Manner of death – coroner’s cases with Society involvement compared with coroner’s cases without Society involvement

The manner of death indicates how children and youth in Ontario die. If the well-being, living environments and circumstances of children and youth across Ontario, aged 0 - 18, with or without Society involvement, were equal, it would be expected that the number of paediatric deaths occurring from a given manner of death would be the same in each category. 

It is recognized that vulnerable children and youth have a greater likelihood of receiving services from Societies. The manner of death may provide valuable insight into the impact of services provided, but should not be used as an indicator of the effectiveness of service in isolation of many other indicators because Societies provide services in the broader context of a number of variables, and are generally not the only service providers engaged with this population of children and youth. 

A significant difference was noted between the number of deaths with Society involvement compared to the number of deaths investigated by a coroner without Society involvement, by manner of death^{footnote 1[1]}.  Chart 15A illustrates that in 2016, undetermined deaths appear to be more prevalent where a Society was involved with the child, youth or their family prior to the death, while accidents and natural deaths appear to be less prevalent.  Suicides were similar or slightly increased. Chart 15B illustrates that in 2017, undetermined deaths and suicides were found to be higher amongst those with Society involvement and accidents and natural deaths were lower amongst those with Society involvement. In both 2016 and 2017, homicides were equivalent amongst those with and without Society involvement. This varies to some extent from findings in previous years.

Interestingly, when viewed as a five year cohort of data, significant differences were present for all manners of death.  In previous years, it was found that a greater proportion of children and youth with Society involvement die as a result of homicide or of undetermined manner, while fewer children and youth with Society involvement died as a result of accidents or of natural causes.  In 2016 and 2017, the number of suicides with Society involvement was higher than previous years. Caution should be exercised when interpreting these results, however, as the data set remains quite small (n=1918 coroner investigations).

Chart 15A: Manner of death of coroners investigations with or without Society involvement in 2016 (n=375)

• Chart 15A illustrates that in 2016, undetermined deaths appear to be more prevalent where a Society was involved with the child, youth or their family prior to the death at 31%, while accidents and natural deaths appear to have been less prevalent respectively (28%, and 18% ). Homicides were found to be equivalent amongst those with and without Society involvement.  

Chart 15B: Manner of death of coroners investigations with or without Society involvement in 2017 (n=403)

• Chart 15B illustrates that in 2017, undetermined deaths were found to be higher amongst those with Society involvement at 28% and accidents and natural deaths were lower (23% and 22% respectively) amongst those with Society involvement than those without Society involvement.  Suicide deaths that had Society involvement were higher (21%) than those without Society involvement. Homicides were found to be somewhat equivalent amongst those with and without Society involvement (4% and 3% respectively). 3% of deaths with Society involvement are currently still under investigation.

What do we know about deaths where the manner of death is undetermined?

When a complete investigation, including an autopsy, review of the clinical history and evaluation of the scene, does not allow for identification of a specific manner of death, or there are competing manners of death, the death will be classified as undetermined.  Most paediatric deaths that are classified as undetermined occur in children under one year of age, with a smaller proportion occurring in children aged one to five and even fewer in the older age groups.

Chart 16A: Paediatric deaths classified as undetermined – with or without Society involvement in 2016 (n=73)

• Chart 16A illustrates the number of undetermined deaths by age group, with and without Society involvement prior to the death in 2016.  Most paediatric deaths that are classified as undetermined occur in children under one year of age, with a smaller proportion occurring in children under five and even fewer in older age groups.

Chart 16B: Paediatric deaths classified as undetermined – with or without Society involvement in 2017 (n=72)

• Chart 16B illustrates the number of undetermined deaths by age group, with and without Society involvement prior to the death in 2017.  Most paediatric deaths that are classified as undetermined occur in children under one year of age, with a smaller proportion occurring in children under five and even fewer in older age groups.

Presence of sleep associated circumstance as a potential contributing factor in undetermined deaths

In 2016, sleep circumstances were identified in 48% (35) of the 73 paediatric deaths where the manner of death was classified as undetermined; in 2017 this value was lower at 32% (23) of the 72 paediatric deaths where the manner of death is undetermined. 34% (n=12) in 2016 and 39% (n=9) in 2017 of these children or their families received services from a Society within 12 months of their death.

While the data demonstrates a statistically significant difference in the number of deaths of children with and without Society involvement where the manner was undetermined, when considering only those cases where sleep circumstances were identified as potential contributing factors to the death there was no significant difference between Society involved and non-Society involved populations^{footnote 2[2]}. This is consistent with the findings of previous years.  Analysis of a five year cohort does not identify a statistically significant difference^{footnote 3[3]}.  Furthermore, the number of deaths of children with Society involvement where sleep circumstances were identified as a potential contributing factor has been decreasing since this type of data analysis began in 2014.

As noted in previous annual reports, many variables require consideration when interpreting this finding. First and foremost, the small sample size must be considered.  In addition, Societies are not the only organizations promoting safe sleep in communities. The independent impact of Society practice on the number of paediatric deaths occurring in unsafe sleep environments is unknown; however, the continued absence of a significant difference between Society involved deaths and those without Society involvement may suggest that the practices of Societies have potentially contributed to the overall prevention of paediatric deaths where sleep environment may be factor.