1. 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

2. 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

3. 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

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

5. 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

6. 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 and 65 plus) were at highest risk. However by 2007, men aged had the highest rates.
Large drops in men older than 45 years in both world wars
Increases in younger men and 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

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

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Chang S-S, unpublished

9. 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

10. 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

11. 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’

12. 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

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