Nigel Hawkes: Why delaying death has created a statistical nightmare

Behind The Numbers
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The Independent Online

The relatives of Terry Jupp, a Ministry of Defence scientist who died testing explosives in 2002, have had to wait eight years for an inquest.

Although this is exceptional, the average wait for an inquest is six months, and a year or more is not uncommon.

While you wait, the dead person is not, officially, dead. In England and Wales (but not Scotland) a death cannot be registered without a cause of death. The delays created by the ancient system of coroners' inquests are a serious problem for statisticians.

For instance, when a new recreational drug such as mephedrone appears, trends in drug-related deaths are impossible to follow because most are referred to coroners whose verdicts appear at unpredictable times in the future. This makes it impossible to compare drug-related deaths with changes in drug-taking behaviour until years later.

Or suppose you wanted to run a trial of different ways of preventing prisoners with a history of drug-taking from dying of an overdose soon after release, as many do. You could allocate half the prisoners at random to a particular intervention after release, do nothing for the other half, and compare outcomes. But only if deaths were recorded promptly. As it is, such a trial would fail the normal ethical tests as it would provide no way of letting participants know quickly if a given intervention worked, or made things worse – and trial volunteers are entitled to this information.

Delays in recording deaths bedevil mortality statistics. The proportion of deaths referred to coroners has risen since the Shipman murders, and with the increasing use of deputising services for out-of-hours care. Last year, 229,000 referrals were made (46 per cent of all deaths) and 31,000 inquests were deemed necessary.

So although a death must normally be registered in England and Wales within five days, many aren't until much later. It's fine to wait a while to establish the cause of a death, but nonsense to wait so long to record the fact of a death. In Scotland, where deaths must be registered in eight days, death certificates can be issued without a known cause of death.

Coroners in England and Wales can issue "an interim certificate as to fact of death" before a cause is determined. This helps the bereaved access bank accounts and administer the estate. It seems only tradition is stopping this provision being applied to all deaths reported to coroners.

Nigel Hawkes is Director of Straight Statistics (