner verdicts in England and Wales in 2011. Jason Roach

Is it a man thing?

When we analysed data according to sex, just under a half (49%) of male deaths were reported to a coroner compared with 39% if female.

On average, a man’s death was 26% more likely to be reported to the coroner.

However, we mustn’t jump to any firm conclusions just yet. For example, since women die later than men, it would be crucial to know age-specific reporting rates, for which there is currently no readily available data.

It may also give us an insight into different health habits between men and women. For example it could be that many men don’t attend doctor’s surgeries on a regular basis so their recorded medical histories are considerably shorter and their cause of death possibly less certain. But we don’t know.

But gender differences continue. There were proportionately fewer inquests for women. For men, 16% of all deaths reported to coroners between 2001-2010 proceeded to inquest while for women that figure was 8%.

Once at inquest, verdicts of natural causes were recorded more often for women (28%) than for men (22%). So, fewer women were reported to the coroner, fewer women proceeded to inquest and fewer women at inquest were considered to have died unnaturally.

The analysis suggests that some coroners may be more “gendered” in their approach to inquest verdicts, that is they are consistently more likely to favour a particular verdict when dealing with a death.

These statistics provide us with an interesting snapshot of health. But to see the true picture we need to analyse further data on age, crime, and gender. It could be that further analysis throws up yet more information on the different health habits between men and women, or potential problems in the system that need to be addressed.