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A proposed theoretical definition to address the undercounting of injury deaths
  1. Colin Cryer1,
  2. Pauline Gulliver1,
  3. John Langley1,
  4. Gabrielle Davie1,
  5. Ari Samaranayaka1,
  6. Christine Fowler2
  1. 1Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  2. 2Mortality Collection, Sector Services, Ministry of Health, Wellington, New Zealand
  1. Correspondence to Dr Colin Cryer, Research Associate Professor, Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; colin.cryer{at}

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Underlying cause of death (UCoD) and injury prevention

Most countries (eg, Australia,1 USA2) have used UCoD to identify cases of injury death. Volume 1 of the WHO's International Classification of Diseases, 10th Revision (ICD10) manual3 describes the UCoD as:

‘(a) the disease or injury which initiated the train of events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury’.

As injury prevention researchers and practitioners, we are interested in preventing death by preventing injury. This leads to an interest in all cases where injury lies on a causal pathway that leads to death, even if the external cause that resulted in the injury is not the UCoD, according to WHO coding rules.3 Intervening anywhere on the causal pathway can prevent the outcome, injury death. The challenge, therefore, is to identify and agree on a theoretical definition of injury death, and an operational definition of injury death that is consistent with it, since the use of UCoD alone for identifying injury deaths results in potentially lost opportunities for prevention.

Concerns regarding UCoD accuracy

Concerns had been expressed about the difficulties of accurate classification of UCoD for older people,4–8 particularly when they had fallen and died. Our concerns were subsequently heightened by the results produced as part of our recent project aimed …

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  • Funding This study was funded by the Accident Compensation Corporation of New Zealand.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of New Zealand Multi-region Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed