A deathly silence: why has the number of people found decomposed in England and Wales been rising?

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Abstract

Objectives

The number of deaths occurring in private homes in England and Wales had been rising for years, increasingly rapidly from 2020. Media stories and research linked decomposing bodies found in private homes with pandemic-related social isolation. We aim to explore whether these incidents are one-offs or part of a wider trend.

Design

Descriptive analysis of publicly available Office for National Statistics (ONS) data.

Setting

England and Wales.

Participants

All residents of England and Wales, 1979 to 2020.

Main outcome measures

Using data from the Office for National Statistics, we calculate European Age Standardised Rates for deaths coded as R98 (‘unattended death’) and R99 (‘other ill-defined and unknown causes of mortality’) in the 10th version of the International Classification of Diseases (ICD-10), and the corresponding codes in ICD-9, by sex and age group from 1979 (when ICD-9 began) to 2020. These are proxy markers for deaths where decomposition precludes attribution of a specific cause at postmortem.

Results

While mortality from all other causes decreased from 1979 to 2020, the opposite was seen for deaths from R98 and R99 (or ‘undefined deaths’), with men more affected than women. There was a sharp rise in these deaths in both sexes but in men particularly in the 1990s and 2000s, coinciding with a time when overall mortality was rapidly improving.

Conclusions

The increase in people found dead from unknown causes suggests wider societal breakdowns of both formal and informal social support networks. They are concerning and warrant urgent further investigation. We call on national and international authorities to consider measures that would make it possible to identify these deaths more easily in routine data.

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Most cited references 10

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Local government funding and life expectancy in England: a longitudinal ecological study

Alexandros Alexiou, Katie Fahy, Kate Mason … (2021)

Background Since 2010, large reductions in funding for local government services have been introduced in England. These reductions in funding have potentially led to reduced provision of health-promoting public services. We aimed to investigate whether areas that showed a greater decline in funding also had more adverse trends in life expectancy and premature mortality. Methods In this longitudinal ecological study, we linked annual data from the Ministry of Housing, Communities, and Local Government on local government revenue expenditure and financing to 147 upper-tier local authorities in England between 2013 and 2017 with data from Public Health England, on male and female life expectancy at birth, male and female life expectancy at age 65 years, and premature (younger than 75 years) all-cause mortality rate for male and female individuals. Local authorities were excluded if their populations were too small or if changes in boundaries meant consistent data were not available. Using multivariable fixed-effects panel regression models, and controlling for local socioeconomic conditions, we estimated whether changes in local funding from 2013 were associated with changes in life expectancy and premature mortality. We included a set of alternative model specifications to test the robustness of our findings. Findings Between 2013 and 2017, mean per-capita central funding to local governments decreased by 33% or £168 per person (range –£385 to £1). Each £100 reduction in annual per person funding was associated over the study period 2013–17 with an average decrease in life expectancy at birth of 1·3 months (95% CI 0·7–1·9) for male individuals and 1·2 months (0·7–1·7) for female individuals; for life expectancy at age 65 years, the results show a decrease of 0·8 months (0·3–1·3) for male individuals and 1·1 months (0·7–1·5) for female individuals. Funding reductions were greater in more deprived areas and these areas had the worst changes in life expectancy. We estimated that cuts in funding were associated with an increase in the gap in life expectancy between the most and least deprived quintiles by 3% for men and 4% for women. Overall reductions in funding during this period were associated with an additional 9600 deaths in people younger than 75 years in England (3800–15 400), an increase of 1·25%. Interpretation Our findings indicate that cuts in funding for local government might in part explain adverse trends in life expectancy. Given that more deprived areas showed greater reductions in funding, our analysis suggests that inequalities have widened. Since the pandemic, strategies to address these adverse trends in life expectancy and reduce health inequalities could prioritise reinvestment in funding for local government services, particularly within the most deprived areas of England. Funding National Institute for Health Research (NIHR) School for Public Health Research, NIHR Applied Research Collaboration North East and North Cumbria, NIHR Applied Research Collaboration North West Coast and Medical Research Council.

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Life expectancy and risk of death in 6791 communities in England from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data

Theo Rashid, James Bennett, Christopher Paciorek … (2021)

Background High-resolution data for how mortality and longevity have changed in England, UK are scarce. We aimed to estimate trends from 2002 to 2019 in life expectancy and probabilities of death at different ages for all 6791 middle-layer super output areas (MSOAs) in England. Methods We performed a high-resolution spatiotemporal analysis of civil registration data from the UK Small Area Health Statistics Unit research database using de-identified data for all deaths in England from 2002 to 2019, with information on age, sex, and MSOA of residence, and population counts by age, sex, and MSOA. We used a Bayesian hierarchical model to obtain estimates of age-specific death rates by sharing information across age groups, MSOAs, and years. We used life table methods to calculate life expectancy at birth and probabilities of death in different ages by sex and MSOA. Findings In 2002–06 and 2006–10, all but a few (0–1%) MSOAs had a life expectancy increase for female and male sexes. In 2010–14, female life expectancy decreased in 351 (5·2%) of 6791 MSOAs. By 2014–19, the number of MSOAs with declining life expectancy was 1270 (18·7%) for women and 784 (11·5%) for men. The life expectancy increase from 2002 to 2019 was smaller in MSOAs where life expectancy had been lower in 2002 (mostly northern urban MSOAs), and larger in MSOAs where life expectancy had been higher in 2002 (mostly MSOAs in and around London). As a result of these trends, the gap between the first and 99th percentiles of MSOA life expectancy for women increased from 10·7 years (95% credible interval 10·4–10·9) in 2002 to reach 14·2 years (13·9–14·5) in 2019, and for men increased from 11·5 years (11·3–11·7) in 2002 to 13·6 years (13·4–13·9) in 2019. Interpretation In the decade before the COVID-19 pandemic, life expectancy declined in increasing numbers of communities in England. To ensure that this trend does not continue or worsen, there is a need for pro-equity economic and social policies, and greater investment in public health and health care throughout the entire country. Funding Wellcome Trust, Imperial College London, Medical Research Council, Health Data Research UK, and National Institutes of Health Research.

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Human decomposition and the reliability of a 'Universal' model for post mortem interval estimations.

Diane Cockle, Lynne Bell (2015)

Human decomposition is a complex biological process driven by an array of variables which are not clearly understood. The medico-legal community have long been searching for a reliable method to establish the post-mortem interval (PMI) for those whose deaths have either been hidden, or gone un-noticed. To date, attempts to develop a PMI estimation method based on the state of the body either at the scene or at autopsy have been unsuccessful. One recent study has proposed that two simple formulae, based on the level of decomposition humidity and temperature, could be used to accurately calculate the PMI for bodies outside, on or under the surface worldwide. This study attempted to validate 'Formula I' [1] (for bodies on the surface) using 42 Canadian cases with known PMIs. The results indicated that bodies exposed to warm temperatures consistently overestimated the known PMI by a large and inconsistent margin for Formula I estimations. And for bodies exposed to cold and freezing temperatures (less than 4°C), then the PMI was dramatically under estimated. The ability of 'Formulae II' to estimate the PMI for buried bodies was also examined using a set of 22 known Canadian burial cases. As these cases used in this study are retrospective, some of the data needed for Formula II was not available. The 4.6 value used in Formula II to represent the standard ratio of time that burial decelerates the rate of decomposition was examined. The average time taken to achieve each stage of decomposition both on, and under the surface was compared for the 118 known cases. It was found that the rate of decomposition was not consistent throughout all stages of decomposition. The rates of autolysis above and below the ground were equivalent with the buried cases staying in a state of putrefaction for a prolonged period of time. It is suggested that differences in temperature extremes and humidity levels between geographic regions may make it impractical to apply formulas developed in one region to any other region. These results also suggest that there are other variables, apart from temperature and humidity that may impact the rate of human decomposition. These variables, or complex of variables, are considered regionally specific. Neither of the Universal Formulae performed well, and our results do not support the proposition of Universality for PMI estimation.