Trends in undetermined intent injuries and their implications for external cause mortality statistics: a cross-sectional study

BACKGROUND: A high mortality rate from undetermined intent injuries can significantly interfere with statistical data on suicide, homicide, and accidental death. These injuries are characterized by a lack of diagnostic and analytical information, which makes it difficult to accurately assess the true rates of external causes of death.

AIM: The study aimed to evaluate the causes of death classified as events of undetermined intent (Y10–Y34) and their impact on statistical reports of external cause mortality rates.

METHODS: This was a retrospective, record-based, cross-sectional, single-center study. The study examined the medical death certificates of individuals who died violently in the Saratov region between 2014 and 2023. ICD-10 codes V01–Y98 were analyzed according to sections V01–X59 (accidental injuries), X60–X84 (intentional self-harm), X85–Y09 (assault), and Y10–Y34 (events of undetermined intent). The data were statistically processed using Microsoft Office 2010 and Microsoft Excel.

RESULTS: From 2014 to 2023, the proportion of violent deaths with undetermined intent increased, whereas the proportion of suicides and homicides decreased. Blunt trauma, asphyxia, and poisoning are the leading causes of death in the Y10–Y34 group. An analysis of trends revealed a substantial increase in asphyxia cases and a decrease in blunt trauma cases. The increase in events of undetermined intent is primarily caused by the reclassification of falls from heights, poisonings, and hangings as part of this group.

CONCLUSION: The study shows an increase in events of undetermined intent (Y10–Y34) among violent deaths, primarily because of the reclassification of hanging, falls from heights, blunt injuries, and some types of poisonings, which were previously classified as intentional self-harm (X60–X84), accidents (V01–X59), or assault (X85–Y09). This reclassification substantially impacts mortality rate statistics for homicides, accidents, and suicides, which reduces the reliability of reports on external causes of death.