2010 Death Stats Show Disturbing Trends

What lessons can be learned from the County Medical Examiner's Annual Report? We speak to the Deputy Medical Examiner about the most common causes of death in San Diego County.

Guests

Dr. Jonathan Lucas, San Diego County Deputy Medical Examiner

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CAVANAUGH: Deaths due to drugs and axal falls are on the increase in San Diego. And a major art exhibit in Balboa Park takes us from el Greco to Dalí. This is KPBS Midday Edition. I'm Maureen Cavanaugh. It's Thursday, July 7th. Works from a private collection of Spanish masters go on display at the San Diego museum of art this weekend. And that's just one of the many events to enjoy on our weekend preview. But we begin today with the most sobering of statistics. The San Diego County medical examiner's office has released its annual report covering deaths in 2010. And while there's some good news in the report about a decrease in homicides and traffic deaths, the increases tell us about some growing concerns in San Diego. I'd like to welcome doctor Jonathan Lucas, San Diego County deputy medical examiner. Hello.

LUCAS: Hello.

CAVANAUGH: Now, first of all, under what circumstances is the county medical examiner's office called in to do an autopsy?

LUCAS: Well, we investigate only a small proportion of the total deaths in the county, just to give you a perspective. There's about 20,000 people that die every year in our county. And we end up taking jurisdiction in about 2700 of them. And they come to us in all cases, all deaths that are related to some type of an injury. Either a violent injury or an intoxication, asphyxia, or any type of an injury that relates to a death. All of those deaths come through oue on office. In addition, people that die suddenly and unexpectedly from many different causes are investigated by us.

CAVANAUGH: So even in the small sample that your office actually performs autopsies on and determines cause of death, what is the most common cause of death in San Diego County. ?

LUCAS: Yes. Upon the most common cause of death that we investigated was cardiovascular disease. That's a reelection, I think accident of the general population. And cardiovascular disease has also been our number one type of death accident historically.

CAVANAUGH: So that would be the sudden death that you were talking about, the person who has -- basically a heart attack at his home or at work, and then the body goes to your office and you do the examination. After cardiovascular deaths, what was the next common cause of death that you've seen?

LUCAS: The next most common cause of death was number two in the ranking, but it was actually the most common nonnatural type of death. And that was drug and or medication related intoxication death.

CAVANAUGH: Can you break that down for us a bit? What kinds of drugs are we talking about?

LUCAS: Well, there's -- when we -- we use the terms drugs, and sometimes we mean illicit drug, and sometimes people mean medications. But we're talking about both categories here. Both the prescriptions that you might get from your doctor and also illicit drugs that are obtained illegally. Historically, we've seen problems with the narcotic type of prescription medications pain medications in general like oxycodone, hydrocodone, Vicodin or OxyContin. Fairly commonly abused. Then in the illicit drug category we've seen problems with heroin and methamphetamine historically. But heroin has sort of been increasing over the last few years. And methamphetamine spiked this year for some reason.

CAVANAUGH: Have prescription drug or illicit drug related deaths figured high in the number of deaths that you've seen over the last several years?

LUCAS: Yes. They have been increasing. Everything -- intoxication related deaths in general, be it prescription medication or illicit drugs, have increased over the last several years. This is a growing problem. You break that down further, if you take just the prescription medications, that group is increasing by itself. So deaths related to any type of a prescription medication, those cases have been increasing over the last several years. If you break that down even further into types of prescription medications, say narcotics or antidepressants or psychotics, all those classes have been increasing as well. And we've been seeing with increased frequency in our office. If you step back to the illicit drug categories, it's a little bit more variable. Methamphetamine has been declining over the last few years, cocaine has been declining, but labor has seen an increase. Methamphetamine like I said, increased this year. Then cocaine had a little uptake this year.

CAVANAUGH: I'm speaking with doctor Jonathan Lucas, San Diego County deputy medical examiner. We're talking about a report that was just released by the medical examiner's office that covers the deaths in 2010, the causes of deaths, how many there were that were autopsied by the medical examiner's office, and a number of other statistics that are broken down in the report. Did I interrupt you? Was there something more that you wanted to say about the drug related deaths?

LUCAS: No. I think that the main problem is like we've been talking that all category, no matter how you look at it, the entire group of intoxication related deaths are increasing as a group. And even if you break things down, we're seeing increases in different types. So not just -- just to step back a tad here, remember that we are seeing relatively small numbers given the numbers of people in the county. Three million people in the county, 400 deaths -- not the biggest number. But you also have to remember that we're the tip of the iceberg, and we're only seeing a small portion of the problem. We're seeing the tragic end result of a long, ongoing problem. And for everybody that dies here, there's nor people out there with these problems.

MAUREEN CAVANAUGH: And another statistic in a subcategory of that statistic is that heroin was the most common substance found in the deaths of those of the -- the drug deaths of those under the age of 30. What message does that statistic send, doctor?

LUCAS: Well, heroin is definitely coming back. It's killing younger people. And actually if you tease that out just a little bit, what you just pointed out which is very important, we had six teenagers die last year of heroin intoxication and another one, a seventh one, due to a withdrawal. That's as many -- that's more, actually than the most ten years combined in that age group of heroin intoxications. We're concerned about this, we're watching it, and law enforcement is aware of this, and they're watching it. And we're concerned because we think it might be tied -- we know it's tied at least in part to prescription drugs -- prescription medication abuse and transition to illicit drugs.

CAVANAUGH: Another statistic in this report is that deaths from accidental falls are on the rise. Why do you think we're seeing an increase in those kinds of deaths?

LUCAS: I think it's primarily tied to the increasing aging population. Accidental fall related deaths, even though the drug and medication related deaths over all age groups are the number one nonnatural cause, when you look at people over the age of 65, accidental falls are their number one nonnatural cause of death. As our population increases, healthcare improves, people live longer, you're going to see a growing adult -- elderly population, we're going to see more falls. It's important to take care of the prevention of balance, and other protective measures.

CAVANAUGH: We've been hearing about a number of very tragic cases, murder suicides in San Diego, over the past couple of months. In your report for 2010, the suicide rate dropped. But there's more to that statistic, isn't there?

LUCAS: That's right. Suicides dropped in the ranking of, if you wanted to -- as we rank causes of death. But suicides as a group have been up in the last few years. They've enjoyed a steady decline over the past half decade, full decade. And then the last few year enforce some reason, we've seen an increase. And it's stayed at a fairly high level. It's too early to tell so far from this year, but obviously given some of the high profile cases we've seen with the murder suicides, that's an issue we're going to focus on and tease out for next year.

CAVANAUGH: Does your office handle all the suicides in San Diego County?

LUCAS: Yes. Any death not due to natural causes.

CAVANAUGH: How many deaths were due to suicide last year?

LUCAS: 372.

CAVANAUGH: I see. On a positive note, and you would think that perhaps in a report like this, there wouldn't know a lot of heap news. But actually, yes, motor vehicle deaths are down. Is that a trend?

LUCAS: Yes. And actually motor vehicle fatalities have been dropping for some time. In fact, this year -- or sorry, 2010 was the lowest number. It was 212, in over 20 years. So we've seen a slow decline. And most likely -- and the big sharp decline has been seen really in the last few years. The sharp decline appears to coincide with spiking gas prices. So things like auto safety, maybe improvements in the trauma system, more awareness about drinking and driving, all of these things, seatbelt usage, have added to the reduction in motor vehicle fatalities.

CAVANAUGH: So gas prices keep going on, do you expect to see the motor vehicle deaths continue to go down?

LUCAS: I sure hope so.

CAVANAUGH: Okay. How does the number of local homicides compare to previous years?

LUCAS: Well, we had 81 homicides San Diego County by our count last year; which is the lowest number in 20 years. And this is part -- this is part and parcel with the national reduction in crime that's been going on over the last several years. That's great. I was looking back at some of the old numbers. In this county, we have had over 200 homicides per year back in the '80s and early 90s. So we've really come a long way. There's a lot less homicides out there. And I think law enforcement certainly has a lot to do with that.

CAVANAUGH: I know this report has a lot of information about the medical examiner's office and the variety of things that your office handles. One of the things -- perhaps you could take a moment talking to us about is the office's contribution to medical research.

LUCAS: Part of the process of this -- or part of the idea of this annual report was to shed light to what is often shrouded in mystery, and that is the office and our office here. We're often thought of as just the county morgue. But that's just not the case. We do participate in various research projects. A lot of it is tissue related. Things like methamphetamine addiction has an -- as it affects the brain. Bipolar disorder, its effects on the brain. And we are a major major contributor to SIDS research, and some of the most ground breaking research that's come out in the last few years has come from research done with tissue from this office. So we are very proud of that and plan to continue that. And that is one way that we can give back to the living through these tragic stories.

CAVANAUGH: You're right. You posed this report in terms of what lessons can people take away from the dead, what messages do the dead leave for the living. And what are you hoping that the public will do with these statistics?

LUCAS: The report's designed -- anybody can go to our website, the San Diego County medical examiner's website, and down load this document. It's meant to be read by anybody. And I hope that people that don't know anything about what we do or anything about science or medicine in general might read this and just guy looking at the graphs, being aware of who's dying of what and in what parts of the county. It's education and awareness, it's sometimes just the best prevention, bringing things into the awareness of people. How many people are actually dying? What's the relationship between alcohol and driving? Those sorts of messages. We hear it all the time. We need to talk about it in the context of death, and each one of these people that lost their lives, and a huge impact on the people around them. We're talking about them as a group, but we never forget that each one has a story to tell. And we're trying to tell that story.

CAVANAUGH: I've been speaking with doctor Jonathan Lucas, San Diego County medical examiner. Thank you so much.

LUCAS: You're very welcome.