Female deaths much less likely to be reported to coroner in England and Wales

Doctors in England and Wales are much less likely to report a woman's death to a coroner than they are a man's, reveals research published online in the Journal of Clinical Pathology.

Furthermore, women's deaths are less likely to proceed to an inquest, and those that do are less likely to result in a verdict of "unnatural" than men's, with some coroners particularly likely to favour a verdict according to the sex of the deceased, the research shows.

The authors analysed figures from the Ministry of Justice on the numbers and proportions of deaths reported to all 98 coroners, in each of the 114 jurisdictions in England and Wales, between 2001 and 2010.

These figures were then set in the context of official on the number of deaths registered in England and Wales over the same period.

Doctors are not obliged to report a death to a coroner, and the legal duty to hold an inquest resides with the coroner, usually prompted by a death in unnatural or violent circumstances, or when the death is sudden, of unknown cause, or happens in prison.

The analysis of the figures showed that coroner reporting rates varied widely across England and Wales.

Plymouth and South West Devon topped the league table, with 87% of registered deaths reported to the coroner between 2001 and 2010, while Stamford in Lincolnshire came bottom, with only 12% of deaths reported to the coroner.

There were no obvious explanations to account for such wide differences, which remained stable throughout the decade, suggesting that local or medico-legal practice had a part to play, say the authors.

Similarly, coroners varied widely in their use of verdicts, which again remained consistent over time, the analysis showed. This is likely to reflect the personal decision making style of the coroner rather than any local patterns in deaths, say the authors.

But when they looked at reporting rates according to the sex of the dead person, a striking gender divide emerged.

While jurisdictions with high reporting rates for men also had high reporting rates for women, and vice versa, male deaths were 26% more likely to be reported to the coroner than female deaths.

Higher reporting rates for men were common across all jurisdictions in England and Wales, and in some areas male deaths were 48% more likely to be reported.

Not only were female deaths less likely to be reported, but they were also less likely to proceed to an inquest.

Female deaths were half as likely to proceed to an inquest as men's, with just 8% going to this stage compared with 16% of all male deaths. And even when female deaths did get an inquest, they were more likely to be given a verdict of natural causes than men (28% compared with 22%).

Among verdicts of unnatural deaths, men were overrepresented in occupational diseases and suicide while women were overrepresented in narrative verdicts—where cause of death is given in the form of a narrative rather than as a single "short form" definition—and accidents, implying that sex of the deceased influences the verdict, say the authors.

Furthermore, some coroners were "gendered," in their approach to inquest verdicts, and more likely to favour a particular verdict when dealing with a death, according to the gender of the deceased.

The government is currently reforming the death certification process in a bid to strengthen arrangements and improve the quality and accuracy of causes of death, but there are some concerns that the move will prompt a fall in deaths reported to the coroner from the present national average of 46% to around 35%, say the authors.

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