Assessing disaster-attributed mortality: development and application of a definition and classification matrix

Background A useful step in developing and implementing sound policies to p revent disaster-attributed mortality is to classify the relationship betwee n disasters and mortality. While there are classification methods for speci fic health outcomes, there is no standard method that includes all potentia l outcomes from exposure to a natural disaster. Without standards, our abil ity to assess health effects from disasters and implement prevention progra mmes is limited. Methods We present a method for ascertaining and classifying disaster-attri buted mortality which includes a case definition, flow chart, and matrix. T he matrix is used for coding, reporting, and evaluating information about m anner, cause, and circumstance of disaster-attributed deaths and geographic al location and time of the disaster. To illustrate its use, two readers de termine and classify deaths attributed to Hurricane Andrew (1992, USA). Results Of 322 deaths investigated by the Dade County Medical Examiner's Of fice, our readers showed 97% (313/322) agreement on case status and 83% (35 /42) agreement on case classification. Conclusions Our definition allows for a liberal interpretation of what cons titutes disaster-related circumstances and the conditions or diseases that might arise from these circumstances. The inclusion of the now chart and ma trix provides a framework for consistent case classification and reporting. It also provides information about relationships between exposures and hea lth effects, thereby identifying prevention policy needs.