Narrative verdicts and their impact on mortality statistics in England and Wales.

BACKGROUND: Annually, there are around 30,000 coroner's inquests held in England and Wales that conclude with a verdict. 'Short form' verdicts such as accident or misadventure; natural causes; suicide; and homicide make up the majority of all verdict conclusions. 'Narrative' verdicts can be used by a coroner or jury, instead of a short form verdict, to express their conclusions as to the cause of death following an inquest. Since 2001 narrative verdicts have been more widely used, with over 3,000 narrative verdicts returned in 2009. In some cases, it can be difficult to code the underlying cause of death from the information provided in the narrative. For some time, the Office for National Statistics (ONS) and other organisations have been concerned about the impact of narrative verdicts on the quality of the statistics on cause of death. Our research investigated the impact of narrative verdicts on trends for deaths attributed to injury and poisoning in England and Wales.
METHODS: The research considered narrative verdicts received by ONS between 2001 and 2009. All available information provided by the coroner from the narrative verdict, together with the underlying cause of death, was used in the analysis. All causes of death where a narrative verdict was returned were investigated. More in-depth analysis of accidental deaths was undertaken, as classification of these deaths by intent is more difficult when the information from the coroner is imprecise. A sensitivity analysis of suicide rates (intentional self-harm and event of undetermined intent) was carried out. This involved using two different scenarios of reclassifying selected proportions of accidental hanging and poisoning deaths, where a narrative verdict was returned, as intentional self-harm. An exercise to measure the consistency of coding cause of death from narrative verdicts was also undertaken.
RESULTS: The increasing proportion of narrative verdicts involving injury and poisoning has not significantly affected published mortality rates for suicide (intentional self-harm and injury or poisoning of undetermined intent). However, if the rise in narrative verdicts continues at the same rate, the accurate reporting of injury and poisoning deaths, including suicides, is likely to be affected. The exercise to establish the consistency of coding the cause of death by ONS cause coders showed that the current coding rules were being applied uniformly.
CONCLUSIONS: The increase in the use of narrative verdicts by coroners has not had a statistically significant impact on published suicide rates in England and Wales and so no revision to these rates is needed. A review of current coding practices and the handling of narrative verdicts will be undertaken by ONS with particular reference to deaths from intentional self-harm. A recommendation has been made to coroners to consider ways of recording narrative verdicts to allow more accurate coding of cause of death. This will ensure that mortality statistics are maintained to the highest standards.List of Tables, 83.