Sensitivity of a national coronial database for monitoring unnatural deaths among ex-prisoners in Australia

Family violence homicide rates: a state-wide comparison of three data sources in Victoria, Australia

BACKGROUND

Family violence homicide (FVH) is a major public health and social problem in Australia. FVH trend rates are key outcomes that determine the effectiveness of current management practices and policy directions. Data source-related methodological problems affect FVH research and policy and the reliable measurement of homicide trends.

OBJECTIVE

This study aimed to determine data reliability and temporal trends of Victorian FVH rates and sex and relationship patterns.

METHOD

FVH rates per 100,000 persons in Victoria were compared between the National Coronial Information System (NCIS), Coroners Court of Victoria (CCoV) Homicide Register, and the National Homicide Monitoring Program (NHMP). Trends for 2001-2017 were analysed using Joinpoint regression. Crude rates were determined by sex and relationship categories using annual frequencies and Australian Bureau of Statistics population estimates.

RESULTS

NCIS closed FVH cases totalled 360, and an apparent downward trend in the FVH rate was identified. However, CCoV and NHMP rates trended upwards. While NCIS and CCoV were case-based, NHMP was incident-based, contributing to rate variations. The NCIS-derived trend was particularly impacted by unavailable case data, potential coding errors and entry backlog. Neither CCoV nor NHMP provided victim-age in their public domain data to enable age-adjusted rate comparison.

CONCLUSION

Current datasets have limitations for FVH trend determination; most notably lag times for NCIS data.

IMPLICATIONS

This study identified an indicative upward trend in FVH rates in Victoria, suggesting insufficiency of current management and policy settings for its prevention and control.

Circumstances and toxicology of violence-related deaths among young people who have had contact with the youth justice system: a data linkage study

Background

Young people who have had contact with the youth justice system have an increased risk of dying from violence. Examining the context of violence-related deaths is essential in informing prevention strategies. We examined the circumstances and toxicology of violence-related deaths among young people who have had contact with the youth justice system in Queensland, Australia.

Methods

This data linkage study linked youth justice records from Queensland, Australia (30 June 1993-1 July 2014) on 48,670 young people to national death and coroner records (1 July 2000-1 January 2017). Circumstances and toxicology of deaths were coded from coroner’s records. We calculated the incidence of violence-related deaths that were reported to a coroner. Fisher’s exact tests were used to examine crude differences in the circumstances and toxicology of violence-related death, according to sex and Indigenous status.

Results

There were 982 deaths reported to a coroner in the cohort. Of which, 36 (4%) were from violence-related causes (incidence: 6 per 100,000 person-years, 95% confidence interval: 4-8). People who died from violence were most frequently male (n = 28/36; 78%), and almost half were Indigenous (n = 16/36; 44%). The majority of violence-related deaths involved a weapon (n = 24/36; 67%), most commonly a knife (n = 17/36; 47%). Compared to men where the violent incident was most frequently preceded by an altercation (n = 12/28; 43%), for women it was frequently preceded by a relationship breakdown or argument (n < 5; p = 0.004). Substances most commonly present in toxicology reports were cannabis (n = 16/23; 70%) and alcohol (n = 15/23; 65%).

Conclusions

Therapeutic alcohol and other drug programs, both in the community and detention, are likely important for reducing violence-related deaths among young people who have had contact with the youth justice system. The majority of violence-related deaths among women were in the context of intimate partner violence, indicating the urgent need for interventions that prevent intimate partner violence in this population. Diversion programs and increased investment in health and social services may reduce the overrepresentation of Indigenous people in the youth justice system and in violence-related deaths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12244-z.

The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System

BACKGROUND

Medico-legal death investigations are a recognised data source for public health endeavours and its accessibility has increased following the development of electronic data systems. Despite time and cost savings, the strengths and limitations of this method and impact on research findings remain untested. This study examines this issue using the National Coronial Information System (NCIS).

METHODS

PubMed, ProQuest and Informit were searched to identify publications where the NCIS was used as a data source for research published during the period 2000-2014. A descriptive analysis was performed to describe the frequency and characteristics of the publications identified. A content analysis was performed to identify the nature and impact of strengths and limitations of the NCIS as reported by researchers.

RESULTS

Of the 106 publications included, 30 reported strengths and limitations, 37 reported limitations only, seven reported strengths only and 32 reported neither. The impact of the reported strengths of the NCIS was described in 14 publications, whilst 46 publications discussed the impacts of limitations. The NCIS was reported to be a reliable source of quality, detailed information with comprehensive coverage of deaths of interest, making it a powerful injury surveillance tool. Despite these strengths, researchers reported that open cases and missing information created the potential for selection and reporting biases and may preclude the identification and control of confounders.

CONCLUSIONS

To ensure research results are valid and inform health policy, it is essential to consider and seek to overcome the limitations of data sources that may have an impact on results.

Understanding death in custody: a case for a comprehensive definition

Prisoners sometimes die in prison, either due to natural illness, violence, suicide, or a result of imprisonment. The purpose of this study is to understand deaths in custody using qualitative methodology and to argue for a comprehensive definition of death in custody that acknowledges deaths related to the prison environment. Interviews were conducted with 33 experts, who primarily work as lawyers or forensic doctors with national and/or international organisations. Responses were coded and analysed qualitatively. Defining deaths in custody according to the place of death was deemed problematic. Experts favoured a dynamic approach emphasising the link between the detention environment and occurrence of death rather than the actual place of death. Causes of deaths and different patterns of deaths were discussed, indicating that many of these deaths are preventable. Lack of an internationally recognised standard definition of death in custody is a major concern. Key aspects such as place, time, and causes of death as well as relation to the prison environment should be debated and incorporated into the definition. Systematic identification of violence within prison institutions is critical and efforts are needed to prevent unnecessary deaths in prison and to protect vulnerable prisoners.

Suicide in adults released from prison in Queensland, Australia: a cohort study

BACKGROUND

Previous research has demonstrated elevated mortality following release from prison. We contrasted the risk of opioid overdose death with the risk of suicide in a cohort of adults released from prison in Queensland, Australia over a 14-year-period. We examine risk factors for suicide in the cohort, and make comparisons with the general population.

METHOD

We constructed a retrospective cohort of all adults released from prison between 1994 and 2007 and linked this to the National Death Index for deaths up to 31 December 2007.

RESULTS

We identified 41 970 individuals released from prison. Of the 2158 deaths in the community, 371 were suicides (crude mortality rate (CMR) 13.7/10 000 person-years) and 396 were due to drug-related causes (CMR 14.6/10 000 person-years). We observed a spike in drug-related deaths in the first 2 weeks after release from prison but no such pattern was observed for suicide. Being married (HR 0.40) and number of prior imprisonments (HR 3.1 for ≥5 prior incarcerations compared with none) independently predicted suicide. Age, sex, Indigenous status, length of incarceration and offence history were not associated with suicide. The standardised mortality ratios indicated that released women were 14.2 times and released men 4.8 times more likely to die from suicide than would be expected in the population.

CONCLUSIONS

This study demonstrates that the rate of suicide in adults released from prison is similar to the rate of drug-related deaths. Strategies that provide support to vulnerable people after release may reduce suicide in this population.

Understanding drug-related mortality in released prisoners: a review of national coronial records

Background

The prisoner population is characterised by a high burden of disease and social disadvantage, and ex-prisoners are at increased risk of death following release. Much of the excess mortality can be attributed to an increased risk of unnatural death, particularly from drug overdose; however, relatively few studies have investigated the circumstances surrounding drug-related deaths among released prisoners. This study aimed to explore and compare the circumstances of death for those who died from accidental drug-related causes to those who died from all other reportable causes.

Methods

A nationwide search of the Australian National Coroners Information System (NCIS) was conducted to identify reportable deaths among ex-prisoners from 2000 to 2007. Using a structured coding form, NCIS records for these cases were interrogated to explore causes and circumstances of death.

Results

Coronial records for 388 deceased ex-prisoners were identified. Almost half of these deaths were a result of accidental drug-related causes (45%). The majority of accidental drug-related deaths occurred in a home environment, and poly-substance use at or around the time of death was common, recorded in 72% of drug-related deaths. Ex-prisoners who died of accidental drug-related causes were on average younger and less likely to be Indigenous, born in Australia, married, or living alone at or around the time of death, compared with those who died from all other reportable causes. Evidence of mental illness or self-harm was less common among accidental drug-related deaths, whereas evidence of previous drug overdose, injecting drug use, history of heroin use and history of drug withdrawal in the previous six months were more common.

Conclusions

Drug-related deaths are common among ex-prisoners and often occur in a home (vs. public) setting. They are often associated with use of multiple substances at or around the time of death, risky drug-use patterns, and even among this markedly disadvantaged group, extreme social disadvantage. These findings reflect the complex challenges facing prisoners upon release from custody and indicate a need to consider drug overdose within the wider framework of ex-prisoner experiences, so that preventive programmes can be appropriately structured and targeted.