Making better use of coroner’s service activity data 13 November 2013 Making better use of coroner’s service activity data David Gunnell Professor of Epidemiology and Head of Research School of Social and Community Medicine

Making better use of coroner’s service activity data NIHR Programme: Suicide Prevention Surveillance to identify rise in use of a new method early to ensure a prompt public health response Sentinel coroners / local authorities Sentinel A&E Departments Early analyses by ONS of incoming death certificates

Why is it important to identify the emergence of new suicide methods? Making better use of coroner’s service activity data Why is it important to identify the emergence of new suicide methods? Preventing access to high-lethality methods of suicide is one of the few effective approaches to suicide prevention

Percentage of Carbon monoxide (CO) in domestic gas, UK 1955-74 Percent CO Natural Experiment North sea gas in the 1950s Burning coal 1955 1960 1965 1970 1975 Year Kreitman N Brit. J. Prev. Soc. Med. (1976), 30, 86-93

England & Wales: sex-specific suicide rates by method Male Female Total Total Other methods Other methods Carbon monoxide Carbon Monoxide 1n 1950s domestic gas poisoning commonest method used in Britain – approx half of all male and female suicides. North Sea gas discovered in 1950s – graded change in domestic gas supply Decline in domestic gas suicides but no rise in other suicides. Implication – if commonly used methods are made less available / lethal some suicides will be prevented – estimates are that around 6,000 deaths averted by the introduction of natural gas Kreitman N Brit. J. Prev. Soc. Med. (1976), 30, 86-93

Trends in age-specific rates: England & Wales 1863-2007 Figure shows trends in male age specific rates over time where youngest age groups are red, black and blue. Historically oldest men over 55 years (ie 55-64 and 65 plus) were at highest risk. However by 2007, men aged 35-44 had the highest rates. Large drops in men older than 45 years in both world wars Increases in younger men 15-24 and 25-34 seen predominantly for world war 1- data artefacts due to reduced population denominator as younger men conscripted and sent to war All age groups show rise in suicide rates in great depression Thomas and Gunnell, Int JEpid 2010 6

Impact of firearm availability on suicide in USA: age-adjusted suicide rates by method, USA vs. New Jersey, 1999 - 2001 Age-adjusted rate per 100,000 population Hempstead Soc Sci Med 2006

Suicide rates by method in men, Taiwan, 1967-2007 Chang S-S, unpublished

Why is it important to identify the emergence of new suicide methods? Making better use of coroner’s service activity data Why is it important to identify the emergence of new suicide methods? Preventing access to high-lethality methods of suicide is one of the few effective approaches to suicide prevention Recent concerns in the UK Car exhaust gases Co-proxamol and paracetamol Helium Charcoal burning

Sentinel coroners / local authorities: Opportunities Making better use of coroner’s service activity data Sentinel coroners / local authorities: Opportunities Here and now monitoring of emerging methods NIHR study includes a pilot study of 12 Coroners in England using the coroners’ database and records We understand there are existing systems of early reporting

Sentinel coroners / local authorities: Challenges Making better use of coroner’s service activity data Sentinel coroners / local authorities: Challenges Coroner’s databases under regular review/change Seagate report effectively redundant Systems/preferences across coroners differ Cause of death on certificate may be uninformative e.g. asphyxiation, therefore need to read records to identify ‘helium’

Making better use of coroner’s service activity data Options Sentinel coroners / local authorities – any areas willing to contribute? Sentinel A&E Departments – not useful for high lethality methods Early analyses by ONS of incoming death certificates – in discussion

Thank you We would welcome your advice.... Making better use of coroner’s service activity data Thank you We would welcome your advice....