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Death

Volume 489: debated on Friday 20 March 2009

To ask the Chancellor of the Duchy of Lancaster (1) how many death certificates included the words (a) smoking, (b) knife injuries, (c) obesity, (d) anorexia, (e) bulimia and (f) influenza in the cause of death section in each of the last five years; (264116)

(2) how many death certificates included the words (a) legionnaires' disease, (b) self-harm, (c) cataract, (d) tuberculosis, (e) measles, (f) mumps and (g) rubella in the cause of death section in each of the last five years.

The information requested falls within the responsibility of the UK Statistics Authority. I have asked the authority to reply.

Letter from Karen Dunnell:

As National Statistician, I have been asked to reply to your recent questions asking:

1) How many death certificates included (a) smoking, (b) knife, (c) overweight, (d) anorexia, (e) bulimia and (f) influenza in the cause of death section in each of the last five years. (264116)

2) How many death certificates included (a) Legionnaires' disease, (b) self-harm, (c) cataract, (d) tuberculosis, (e) measles, (f) mumps and (g) rubella in the cause of death section m each of the last five years. (264117)

The accurate reporting of deaths by specific causes depends on the complete recording of all relevant causes of death by medical practitioners and coroners. Medical practitioners are required to complete the Medical Certificate of Cause of Death (MCCD) to the best of their knowledge and belief. Internationally accepted guidance from the World Health Organisation requires only those conditions that contributed directly to death to be recorded, and medical practitioners and coroners are not supposed to record all of the diseases or conditions present at or before death. Whether a condition contributed is a matter for their clinical judgment. The MCCD is not designed to collect information on risk factors or exposures related to the development of disease, such as smoking behaviour.

The tables attached provide the number of deaths where:

1) (a) Mental and behavioural disorders due to use of tobacco (b) contact with sharp object, (c) obesity, (d) anorexia nervosa, (e) bulimia nervosa, (f) influenza, or

2) (a) Legionnaires' disease, (b) intentional self-harm, (c) cataract, (d) tuberculosis, (e) measles, (f) mumps and (g) rubella were mentioned on the death certificate, in England and Wales, for 2003 to 2007 (the latest year available).

The number of deaths due to (1) (a) mental and behavioural disorders due to use of tobacco is not the same as the number of deaths attributable to smoking. The cause of death recorded in the great majority of cases where smoking was a causal factor would be the specific disease, such as lung cancer or ischaemic heart disease, which led to death.

Although there are codes for contact, assault and intentional self-harm by sharp object, there are no specific codes for 'knife1, so these figures are likely to exceed the actual number of deaths involving (1) (b) knives.

Figures for (2) (b) self-harm are likely to be an underestimate, as they exclude any deaths where intent could not be ascertained. These figures do not correspond directly to the statistics published by ONS on suicides.

Table 1. Deaths where certain named causes were mentioned on the death certificate1, England and Wales2, 2003-073

2003

2004

2005

2006

2007

Mental and behavioural disorders due to use of tobacco

676

622

614

719

596

Contact with sharp object

160

182

171

164

160

Obesity

888

901

993

1,150

1,203

Anorexia nervosa

26

19

30

35

29

Bulimia nervosa

3

3

3

3

5

Influenza

80

51

57

25

37

Legionnaires' disease

30

38

24

37

38

Intentional self-harm

3,286

3,453

3,316

3,332

3,165

Cataract

19

11

15

15

9

Tuberculosis

641

606

627

633

561

Measles

3

5

0

2

1

Mumps

4

2

1

2

1

Rubella

1

0

0

0

0

1 Cause of death was defined using the International Classification of Diseases, Tenth Revision (ICD-10). The specific causes of death categorised in Table 1, and their corresponding ICD-10 codes, are shown in the box below. Deaths were included where one of these causes was mentioned anywhere on the death certificate.

2 Figures for England and Wales include deaths of non-residents.

3 Figures are for deaths registered in each calendar year.

Box 1. Causes of death codes used—International Classification of Diseases, Tenth Revision (ICD-10)

Cause of death

ICD-10 code(s)

Mental and behavioural disorders due to use of tobacco

F17

Contact with sharp object

X78. X99, Y28

Obesity

E66

Anorexia nervosa

F50.0, F50.1

Bulimia nervosa

F50.2

Influenza

J10-J11

Legionnaires' disease

A48.1

Intentional self-harm

X60-X84

Cataract

H25-H26

Tuberculosis

A15-A19

Measles

BOS

Mumps

B26

Rubella

B06