Medical examiner data in injury surveillance: a comparison with death certificates

Increasingly, researchers use medical examiner reports to study the epidemiology of fatal injuries, often assuming that reports of all fatal injuries are included in medical examiner databases. This study evaluated that assumption by comparing the medical examiner database with the death certificates of persons who died of fatal injuries in Iowa during 1990-1991. The authors also examined the association between demographic variables and the presence of a medical examiner report. Overall, medical examiners reported 68.7% of fatal injuries. Among broad categories of injury deaths, the percentages of medical examiner reports varied: 36.9% of fatalities from unintentional falls, 79.2% of transportation fatalities, 82.6% of intentional fatalities, and 57.3% of other external causes of death. Age and sex were also associated with the presence of a medical examiner report. Women's deaths were half as likely as men's to be reported by the medical examiner. Deaths among the elderly were underreported as well. Among the elderly, fatalities from unintentional falls and, to a lesser extent, transportation fatalities were less likely to be investigated by a medical examiner, but intentional fatalities were more likely to be. Although medical examiner reports may contain detailed information, they underreport the actual number of injury deaths. This underreporting is of special concern for injury research, since certain demographic groups were found to be underrepresented in medical examiner reports.