Despite an increase in overall death rates, the number of people in parts of the UK whose bodies have been found so decomposed that their cause of death cannot be determined is rising. A new study led by researchers at the University of Oxford seeks to unravel why.
The study examined data from the Office for National Statistics (ONS). To comb through records and come up with a disaggregated number, the researchers used two proxy codes assigned to deaths by the World Health Organization's International Classification of Diseases. One is the R98 code, which stands for "death without care." The other is R99, which stands for "Other Unspecified and Unknown Cause of Death," which is the only code that can be used when the death is expressed as decayed or undetermined.
The researchers reasoned that the two codes could be a substitute for identifying badly decomposed bodies found in homes, and they said that if someone died in hospital, the likelihood of the cause of death being unexplained was slim. They also said that if the body was found outdoors, the cause of death was likely some kind of trauma, which an autopsy could determine. Nonetheless, the research team acknowledges that using this coding as a proxy for their study has its limitations.
"To our knowledge, the ICD-10 codes R98 and R99 (and equivalent codes) have never before been used as a proxy for severe decay," the researchers wrote in their paper published in the Journal of the Royal Society of Medicine. "These codes would miss cases where the body had decomposed but autopsy results could still determine the cause of death," they added. "However, we cannot say with certainty that these codes are good proxies for late-stage decay."
Still, the researchers found that the number of undetermined deaths due to decomposition did rise steadily over the 41-year study period when surrogate codes were used. Men were almost twice as likely to be found in a state of decay. Particularly in the 1990s and 2000s, there was a spike in the proportion of men in this category, even as overall mortality rates improved at the time.
The study also found that deaths at home rose from 0.15 per cent of all deaths from all causes to just over 0.3 per cent across all age groups, while the number of undetermined deaths almost quadrupled during the study period.
Researchers concluded that the rise in unidentified deaths points to problems of social neglect and isolation, as bodies go undiscovered for so long.
Theodore Estrin-Serlui, co-author of the study, from Imperial College London NHS Trust, said: "Many people will be shocked that someone will die at home for days, weeks or even longer, without anyone raising the alarm in the community where they live. The increase in people being found dead and decomposed suggests a widespread social breakdown in formal and informal social support networks even before the pandemic. These conditions are worrying and urgently require further investigation."