Spatiotemporal epidemiology of substance-related accidental acute toxicity deaths in Canada from 2016 to 2017.

OBJECTIVES: In Canada, substance-related accidental acute toxicity deaths (AATDs) continue to rise at the national and sub-national levels. However, it is unknown if, where, when, and to what degree AATDs cluster in space, time, and space-time across the country. The objectives of this study were to 1) assess for clusters of AATDs that occurred in Canada during 2016 and 2017 at the national and provincial/territorial (P/T) levels, and 2) examine the substance types detected in AATD cases within each cluster. METHODS: Two years of person-level data on AATDs were abstracted from coroner and medical examiner files using a standardized data collection tool, including the decedent's postal code and municipality information on the places of residence, acute toxicity (AT) event, and death, and the substances detected in the death. Data were combined with Canadian census information to create choropleth maps depicting AATD rates by census division. Spatial scan statistics were used to build Poisson models to identify clusters of high rates (p < 0.05) of AATDs at the national and P/T levels in space, time, and space-time over the study period. AATD cases within clusters were further examined for substance types most present in each cluster. RESULTS: Eight clusters in five regions of Canada at the national level and 24 clusters in 15 regions at the P/T level were identified, highlighting where AATDs occurred at far higher rates than the rest of the country. The risk ratios of identified clusters ranged from 1.28 to 9.62. Substances detected in clusters varied by region and time, however, opioids, stimulants, and alcohol were typically the most commonly detected substances within clusters. CONCLUSION: Our findings are the first in Canada to reveal the geographic disparities in AATDs at national and P/T levels using spatial scan statistics. Rates associated with substance types within each cluster highlight which substance types were most detected in the identified regions. Findings may be used to guide intervention/program planning and provide a picture of the 2016 and 2017 context that can be used for comparisons of the geographic distribution of AATDs and substances with different time periods.

Maternal Deaths Using Coroner's Data: A Latent Class Analysis.

OBJECTIVE: Knowledge regarding the antecedent clinical and social factors associated with maternal death around the time of pregnancy is limited. This study identified distinct subgroups of maternal deaths using population-based coroner's data, and that may inform ongoing preventative initiatives. METHODS: A detailed review of coroner's death files was performed for all of Ontario, Canada, where there is a single reporting mechanism for maternal deaths. Deaths in pregnancy, or within 365 days thereafter, were identified within the Office of the Chief Coroner for Ontario database, 2004-2020. Variables related to the social and clinical circumstances surrounding the deaths were abstracted in a standardized manner from each death file, including demographics, forensic information, nature and cause of death, and antecedent health and health care factors. These variables were then entered into a latent class analysis (LCA) to identify distinct types of deaths. RESULTS: Among 273 deaths identified in the study period, LCA optimally identified three distinct subgroups, namely, (1) in-hospital deaths arising during birth or soon thereafter (52.7% of the sample); (2) accidents and unforeseen obstetric complications also resulting in infant demise (26.3%); and (3) out-of-hospital suicides occurring postpartum (21.0%). Physical injury (22.0%) was the leading cause of death, followed by hemorrhage (16.8%) and overdose (13.3%). CONCLUSION: Peri-pregnancy maternal deaths can be classified into three distinct sub-types, with somewhat differing causes. These findings may enhance clinical and policy development aimed at reducing pregnancy mortality.

Preventable deaths involving sepsis in England and Wales, 2013-2022: a systematic case series of coroners' reports.

PURPOSE: Coroners' Prevention of Future Death (PFDs) reports are an under-utilized resource to learn about preventable deaths in England and Wales. We aimed to identify sepsis-related PFDs and explore the causes and concerns in this subset of preventable sepsis deaths. METHODS: Four thousand three hundred five reports were acquired from the Courts and Tribunals Judiciary website between July 2013 and November 2022, which were screened for sepsis. Demographic information, coroners concerns and responses to these reports were extracted and analyzed, including a detailed paediatric subgroup analysis. RESULTS: Two hundred sixty-five reports (6% of total PFDs) involved sepsis-related deaths. The most common cause of death in these reports was "sepsis without septic shock" (42%) and the most common site of infection was the respiratory system (18%) followed by gastrointestinal (16%) and skin (13%) infections. Specific pathogens were named in few reports (27%). Many deaths involved multimorbid patients (49%) or those with recent surgery (26%). Coroners named 773 individual concerns, the most frequent were: a failure to keep accurate records or notes (28%), failure in communication or handover (27%) or failure to recognize risk factors or comorbidities (20%). Paediatric cases frequently reported issues with sepsis screening tools (26%). Sepsis PFDs resulted in 421 individual reports being sent, of which 45% received no response. Most organisations who did respond acknowledged concerns and initiated a new change (74%). CONCLUSION: Sepsis-related PFDs provide valuable insights into preventable causes of sepsis and identify important sources of improvement in sepsis care. Wider dissemination of findings is vital to learn from these reports.

Lethal event in diving with self-contained underwater breathing apparatus: A forensic study.

Introduction: In fatal accidents during scuba diving, it is necessary to differentiate a death from primary drowning from a secondary drowning death that is primarily due to other etiopathogenetic factors. The inhalation of water can only be the end point of a series of events capable of causing the diver's exitus. This study aims to demonstrate that even low-risk heart disease in daily life become potentially fatal during scuba diving. Methods: In this case series, we describe all cases of deaths in the course of diving that came to the observation of the Forensic Institute of the University Bari over 20 years (2000-2020). A judicial autopsy was performed on all subjects, with ancillary execution of histological and toxicological investigations. Results: The results of the medicolegal investigations carried out in the complex identified heart failure with acute myocardial infarction as the cause of death in four cases characterized by severe myocardiocoronarosclerosis, a primary drowning in a subject without previous pathological substrate in one case, and a terminal atrial fibrillation induced by acute dynamic heart failure due to functional overload of the right ventricle in one case. Conclusion: Our study demonstrates that lethal events during diving are often related to the presence of unrecognized or subclinical cardiovascular diseases. Such deaths could be prevented and avoided if a greater regulatory sensitivity to preventing and controlling diving was encouraged, considering both the inherent risks of this activity and the possible unrecognized or underestimated pathologies.

Exploring family experiences of missing persons inquests through the eyes of professionals and the lens of therapeutic jurisprudence.

In some Australian and international jurisdictions, coroners can deliver a legal determination of death whilst a person remains missing. Empirical attention to this unique area of law is sparse. Semi-structured interviews with 22 coronial professionals in New South Wales (NSW), Australia revealed their views about suspected death inquests, the impact of this judicial process on family well-being and measures to support and inform relatives in the coroner's court. Thematic analysis yielded five themes: (1) Information to the greatest extent possible; (2) Timeliness; (3) Opportunity to share their views; (4) In the public arena; and (5) Treat people like human beings. The professionals believed that relatives derive therapeutic benefit from timely, sensitive, comprehensible proceedings with opportunities for ritual, meaningful participation and fresh evidence whereas insensitive, incomprehensible and/or untimely proceedings magnify distress. Our findings promote understanding of trauma-informed practices which could mitigate harm to court participants and benefit other courts and jurisdictions.

Death, social reform and the scrutiny of social welfare provision: the role of the contemporary inquest.

Suggesting there is an emerging and important focus on social welfare in inquests into death, this article argues that there is value for both social welfare and inquest scholarship in examination of links between the two. Emphasising the process of investigation, it aims to introduce the inquest to social welfare scholars, and proposes an agenda for research. The discussion examines a range of inquests in which questions of social welfare (understood broadly) were examined, including inquests into the death of Jackie Maguire in a care home (see R (Maguire) v. HM Senior Coroner for Blackpool & Fylde [2023] UKSC 20), the death of Jodey Whiting after her welfare benefits were stopped (in a case brought by her mother, Joy Dove, see Dove v. HM Assistant Coroner for Teesside and Hartlepool [2023] EWCA Civ 289), the death of Awaab Ishak due to mould in his housing association home, and the death of Ella Kissi-Debra which suggested a link between traffic, air pollution and asthma, as well as other cases, including the inquest into the death of Molly Russell which focused on the role of social media.

Coroner county systems are associated with a higher likelihood of unclassified drug overdoses compared to medical examiner county systems.

Background: There is a striking geographic variation in drug overdose deaths without a specific drug recorded, many of which likely involve opioids. Knowledge of the reasons underlying this variation is limited.Objectives: We sought to understand the role of medicolegal death investigation (MDI) systems in unclassified drug overdose mortality.Methods: This is an observational study of 2014 and 2018 fatal drug overdoses and U.S. county-level MDI system type (coroner vs medical examiner). Mortality data are from the CDC's National Center for Health Statistics. We estimated multivariable logistic regressions to quantify associations between MDI system type and several outcome variables: whether the drug overdose was unclassified and whether involvement of any opioid, synthetic opioid, methadone, and heroin was recorded (vs unclassified), for 2014 (N = 46,996) and 2018 (N = 67,359).Results: In 2018, drug overdose deaths occurring in coroner counties were almost four times more likely to be unclassified (OR 3.87, 95% CI 2.32, 6.46) compared to medical examiner counties. These odds ratios are twice as large as in 2014 (difference statistically significant, P < .001), indicating that medical examiner counties are improving identification of opioids in drug overdoses faster than coroner counties.Conclusions: Accurate reporting of drug overdose deaths depends on MDI systems. When developing state policies and local interventions aimed to decrease opioid overdose mortality, decision-makers should understand the role their MDI system is playing in underestimating the extent of the opioid overdose crisis. Improvements to state and county MDI systems are desirable if accurate reporting and appropriate policy response are to be achieved.

Managing Families' Expectations in the Coronial Jurisdiction: Barriers to Enacting an Ethic of Care.

The coronial jurisdiction is different in function, character and procedure to most other legal processes in Australia, being inquisitorial rather than adversarial. It is also, by virtue of its focus on the circumstances of death, situated at the intersection of trauma and grief on the one hand, and legal exploration and evidence-gathering, on the other. For families a coronial investigation offers the potential for resolution about a death, but it can also exacerbate grief and trauma, particularly in the public forum of an inquest. This article utilises interviews with legal professionals engaged in the coronial jurisdiction to explore their understanding of the issues that impact upon families during a death investigation. Our findings indicate that an ethics of care is evident in the court but that this remains contingent on adequate resourcing of the sector, and that this is increasingly the case as the jurisdiction becomes more specialised.

Fitness to drive and seizures - Recent medicolegal considerations to tell or not to tell? - THAT IS THE QUESTION!

This paper reviews a Coroner's inquest into the deaths of two people. The deaths were caused when a driver had a seizure, and lost control of his car, which then plowed into a café. The Coroner reviews the roles and responsibilities of primary and tertiary caregivers, with special focus on the question of who has the responsibility to inform the Drivers' Licensing Authority of a patient's unfitness to drive - the patient or the practitioner? The Coroner recommends the establishment of a multi-agency committee to advance work in this area. The paper notes a separate but parallel development - a review of AUSTROADS Assessing Fitness to Drive Guidelines, which may achieve the outcomes sought by the Coroner.

Navigating the perils and pitfalls of pediatric forensic postmortem imaging in the United States.

Postmortem CT is widely used in the general adult and military populations. It is used extensively in pediatric death investigations in Europe and Asia, but distinctive challenges are encountered when launching a postmortem imaging program in the United States. We describe the issues we have encountered specific to establishing a pediatric postmortem imaging service in this country and propose potential solutions.

The Epidemiology of Suicide and Suicidal Behaviour across the Lifespan in Nigeria: A Systematic Review of the Literature.

BACKGROUND/PURPOSE: Suicidal behaviour is a global public health issue affecting all ages, gender, and regions of the world. This systematic review sought to synthesize the available evidence on the prevalence and risk factors for suicide and suicidal behaviour across the lifespan in Nigeria. DATA SOURCE: The databases of PubMed, Embase, Medline, PsychInfo, Google Scholar and African Journals OnLine (AJOL). STUDY SELECTION: Literature on suicidal behaviour and suicide from Nigeria published between 2000 and 2019. DATA EXTRACTION: Data were extracted independently by two authors using a fixed template. RESULTS: The search identified 431 articles; 23 were eligible for inclusion. The 12-month prevalence of suicide ideation among adolescents was between 6.1-22.9% and 3-12.5% for attempts; identified risk factors were sexual abuse, family dysfunction and food insecurity. For the adult population, lifetime rates of suicidal ideation, plan and attempt were 3.2%, 1.0% and 0.7% respectively; risk factors included age (peak in the third decade of life), childhood adverse experiences and the presence of mood disorders. In the elderly the rates were 4.0% for ideation, 0.7% for plan and 0.2% for attempt. Risk factors identified in the elderly were being single (separation or widowhood) and rural residence. Suicides accounted for 0.3- 1.6% of autopsies performed by the coroners and constituted the least common cause of death. Suicides were more common in males and peaked in the third decade of life. CONCLUSION: Suicide and suicidal behaviour in the Nigerian population seem to peak in young adult life suggesting that suicide prevention initiatives should target late adolescence.

CONTEXTE/BUT: Le comportement suicidaire est un problème mondial de santé publique qui touche tous les âges, tous les sexes et toutes les régions du monde. Cet examen systématique visait à synthétiser les données probantes disponibles sur la prévalence et les facteurs de risque de suicide et de comportement suicidaire tout au long de la vie au Nigéria. SOURCE DE DONNEES: Les bases de données de PubMed, Embase, Medline, PsychInfo, Google Scholar et African Journals OnLine (AJOL). SELECTION DE L'ETUDE: Publication de la littérature sur les comportements suicidaires et le suicide au Nigéria entre 2000 et 2019. EXTRACTION DE DONNEES: Les données ont été extraites indépendamment par deux auteurs à l'aide d'un modèle fixe. RESULTATS: La recherche a permis d'identifier 431 articles; 23 étaient admissibles à l'inclusion. La prévalence sur 12 mois de l'idée de suicide chez les adolescents se situe entre 6,1 et 22,9 % et 3 à 12,5 % pour les tentatives; les facteurs de risque identifiés étaient la violence sexuelle, le dysfonctionnement familial et l'insécurité alimentaire. Pour la population adulte, les taux à vie d'idées, de planifier et de tenter suicidaires étaient de 3,2 %, 1,0 % et 0,7 % respectivement; les facteurs de risque comprenaient l'âge (sommet au cours de la troisième décennie de la vie), les expériences indésirables de l'enfance et la présence de troubles de l'humeur. Chez les personnes âgées, les taux étaient de 4,0 % pour l'idée, de 0,7 % pour le régime et de 0,2 % pour les tentatives. Les facteurs de risque identifiés chez les personnes âgées étaient état matrimonial célibataire (séparation ou veuvage) et la résidence rurale. Les suicides représentaient de 0,3 à 1,6 % des autopsies effectuées par les coroners et constituaient la cause de décès la moins fréquente. Les suicides étaient plus fréquents chez les hommes et ont atteint un sommet au cours de la troisième décennie de leur vie. CONCLUSION: Le suicide et les comportements suicidaires dans la population Nigériane semblent culminer chez les jeunes adultes, ce qui suggère que les initiatives de prévention du suicide devraient cibler la fin de l'adolescence. Mots-clés: Le suicide, comportements suicidaires, Les facteurs de risque, autopsies du coroner, la vie.

Factors related to absence of toxicological investigation following fatal injury: a retrospective quantitative review of Coronial records in New Zealand.

PURPOSE: The accuracy of cause of death certification is strongly influenced by the quality of post mortem investigations (autopsies). In New Zealand, this can include toxicological investigation at the discretion of the Coroner. Little is known both within New Zealand and internationally about potential selection biases related to Coronial cases not undergoing toxicology investigation. METHODS: A retrospective review of eligible injury-related deaths referred to a Coroner in New Zealand in 2014 was undertaken. Using data collected from the Australasian National Coronial Information System and New Zealand's Mortality Collection, descriptive analyses were undertaken to understand patterns related to toxicology report requests and patterns within toxicology reports. RESULTS: In New Zealand in 2014, 25% of 744 Coronial cases for fatal injury in those under 85 years of age did not have corresponding toxicological reports. Reports were more likely to be absent in females (adjusted Odds Ratio (aOR) 1.7, 95%CI 1.0, 2.7), and in decedents aged under 15 and over 65 years (aOR 11.0 and 4.1 respectively). More than half (56%, 95% CI 45%, 67%) of the deaths due to falls did not receive toxicological investigation. CONCLUSION: Better understanding of selection biases in Coronial processes helps inform policymakers, researchers, and practitioners of the limitations of available toxicological evidence.

The Health Impact of Alcohol on American Cities: Modeling the Local Burden of Current Alcohol Use in One Jurisdiction.

Measurement of alcohol use and associated harms at the city level is often incomplete or non-existent even though such data are often critical to informing local prevention strategies. This paper models how to generate local estimates of the morbidity, mortality, and cost of current alcohol use instead of abstaining. Administrative data sources, including medical examiner records, hospital records, and police records, among others, were used to obtain local estimates of alcohol-attributable outcomes. In 2018, we used alcohol-attributable fractions and scaled national estimates to quantify the burden of current alcohol use in Baltimore, MD, in 2013. Fifty-two percent of Baltimore adults reported past 30-day drinking. There were 276 alcohol-attributable deaths in 2013, and 106 (38.4%) of these were persons other than the drinker. In 2013, current alcohol use cost $582.3 million in Baltimore City. This burden was distributed across drinkers (40.1%), persons other than the drinker (21.3%), and the government (38.6%). It is possible to quantify this burden at the local level, and these data could be used to inform evidence-based alcohol policy strategies at the local level.

Protocols, practices, and needs for investigating sudden unexpected infant deaths.

Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs. Of the 377 respondents, use of the SUID Investigation Reporting Form or an equivalent was 89% for large, 87% for medium, and 52% for small jurisdictions. Routine completion of infant medical history, witness interviews, autopsy, photos or videos, and family social history for infant death investigations was ≥80%, but routine scene re-creation with a doll was 30% in small, 64% in medium, and 59% in large offices. Seventy percent of MECs reported infant death investigation training needs. Increased training and use of standardized practices may improve SUID cause-of-death certification, allowing us to better understand SUID.

Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein

Background/aim: Our aim in this study was to compare the efficacy and safety of crystalloid del Nido solution and cold blood cardioplegia solution on clinical and laboratory parameters. Materials and methods: Sixty patients who underwent elective coronary bypass operation between July 2019 and January 2020 were included in our study. Patients were divided into 2 groups of 30 patients using del Nido solution (DNS) and cold blood cardioplegia solution (CBCS), which were given for cardiac arrest. Demographic data, preoperative, postoperative 0th h, 6th h and 4th day creatine kinase myocardial band (CK-MB) and troponin I values were compared with a specific cardiac enzyme heart-type fatty acid-binding protein (H-FABP). Results: We found that aortic cross clamp duration and cardiopulmonary bypass (CPB) time were shorter in patients using del Nido solution than cold blood cardioplegia solution (57.30 ± 23.57 min, 76.07 ± 27.18 min, P = 0.006) (95.07 ± 23.06 min, 114.13 ± 33.93, P = 0.014). Total cardioplegia solution volume was higher in the cold blood cardioplegia solution group (1426.67 ± 416.00 vs. 1200 ± 310.73 P = 0.02). Preoperative and postoperative levels of cardiac enzymes including CK-MB, troponin I and H-FABP were comparable in del Nido solution and cold blood cardioplegia solution groups. Conclusion: According to these results, when we compare both demographic data and CK-MB, troponin I and H-FABP levels, both cardioplegia solutions were comparable regarding safety and efficacy in terms of myocardial protection.

Characteristics of patients with cancer who die by suicide: Coronial case series in an Australian state.

OBJECTIVE: Suicide rates are elevated in epidemiological studies, but extrapolating population level data to the individual patient cancer is difficult, and there is a dearth of studies examining how suicidality might be linked to the cancer experience. We examine the cancer-suicide correlates to explore clinical implications and future research directions. METHOD: We used a novel database to examine all suicide deaths reported to the Coroners Court of Victoria between 2009 and 2013 in individuals with active, diagnosed cancer. Cases were classified in relation to whether cancer had been a probable, possible, or unlikely influence on suicidal ideation. Sociodemographic, clinical, health service contacts, and suicide method data were analysed to describe the characteristics of individuals with cancer at the time of their suicide. RESULTS: There were 2870 suicide deaths, and 118 cases met inclusion criteria. Clinically distinct patient subgroups emerged through a contrast between those cases where the data suggested a correlate between cancer and suicide, and those where the data did not. The former group had many more cancer-related health problems than the latter group, who had a higher burden of psychiatric illness that predated their cancer diagnosis. The intent to suicide was known to most clinicians. CONCLUSIONS: All clinicians working with cancer patients should be prepared to explore suicidal ideation. Understanding how the patient conceptualises suicidality with respect to cancer experience and mental health may be of central importance in determining whether mental health care is best provided as part of cancer care, or through a separate mental health service.

Epilepsy and seizure-related deaths: Mortality statistics do not tell the complete story.

INTRODUCTION: The objective of the study was to identify where epilepsy or seizures may be the underlying cause of death but not identified by the death certification process in the Australian coronial system and to better characterize such deaths. METHODS: Australian National Coronial Information System (NCIS) closed cases for the Australian Capital Territory (ACT) (population average 348,000) over 13 years were searched using cause of death, and a text search of police and autopsy reports, to identify all deaths where epilepsy or seizures were mentioned. Deaths where the underlying cause of death was not seizures or epilepsy were excluded (including suicide). The remaining cases (75) were categorized by the circumstances of death. Suspected sudden unexpected death in epilepsy (SUDEP) cases were further classified using the unified definition of SUDEP of Nashef and colleagues (2012). RESULTS: Of the final 75 cases, only 44 were found by the cause of death search. Key word document searches found another 31. Cases were classified as Definite SUDEP (37), Definite SUDEP Plus (10), Probable SUDEP (1), Possible SUDEP (3), Near SUDEP (4), Near SUDEP Plus (1), Asphyxia (3), Treatment-related (1), Head injury (2), Drowning (2), motor vehicle accident (MVA) (1), deaths related to a single convulsive seizure (6), and status epilepticus (SE) (4). Cases were 80% male. CONCLUSIONS: Epilepsy and seizure-related deaths are underreported in the Australian Coronial system. Enhanced documentation of the causal chain of events leading to deaths would increase recognition. Using the unified SUDEP definition would expand SUDEP identification.

Interstate and Overseas Deaths: Jurisdictional and Decision-Making Challenges for Coroners.

This editorial addresses the jurisdictional challenges for decision-making about which coroners should exercise jurisdiction over a dead body, when more than one has the potential to do so, including when a tragedy has occurred involving deceased persons ordinarily residing in diverse jurisdictions. It considers the criteria that are applied and should be applied by coroners to assumption of jurisdiction in relation to overseas deaths and reflects on considerations relevant to the exercise of such decision-making. It reviews significant cases, including appellate case law, in relation to coroners' investigations of overseas deaths and concludes by reflecting upon the need for consistent legislation throughout Australia and New Zealand on exercise of jurisdiction by coroners. It considers the expedient of a federal coroner for Australia.

Interpretation of 'Unnatural Death' in Coronial Law: A Review of the English Legal Process of Decision Making, Statutory Interpretation, and Case Law.

The article examines the decision-making process for medical reporting of deaths to a coroner and the statutory basis for coronial decisions whether to investigate. It analyses what is published about the consistency of decision making of coroners and discusses what should be the legal basis for determining whether a particular death is natural or unnatural in English law. There is a review of English case law, including the significance of Touche and Benton and the development of 'unnatural' as a term of art, which informs what the courts have held to be an unnatural death. What case law indicates about multiple causes and the significance of the wording in the Coroners & Justice Act 2009 that triggers an investigation are considered. It highlights the importance of considering the medical cause of death and to what extent information other than the initial death report is required, before making the decision that the coroner's duty to open an investigation is triggered. The article concludes that a two-stage test is required. Firstly, is the cause of death medically unnatural? Secondly, whether the circumstances themselves are unnatural or such as to make a medically natural cause of death unnatural. If the coroner has reason to suspect the medical cause of death is unnatural per se the statutory duty to investigate will be engaged, regardless of the circumstances.

Comparison of Vital Statistics Definitions of Suicide against a Coroner Reference Standard: A Population-Based Linkage Study.

OBJECTIVE: We sought to determine the utility of health administrative databases for population-based suicide surveillance, as these data are generally more accessible and more integrated with other data sources compared to coroners' records. METHOD: In this retrospective validation study, we identified all coroner-confirmed suicides between 2003 and 2012 in Ontario residents aged 21 and over and linked this information to Statistics Canada's vital statistics data set. We examined the overlap between the underlying cause of death field and secondary causes of death using ICD-9 and ICD-10 codes for deliberate self-harm (i.e., suicide) and examined the sociodemographic and clinical characteristics of misclassified records. RESULTS: Among 10,153 linked deaths, there was a very high degree of overlap between records coded as deliberate self-harm in the vital statistics data set and coroner-confirmed suicides using both ICD-9 and ICD-10 definitions (96.88% and 96.84% sensitivity, respectively). This alignment steadily increased throughout the study period (from 95.9% to 98.8%). Other vital statistics diagnoses in primary fields included uncategorised signs and symptoms. Vital statistics records that were misclassified did not differ from valid records in terms of sociodemographic characteristics but were more likely to have had an unspecified place of injury on the death certificate ( P < 0.001), more likely to have died at a health care facility ( P < 0.001), to have had an autopsy ( P = 0.002), and to have been admitted to a psychiatric hospital in the year preceding death ( P = 0.03). CONCLUSIONS: A high degree of concordance between vital statistics and coroner classification of suicide deaths suggests that health administrative data can reliably be used to identify suicide deaths.