The ?nal cause of death is usually the failure of the vital centres in the brain that control the beating of the heart and the act of breathing. The important practical question, however, is what disease, injury or other agent has led to this failure. Sometimes the cause may be obvious – for example, pneumonia, coronary thrombosis, or brain damage in a road accident. Often, however, the cause can be uncertain, in which case a POST-MORTEM EXAMINATION is necessary.
The two most common causes of death in the UK are diseases of the circulatory system (including strokes and heart disease) and cancer.
Overall annual death rates among women in the UK at the start of the 21st century were
7.98 per 1,000 population, and among men,
5.58 per 1,000. Comparable ?gures at the start of the 20th century were 16.3 for women and
18.4 for men. The death rates in 1900 among infants up to the age of four were 47.9 per 1,000 females and 57 per 1,000 males. By 2003 these numbers had fallen to 5.0 and 5.8 respectively. All these ?gures give a crude indication of how the health of Britain’s population has improved in the past century.
Death rates and ?gures on the causes of deaths are essential statistics in the study of EPIDEMIOLOGY which, along with information on the incidence of illnesses and injuries, provides a temporal and geographical map of changing health patterns in communities. Such information is valuable in planning preventive health measures (see PUBLIC HEALTH) and in identifying the natural history of diseases – knowledge that often contributes to the development of preventive measures and treatments for those diseases.
The proportion of deaths in a specified population. The death rate is calculated by dividing the number of deaths in a population in a year by the midyear resident population. Death rates are often expressed as the number of deaths per 100 000 persons. The rate may be restricted to deaths in specific age, race, sex, or geographic groups or deaths from specific causes of death (specific rate), or it may be related to the entire population (crude rate).... death rate
For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using the international rules for selecting the underlying cause of death from the reported conditions. See “International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10)”.... cause of death
Cause-of-death ranking for adults is based on the List of 72 Selected Causes of Death, HIV Infection, and Alzheimer’s Disease. The List was adapted from one of the special lists for mortality tabulations recommended for use with the International Classification of Diseases, ninth revision. Two group titles – “Major cardiovascular diseases” and “Symptoms, signs, and ill-defined conditions” – are not ranked based on the list of 72 selected causes. In addition, category titles that begin with the words “other” and “all other” are not ranked. The remaining category titles are ranked according to number of deaths to determine the leading causes of death. When one of the titles that represents a subtotal is ranked (for example, unintentional injuries), its component parts are not ranked (in this case, motor vehicle crashes and all other unintentional injuries).... cause-of-death ranking
There are some minor signs, such as: relaxation of the facial muscles (which produces the staring eye and gaping mouth of the ‘Hippocratic countenance’), as well as a loss of the curves of the back, which becomes ?at by contact with the bed or table; discoloration of the skin, which takes on a wax-yellow hue and loses its pink transparency at the ?nger-webs; absence of blistering and redness if the skin is burned (Christison’s sign); and failure of a ligature tied round the ?nger to produce, after its removal, the usual change of a white ring, which, after a few seconds, becomes redder than the surrounding skin in a living person.
The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.
In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)
Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of
deaths of women while pregnant or within 42 days of the end of the pregnancy from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes. These deaths can be subdivided into four main categories: (1) direct deaths: directly related to pregnancy; (2) indirect deaths: due to pre-existing maternal disease aggravated by pregnancy; (3) coincidental: unrelated to pregnancy; (4) late deaths: occurring between six weeks and one year following delivery. See also maternal mortality rate.... maternal death
a legal document, signed by a doctor, stating (in Part 1) the immediate cause of a person’s death followed by diseases underlying the condition. For example, if the immediate cause of death was a myocardial infarction, the underlying disease might have been ischaemic heart disease or hypertension. Other diseases, which were not directly linked with the immediate cause of death but may have contributed to the patient’s overall condition, are mentioned in Part 2 of the certificate. The document usually states the decedent’s gender and date and place of death; other details, such as occupation, may also be included. The death certificate forms a vital record in most countries throughout the world; without a death certificate, there can be no funeral. For England and Wales, this information is held at the General Register Office, which is now in Southport. In Scotland death certificates are kept at the National Records of Scotland, and in Northern Ireland at the General Register Office for Northern Ireland. Following the case of the serial killer Dr Harold Shipman and the subsequent public enquiry, legislation has introduced greater checks on, and scrutiny of, death certification by doctors.... death certificate
Health Encyclopedia