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Mortality in medicolegal deaths in Hyogo Prefecture (1986-88)
K Saijoh1, T Fukunaga, W Ajiki
1Department of Public Health, Kobe University School of Medicine.
Insights
In Japan, "heart failure" is often misused for unknown causes of death, skewing mortality statistics. Improving the accuracy of death certification is crucial for public health initiatives.
Area of Science:
- Forensic Pathology
- Public Health Statistics
Background:
- Japan lacks a coroner system, with medical practitioners conducting medicolegal death inquests.
- Existing medicolegal death investigation practices in Japan may impact mortality data accuracy.
Purpose of the Study:
- To compare death certification practices between medical examiners and medical practitioners in Japan.
- To investigate the potential misuse of "heart failure" as a cause of death in Japanese mortality statistics.
Main Methods:
- Comparative analysis of death certificates filed by medical examiners and medical practitioners in Hyogo Prefecture.
- Examination of autopsy findings for deaths certified as "heart failure" by medical examiners.
Main Results:
- Medical examiners reserve "heart failure" certification for cases with no autopsy-confirmed pathological changes.
- A significant number of deaths (1,707 of 2,622 disease-related deaths) were certified as "heart failure" by medical practitioners without autopsies.
- "Heart failure" accounted for a substantial portion (53.9 per 100,000) of the age-adjusted mortality rate for "heart disease" in Japan.
Conclusions:
- The term "heart failure" is likely misused in Japan for deaths with undetermined causes, introducing bias into mortality statistics.
- Lack of understanding regarding mortality statistics and the International Classification of Diseases (ICD) contributes to this inaccuracy.
- Enhancing the reliability of mortality statistics is essential for effective disease prevention strategies in clinical medicine and public health.
Abstract:
Only three medical examiner offices are undertaking inquests on medicolegal deaths and no coroner system exists in Japan. Medical practitioners are also entrusted to hold such inquests. Certificates filed by the medical examiners of Hyogo Prefecture were compared with those filed by medical practitioners. Medical examiners certified deaths as "heart failure" only when no pathological changes were found after an autopsy. Of 2,622 deaths caused by diseases, 1,707 were certified as "heart failure" by medical practitioners without performing an autopsy. The term "heart failure" seems likely to be misused for deaths of which causes are unknown. Although the age-adjusted mortality rate for "heart disease" in Japan (98.7 per 100,000 population) showed a higher rate than for "cerebrovascular disease" (84.2), it included 53.9 for "heart failure". The misuse of the term "heart failure" seems to have introduced serious bias into the recent mortality statistics of Japan. This inaccuracy is due to ignorance about the importance of mortality statistics and ICD. Improvement in the reliability of mortality statistics is necessary for disease prevention projects through clinical medicine and public health means.