statistics on Iatrogenic deaths

Margaret made this Freedom of Information request to Office for National Statistics

The request was successful.

From: Margaret

29 March 2011

Dear Office for National Statistics,
Please provide me with the number of Iatrogenic deaths per annum in
UK and
the number of deaths per annum caused by consuming Vitamins,
Minerals and herbal supplements.
Thank you.

Yours faithfully,

Margaret M Flockhart

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From: Margaret

29 April 2011

Dear Office for National Statistics,
By law you should have responded to my request by April 28th. It is
now April 29th and I have had no response.
Why?

Yours faithfully,

Margaret

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From: Margaret

1 June 2011

Dear Office for National Statistics,

It is now two months since I requested statistics on Iatrogentic
deaths in the UK. Your response is long overdue and I request an
internal review

Yours faithfully,

Margaret

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From: Paul Wearn
Office for National Statistics

9 June 2011

Our Reference: FOI01153/Flockhart/QE1

Dear Ms Flockhart,

Thank you for your freedom of information request for the number of
iatrogenic deaths per annum in UK and the number of deaths per annum
caused by consuming vitamins, minerals and herbal supplements.

ONS only hold mortality data for England and Wales, so you will need to
contact the Northern Ireland Statistics and Research Agency
([1]www.nisra.gov.uk) and National Records of Scotland
([2]www.gro-scotland.gov.uk) to obtain statistics for the rest of the UK.

All of the mortality data held by the Office for National Statistics (ONS)
comes from information collected when a death is registered. Information
on the causes of death is obtained from the doctor's medical certificate
of cause of death or the coroner's death certificate. ONS code all of the
causes mentioned on the death certificate using the International
Classification of Diseases, tenth revision (ICD 10). From all of the
causes mentioned an underlying cause is selected using ICD coding rules,
this is defined by the World Health Organisation as:
a) the disease or injury that initiated the train of events directly
leading to death, or
b) the circumstances of the accident or violence that produced the fatal
injury

Deaths which have an external underlying cause such as accidents,
poisonings and violence are also assigned a nature of injury, or main
injury code. These are also known as secondary causes, and have an ICD 10
code in the range S00-T98.

The number of deaths registered in England and Wales each year broken down
by sex, age and cause (ICD 10 code) are published on the ONS website:
[3]www.statistics.gov.uk/statbase/Product.asp?vlnk=15096.
Please click the 8th link down: 'Mortality Statistics: Deaths registered
in 2009'.

ONS do not have a National Statistics definition for iatrogenic deaths.
The causes most closely fitting this concept are 'complications of medical
and surgical care', ICD 10 codes Y40-Y84. Table 5.19, from the annual
'Mortality Statistics' publication shows that there were 236 male deaths
and 226 females deaths where the underlying cause was a complication of
medical and surgical care, in England and Wales, for 2009. Equivalent
figures for 2006-2008 are available in the relevant annual publications,
on the same webpage.

Identifying deaths caused by consuming vitamins, minerals and herbal
supplements is more complicated. It is possible to use the secondary cause
/ nature of injury code to identify some of these deaths. However, the
difficulty is that most of the ICD 10 codes that would include poisoning
by vitamins, minerals and herbal supplements, also include other drugs or
substances, ie they are not specific enough. Also, please note that these
poisonings could be accidental, intentional self-harm (suicide),
undetermined intent (here normally the harm is self-inflicted) or even
assault.

I've listed the codes below which could be used for vitamin or mineral
poisonings. The numbers of deaths from these causes can be found in table
6 of the annual mortality statistics publication.

* Poisoning by vitamins not elsewhere classified (including A, B, C, D
and E), ICD 10 code T45.2, which is a specific code.
* Poisoning by anticoagulant antagonists, vitamin K and other
coagulants, ICD code, T45.7, which is not specific to vitamins.
* Poisoning by peripheral vasodilators, including nicotinic acid, code
T46.7, which is not specific to vitamins.

There were no deaths from vitamin poisonings in England and Wales in 2009.

There are a large number of minerals and mineral compounds and it would be
difficult to list them all in this e-mail. I have listed a small selection
of minerals below, but please note that these minerals may not have come
from supplements.

* Toxic effects of chromium and its compounds - T56.2
* Toxic effects of copper and its compounds - T56.4
* Toxic effects of zinc and its compounds - T56.5

There were no deaths from these causes in England and Wales in 2009.

* Poisoning by iron and its compounds - T45.4.

This code is specific to iron, and there was one death from this cause in
England and Wales in 2009.

Depending on which mineral was involved, deaths may also be assigned any
of the following secondary cause ICD codes: T47.2, T47.4, T50.3, T52.0, or
T54.2. However, none of these codes are specific to mineral supplements.

Regarding herbal supplements, unless the coroner specified which herbal
supplement had been consumed, a general poisoning code would be assigned -
T50.9 - poisoning by other and unspecified drugs, medicaments and
biological substances. This code includes poisoning by many different
types of substances, not just herbal supplements.

Although there will only be a handful of deaths per year from this cause,
it may be possible to gain further information by examining the text on
the death certificate. However, there is a lot of variation in the amount
of detail coroners record on death certificates, and when such small
numbers are involved, the figures may not be reliable. This work would be
time-consuming and we would need to charge, and also schedule it into our
future work programme. If you would like us to investigate this further,
please e-mail [email address] and let us know which specific
vitamins, minerals and herbal supplements you are interested in, and we
will provide you with a cost estimate.

You have the right to have this response to your freedom of information
request reviewed internally by an internal review process and, if you
remain unhappy with the decision, by the Information Commissioner. If you
would like to have the decision reviewed please write to Frank Nolan,
Office for National Statistics, Room 1127, Government Buildings, Cardiff
Road, Newport, Gwent, NP10 8XG.

If you have any queries about this email, please contact me. Please
remember to quote the reference number above in any future communications.

Kind regards,

Paul Wearn LLB (Hons)
Legal Services
Office for National Statistics

For the latest data on the economy and society consult National Statistics
at http://www.ons.gov.uk

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not necessarily those of the Office for National Statistics

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References

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2. file:///tmp/www.gro-scotland.gov.uk
3. file:///tmp/www.statistics.gov.uk/statbase/Product.asp?vlnk=15096

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