Where They Die of the Unknown : A Study of United States Medicolegal Death Investigation Systems and Morality Data Quality




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In the case of unnatural deaths in the United States, medical examiners and coroners are primarily responsible for establishing the cause and manner of death, as well as completing the death certificate. The cause of death portion of death certificates is used by the National Center of Healthcare Statistics to compile national health statistics. The degree of specificity of the cause of death varies significantly across states and types of deaths. This research examines the relationship between differences in medicolegal death investigation (MDI) systems (i.e., coroner and medical examiner systems) and the quality of mortality data. Three analyses were performed. The first uses difference-in-difference modeling to assess a causal link between MDI systems and mortality data quality. The second expands existing research by exploring the cross sectional relationship between these variables with regards to different causes and manners of death, using principle components analysis and regression. The third analysis uses multi-level regression to explore whether death certificate data quality impacts eligibility for FEMA’s disaster funeral assistance program. The findings of these analyses do not show a strong longitudinal or cross-sectional relationship between MDI system type and mortality data specificity. Although previous studies have suggested a relationship between these variables, this study indicates such a relationship is confined to drug poisoning deaths. The findings suggest that individual office holders and local office policies may have a broader impact on data quality than system-wide variables.



Medicolegal investigators, Autopsy, Death -- Causes, Death -- Proof and certification, Death certificates, Coroners, Forensic pathology