Use of Vital Records to Improve Identification of Suicide as Manner of Death for Opioid-Related Fatalities.

Background

Accurate classification of intentional death as suicide is essential to target prevention measures appropriately. Unfortunately, manner of death (MOD) for many opioid-related fatalities are unclassified in the United States, and in Maryland, as many as 82% of overdose deaths are classified as undetermined manner. Aims: For opioid-related fatalities in Maryland, leverage death certificate data to develop a model for identifying suicide as MOD among those classified as undetermined by the medical examiner. Method: Demographic and toxicology data were used to develop a classification model for opioid-related deaths where MOD was known, and then applied to a cohort where MOD was undetermined to estimate the likelihood that the intent was suicide.

Results

Antidepressants, neuroleptics, oxycodone, benzodiazepines, and acetaminophen were more common in deaths classified as suicide while fentanyl, cocaine, and morphine were more common among accidental deaths. Our classification model correctly identified suicide cases 82% of the time (PPV = 0.82; AUC = 0.90) and expanded the number of suicide cases by 43% when applied to undetermined deaths. Limitations: The accuracy and completeness of death records.

Conclusions

Data from standard autopsies can be used to detect additional suicide deaths with good statistical precision. Incorporating clinical information could enhance predictive accuracy and improve classification.