Allan Baker

Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010

Objectives To quantify mortality associated with sepsis in the whole population of England. Design Descriptive statistics of multiple cause of death data. Setting England between 2001 and 2010. Participants All people whose death was registered in England between 2001 and 2010 and whose certificate contained a sepsis-associated International Classification of Diseases, 10th Revision (ICD-10) code. Data sources Multiple cause of death data extracted from Office for National Statistics mortality database. Statistical methods Age-specific and sex-specific death rates and direct age-standardised death rates. Results In 2010, 5.1% of deaths in England were definitely associated with sepsis. Adding those that may be associated with sepsis increases this figure to 7.7% of all deaths. Only 8.6% of deaths definitely associated with sepsis in 2010 had a sepsis-related condition as the underlying cause of death. 99% of deaths definitely associated with sepsis have one of the three ICD-10 codes—A40, A41 and P36—in at least one position on the death certificate. 7% of deaths definitely associated with sepsis in 2001–2010 did not occur in hospital. Conclusions Sepsis is a major public health problem in England. In attempting to tackle the problem of sepsis, it is not sufficient to rely on hospital-based statistics, or methods of intervention, alone. A robust estimate of the burden of sepsis-associated mortality in England can be made by identifying deaths with one of the three ICD-10 codes in multiple cause of death data. These three codes could be used for future monitoring of the burden of sepsis-associated mortality.

Deaths from antidepressants in England and Wales 1993-1997 : analysis of a new national database

BACKGROUND The prescription of antidepressants has increased substantially over the last 10 years. It is therefore timely to examine trends in mortality associated with overdoses of antidepressants and to compare the relative mortality associated with different antidepressants. METHODS Data were derived from a newly developed national database of deaths from overdose and poisoning in England and Wales between 1993 and 1997. Age and sex specific death rates associated with overdose and poisoning with antidepressants were calculated together with numbers of deaths per 100,000 prescriptions of individual antidepressants. RESULTS Twenty per cent (2,503) of all deaths from overdose or poisoning were antidepressant related. The number of deaths increased by 18% between 1993 and 1997. Ninety-five per cent of deaths from antidepressants were associated with tricyclic antidepressants, particularly dothiepin and amitriptyline. Tricyclic antidepressants were associated with 5.3 deaths per 100,000 prescriptions, 4.4 for monoamine oxidase inhibitors and 0.4 for selective serotonin reuptake inhibitors. Annual death rates were highest in men aged 30-44 years (18.2 per million) and women aged 45-59 years (14.8). Death rates from antidepressants were 2.5 times higher in the most deprived fifth than in the least deprived fifth of enumeration districts. CONCLUSIONS Antidepressants are an important cause of death from poisoning and overdose. SSRIs and newer antidepressants are associated with <10% of the risk of death than the older antidepressants. There is a strong association between area deprivation and deaths from antidepressants.

Alcohol-related deaths by occupation: what do data for england and wales in 2001–2005 tell us about doctors' mortality?

Alcohol-related mortality for different occupations in England and Wales has long been monitored by the Office for National Statistics and its predecessor organizations. Staff at the General Register Office in the early 1890s sorted half a million paper death records into separate occupational groups, which were in turn classified by cause of death. The results of the consequent analyses, published in 1895, were the first comprehensive assessment of mortality from a range of causes for men in particular occupations (General Register Office, 1895). From the wealth of results, we learn that mortality in publicans from alcoholism was seven times that of all working men, while deaths from liver disease were six and a half times higher. Mortality from alcoholism for workers in agriculture was, conversely, less than a third of that for men in all occupations. Subsequent reports show some consistencies, including that the highest levels of alcohol-related mortality are generally found among those who work in the drinks industry. The last ONS report considered deaths up to 1990 (Drever, 1995), but since then death rates from causes related to alcohol misuse have been rising rapidly. In fact, rates in the UK almost doubled between 1991 and 2005 (Office for National Statistics, 2006). It was therefore timely for ONS to undertake a new analysis of alcohol-related mortality by occupation, the results of which were published in August 2007 (Romeri et al ., 2007). Using the National Statistics definition of alcohol-related mortality (which includes only those causes regarded as being most directly due to alcohol consumption, such as alcoholic liver disease and fibrosis and cirrhosis of the liver), we examined deaths in England and Wales between 2001 and 2005. From the information collected at death registration, we have the occupation of the deceased, …

Health inequalities under New Labour: difference in findings is due to geographical coverage.

EDITOR—Shaw et al argue that any study that does not use the recently released, final revised population estimates will produce erroneous results, citing a paper by one of us (MB), which showed a narrowing of the life expectancy gap in England.1 2 How much do revisions to population estimates influence the conclusions and can this alone account for the apparently different conclusions in the two papers? Bajekal …