Duration of death investigations that proceed to inquest in Australia.

BACKGROUND: Recent government inquiries in several countries have identified the length of time it takes coroners to investigate deaths due to injury and other unnatural causes as a major problem. Delays undermine the integrity of vital statistics and adversely affect the deceased's family and others with interests in coroners' findings. Little is publicly known about the extent, nature and causes of these delays. METHODS: We used Kaplan-Meier estimates and multivariable regression analysis to decompose the timelines of nearly all inquest cases (n=5096) closed in coroners' courts in Australia between 1 January 2007 and 31 December 2013. RESULTS: The cases had a median closure period of 19.0 months (95% CI 18.4 to 19.6). Overall, 70% of cases were open at 1 year, 40% at 2 years and 22% at 3 years, but there was substantial variation by jurisdiction. Adjusted analyses showed a difference of 22 months in the average closure time between the fastest and slowest jurisdictions. Cases involving deaths due to assault (+12.2 months, 95% CI 7.8 to 17.0) and complications of medical care (+9.0 months, 95% CI 5.5 to 12.3) had significantly longer closure periods than other types of death. Cases that produced public health recommendations also had relatively long closure periods (+8.9 months, 95% CI 7.6 to 10.3). CONCLUSIONS: Nearly a quarter of inquests in Australia run for more than 3 years. The size of this caseload tail varies dramatically by jurisdiction and case characteristics. Interventions to reduce timelines should be tried and carefully evaluated.

Relationship between penalties for road traffic infringements and crash risk in Queensland, Australia: a case-crossover study.

BACKGROUND: Most countries have detailed lists of traffic rules and elaborate legal regimes for penalizing drivers who break them. Previous research has suggested that drivers tend to drive more safely after receiving penalties for traffic infringements. METHODS: We linked driver-level data on infringements and crashes in Queensland, Australia (1995-2010) with information on the licence histories of all drivers in the state. We used a case-crossover design to examine drivers' risk of crashing in the month following an infringement penalty. We also examined whether changes in crash risk following infringement penalties varied according to driver age and gender, type of infringement and whether the offender was at fault in a subsequent crash. RESULTS: Drivers had higher risks of crashes following infringement penalties [odds ratio (OR) 1.32; 95% confidence interval (CI) 1.29-1.36], especially crashes in which the offender was at fault (1.41; 1.36-1.46). Crash risk relative to a comparable period was particularly high for teenage drivers (1.55; 1.34-1.78) and among drivers penalized for dangerous driving (3.19; 2.52-4.03) or driving under the influence of alcohol (1.99; 1.67-2.37). The risk remained relatively high for more than 6 months after the penalty, but declined steadily over this period. CONCLUSIONS: Crash risk among drivers in Queensland was higher, not lower, following receipt of penalties for traffic infringements. Penalties themselves are unlikely to increase crash risk. A more likely explanation is that penalties (or the corresponding infringements) mark episodes of risky driving. Our findings suggest that such episodes trounce any deterrent effect penalties may produce.

Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era.

OBJECTIVE: To determine whether Olympic medallists live longer than the general population. DESIGN: Retrospective cohort study, with passive follow-up and conditional survival analysis to account for unidentified loss to follow-up. SETTING AND PARTICIPANTS: 15 174 Olympic athletes from nine country groups (United States, Germany, Nordic countries, Russia, United Kingdom, France, Italy, Canada, and Australia and New Zealand) who won medals in the Olympic Games held in 1896-2010. Medallists were compared with matched cohorts in the general population (by country, age, sex, and year of birth). MAIN OUTCOME MEASURES: Relative conditional survival. RESULTS: More medallists than matched controls in the general population were alive 30 years after winning (relative conditional survival 1.08,95% confidence interval 1.07 to1.10). Medallists lived an average of2.8 years longer than controls. Medallists in eight of the nine country groups had a significant survival advantage compared with controls. Gold, silver, and bronze medallists each enjoyed similar sized survival advantages. Medallists in endurance sports and mixed sports had a larger survival advantage over controls at 30 years (1.13, 1.09 to 1.17; 1.11,1.09 to 1.13) than that of medallists in power sports (1.05,1.01 to 1.08). CONCLUSIONS: Olympic medallists live longer than the general population, irrespective of country, medal, or sport. This study was not designed to explain this effect, but possible explanations include genetic factors, physical activity, healthy lifestyle, and the wealth and status that come with international sporting glory.

Effectiveness of the 2005 compulsory personal flotation device (PFD) wearing regulations in reducing drowning deaths among recreational boaters in Victoria, Australia.

OBJECTIVE: To investigate whether the Victorian mandatory personal flotation device wearing regulations that came into effect on 1 December 2005 reduced drowning deaths among recreational boaters in Victoria, Australia. DESIGN: A retrospective population-based 'before and after' study using Victorian coronial data on drowning deaths of occupants of recreational vessels operating in Victorian waters. METHODS: The annual numbers of deaths in the 5 years after the transition year of the regulations (2005) was compared with the annual numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test. RESULTS: There were 59 recreational boating drowning deaths in the 6-year preintervention period (1 December 1998 to 30 November 2004) compared with 16 in the 5-year postintervention period (1 December 2005 to 30 November 2010). The analysis showed a significant decrease in drowning deaths among all recreational boaters (U=30.0, p=0.01) and among these strata: vessel occupants aged 0-29 years (U=28.0, p=0.02) and 30-59 years (U=27.5, p=0.02), vessel occupants engaged in pleasure cruising (U=29.0, p=0.01) and in 'other' boating activities (U=25.0, p=0.04), boaters on small powerboats ≤4.8 m in length (U=29.5; p=0.01), boaters on motorised (U=29.5; p=0.01) and sail-powered vessels (U=26.0; p=0.04), and occupants of vessels operating in inland waterways (U=30.0; p=0.01). CONCLUSIONS: These findings provide further support for the adoption of a regulatory approach to personal flotation device wearing to reduce drowning among recreational boaters.

The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria.

OBJECTIVES: To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area. METHODS: This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond. RESULTS: Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service's quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board's level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be 'moderately useful' or 'very useful'. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service. CONCLUSIONS: Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful.

Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era.

OBJECTIVE: To determine whether Olympic medallists live longer than the general population. DESIGN: Retrospective cohort study, with passive follow-up and conditional survival analysis to account for unidentified loss to follow-up. SETTING AND PARTICIPANTS: 15,174 Olympic athletes from nine country groups (United States, Germany, Nordic countries, Russia, United Kingdom, France, Italy, Canada, and Australia and New Zealand) who won medals in the Olympic Games held in 1896-2010. Medallists were compared with matched cohorts in the general population (by country, age, sex, and year of birth). MAIN OUTCOME MEASURES: Relative conditional survival. RESULTS: More medallists than matched controls in the general population were alive 30 years after winning (relative conditional survival 1.08, 95% confidence interval 1.07 to 1.10). Medallists lived an average of 2.8 years longer than controls. Medallists in eight of the nine country groups had a significant survival advantage compared with controls. Gold, silver, and bronze medallists each enjoyed similar sized survival advantages. Medallists in endurance sports and mixed sports had a larger survival advantage over controls at 30 years (1.13, 1.09 to 1.17; 1.11, 1.09 to 1.13) than that of medallists in power sports (1.05, 1.01 to 1.08). CONCLUSIONS: Olympic medallists live longer than the general population, irrespective of country, medal, or sport. This study was not designed to explain this effect, but possible explanations include genetic factors, physical activity, healthy lifestyle, and the wealth and status that come with international sporting glory.

Geographic variation in inquest rates in Australia.

This paper examines the relationship between the remoteness of locations in which deaths occur and coroners' decisions to hold inquests. We analysed 16,242 deaths investigated by coroners in three Australian states over 7.5 yrs. We used a choropleth map to show inquest rates in each remoteness locality (excluding deaths for which inquests were mandated by statute). We then used adjusted logistic regression to assess the association between the remoteness of a death's location and the odds coroners would select it for investigation by inquest. We found the remoteness of a death's location strongly and positively predicts the chance that an inquest will be held. Like analogous findings in the delivery of health services, this small-area variation in legal decision making raises questions of appropriateness.

Factors predicting coroners' decisions to hold discretionary inquests.

BACKGROUND: Coroners in Australia, Canada, New Zealand and other countries in the Commonwealth hold inquests into deaths in two situations. Mandatory inquests are held when statutory rules dictate they must be; discretionary inquests are held based on the decisions of individual coroners. Little is known as to how and why coroners select particular deaths for discretionary inquests. METHODS: We analyzed the deaths investigated by Australian coroners for a period of seven and one-half years in five jurisdictions. We classified inquests as mandatory or discretionary. After excluding mandatory inquests, we used logistic regression analysis to identify the factors associated with coroners' decisions to hold discretionary inquests. RESULTS: Of 20 379 reported deaths due to external causes, 1252 (6.1%) proceeded to inquest. Of these inquests, 490 (39.1%) were mandatory and 696 (55.6%) were discretionary. In unadjusted analyses, the rates of discretionary inquests varied widely in terms of age of the decedent and cause of death. In adjusted analyses, the odds of discretionary inquests declined with the age of the decedent; the odds were highest for children (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.54-3.06) and lowest for people aged 65 years and older (OR 0.38, 95% CI 0.28-0.51). Using poisoning as a reference cause of death, the odds of discretionary inquests were highest for fatal complications of medical care (OR 12.83, 95% CI 8.65-19.04) and lowest for suicides (OR 0.44, 95% CI 0.30-0.65). INTERPRETATION: Deaths that coroners choose to take to inquest differ systematically from those they do not. Although this vetting process is invisible, it may influence the public's understanding of safety risks, fatal injury and death.