So I am curious how death statistics are shown and calculated. I understand the average age of people dying but the causes I sometimes don’t. What percentage of deaths are caused just by old age? Does there always have to be a cause, and if so, how direct does it have to be?
I guess what I’m trying to say is, a healthy person will die eventually anyways, is there a classification of dying without a cause? Is it even possible, or does something have to always be creeping up on you.
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As direct or indirect as the person writing the certificate wants it to bewithin the scope of the law.
A direct cause of death may be “aneurism”.
Another person writing a certificate for the same person may attribute death to “Aneurysm due to anti-coagulant medications administered for treatment of thrombosis brought about by prolonged immobilisation due to burns sustained from falling into a fire due to excessive alcohol consumption and fatigue”.
Either one works, and different jurisdictions will have differing standards in addition to personal standards. One of the uses for death certificates is collating data on causes of death. So this example can get filed under “Alcohol abuse” “drug reactions”, and “aneurism” amongst other things, whereas the single word “aneurysm” doesn’t provide as much useful data.
By definition, they won’t. Dying is not compatible with being healthy.
You certainly get death certificates with “cause unknown” attributions, usually when the corpse is found so long after death that it becomes impossible to determine the cause. For fresh corpses, I’ve never heard of a “cause unknown”. It’s usually fairly easy these days to work out how a fresh corpse died, and if that isn’t easy there is usually some sort of coronial inquiry.
You have to die of something organic. You can’t just stop living.
I guess the way to look at this is this:
As a human organism ages, it’s health inevitably deteriorates to the point where it breaks down completely and eventually dies, the very definition of aging, if you wish.
So basically, there is no such thing as “dying without a cause”. Every death is caused by a medical condition that can (at least in theory) be identified.
Yet if a 95 years old man dies in his sleep, this would be seen by many as, well: natural. Whereas if a 20 years old man suddenly dies in his sleep, we feel that’s not “natural” at all.
I’ve read that the last person in the U.S. who had “old age” as their cause of death died in 1955. After that point it was required to put a more specific cause of death on the death certificate. I can’t find any reliable source for this fact though. Perhaps someone else can.
Well–maybe. It might be very difficult or impossible to determine a “cause” of death after the fact. To all intents and purposes, the person just dropped dead. The autopsy needs to rule out some things–murder and/or medical malpractice would be high the list–but after that it may or may not be possible to identify “something organic”.
Coroners have a bunch of options that basically mean “the guy was old, now he is dead.”
Around these parts, the death rate has been holding steady at one per person for a while now.
As a physician who is a pathologist and medical examiner, death certificates are one of my main work products. Plus, I review many more DCs than I produce, as there is a law in the jurisdiction where I work that all DCs must be reviewed by an ME. What the OP seems to ask are two separate but related questions: 1. Can people die of “old age”? and 2. (perhaps reading between the lines a bit) Are DCs a reliable indicator of actual “cause of death?”
Second question first. The short answer is, on the whole, No. The OP mentions that he/she sometimes has trouble understanding the causes of death listed on DCs. What I would say is don’t be too hard on your intelligence. A lot of times those causes of death don’t make much sense. Completing death certificates, per my estimation, is one area of medicine where people (i.e. physicians), who as a group are usually highly compulsive about doing things right and proper, seem to give themselves license to produce work of very poor quality that is often incomplete, illogical, and meaningless, and not infrequently misleading. Of course, that is not always the case, probably not the majority, but it is common enough to make the data very messy and not really reliable as a whole, and to give reason to at least question any particular DC.
As far as dying of “old age” goes, the conventional wisdom in medical science, and as reflected in previous posts here, is that it doesn’t happen. There always has to be some intervening “pathology.” Well, being a dutiful pathologist, I used to agree with that, but now I have to confess I’m not so sure. After doing hundreds and hundreds of autopsies on people who have died from all manner of causes, what I can say is that occasionally, not too infrequently actually, you do an autopsy on an older person and there is no clear cause of death. Yes, they may have identifiable pathology in some or maybe even all organ systems, but none of it clearly rises to the level that I can unambivalently point to and say, that’s it. And then sometimes they have no significant pathology, none that I can identify anyway. So you might look at the story of how they died to get some clues. Nothing there either. They were just found dead in bed. Or occasionally they were witnessed to “stop breathing”. Everything seems like a natural death, with an internal cause. But what was it? What caused the whole system to shut down? It’s a mystery.
The flip side is that I’ve also done plenty of autopsies on people in the same category, older people who have the same level of disease, or nondisease, and who died clearly unnatural deaths: Hit by a car, gunshot, tripped and fell down some stairs. All indications were that they were doing just fine, in their customary way, right up until that sudden and most certainly external fatal event.
How to explain this discrepancy? Maybe the first person had some pathology that I could not, or did not, identify. That’s possible. Perhaps a better pathologist would have found it. Maybe so. Or perhaps it can’t be found, not using the tools we have at our disposal. So what we need is better tools. Maybe. Maybe it is some pathological condition that we haven’t discovered yet. If I ever identify it, I can name it after myself. That’d be nice. Or maybe we are getting to the limit of what can ever be known with any certainty when dealing with a complex biological system. A sort of autopsy uncertainty principle. If so, why not just consider it “Old Age?”
FWIW, in my review of DCs, I see plenty (although a small fraction of the whole) that do in fact list “Old Age”, either verbatim or some equivalent, quite frequently. “Senescence”, “Failure to thrive”, “Undetermined Natural Causes” or just “Natural Causes” are some of the alternative wordings. As long as the person is above 75 or so, and there is no reason to think the death was due to anything other than natural causes, I let it pass. But don’t tell anyone.
While the fact that a death must be certified may be stipulated by law, to my knowledge, there is no law that says “how” a DC must be certified, at least not in any jurisdiction I’m familiar with - with one exception. That is in Washington State, regarding deaths that occur in the context of their relatively new Death With Dignity statute, which specifies that the death be certified as Natural due to the underlying terminal illness that enabled the person to take advantage of the statute to get and ingest a lethal quantity of presciption medication.
“Aneurysm” of what? Aorta? Heart? Carotid artery? Coronary artery? Cerebral vessel? That “cause of death” says very little. Not to mention that an aneurysm in itself is harmless unless it does something. Break and cause bleeding? Dialate and cause heart failure? Thrombose and throw a clot causing a stroke? Again, we don’t know. Plus, how did it get there? Naturally occuring? A result of trauma, like a stab wound or gunshot? Perhaps a complication of a medical procedure? As an ME, how it got there makes a big difference, as it determines whether the death would be classified as natural, accident, suicide, or homicide, depending on what (or who) did what to cause the “aneurysm”. Therefore, if that were all that is listed, I would reject that DC as not specific enough, and send it back to the certifier for more information. Having said that, this is quite typical of the “quality” of DCs that are often enough submitted, and, in jurisdictions where they are not reviewed, entered into vital stats.
I would also not accept this one (I don’t mean to hammer the poster, and I apologize for seeming to. But these are such perfect examples of what gets done, as mentioned in my previous post). For one thing, anti-coagulant medication (blood thinners) do not cause aneurysms, which are anatomical distortions of a vessel or heart wall. And “falling into a fire” doesn’t belong in the cause of death formulation, which, admittedly by convention, should be limited to physiological/biological diagnoses, not behavior or circumstances. Not that those latter things are unimportant - they are - but there is another section on the DC (namely, the “How Injury Occurred” section) to enter that. Seems like technicalities, and they are, but important ones. As formulated here, based on the “How Injury Occurred” this death should not be certified as Natural, but sounds like Accident, or perhaps Homicide if someone pushed the decedent. It makes a difference. But, again, this is very reflective of what gets done and DCs so formulated undoubtedly have gone into public record as a Natural deaths and that was the end of it.
Finding a cause of death in decomposed or skeletonized remains can be challenging. But a good forensic pathologist can look through that and usually find something. Likewise, a good forensic anthropologist can tell a lot from bones. The flip side is that it is not always so easy to find a cause of death in a “fresh corpse,” as indicated in my previous post. Ultimately, it’s a judgement, or opinion, based on the available information, like any diagnosis. Not finding a cause of death is not a reason to initiate a “coronial inquiry”. Again, as said previously, people are unsure why a person died all the time and indicate such on a DC. As long as everything seems like Natural causes, it’s all good.