title: Assessing disaster-attributed mortality: development and application of a definition and classification matrix.
abstract: BACKGROUND
  A useful step in developing and implementing sound policies to prevent disaster-attributed mortality is to classify the relationship between disasters and mortality. While there are classification methods for specific health outcomes, there is no standard method that includes all potential outcomes from exposure to a natural disaster. Without standards, our ability to assess health effects from disasters and implement prevention programmes is limited.
  
  
  METHODS
  We present a method for ascertaining and classifying disaster-attributed mortality which includes a case definition, flow chart, and matrix. The matrix is used for coding, reporting, and evaluating information about manner, cause, and circumstance of disaster-attributed deaths and geographical location and time of the disaster. To illustrate its use, two readers determine and classify deaths attributed to Hurricane Andrew (1992, USA).
  
  
  RESULTS
  Of 322 deaths investigated by the Dade County Medical Examiner's Office, 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 constitutes disaster-related circumstances and the conditions or diseases that might arise from these circumstances. The inclusion of the flow chart and matrix provides a framework for consistent case classification and reporting. It also provides information about relationships between exposures and health effects, thereby identifying prevention policy needs.
authors.affiliation: Surveillance and Programs Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Combs
authors.forename: L E
authors.initials: LE
authors.lastname: Quenemoen
authors.forename: R G
authors.initials: RG
authors.lastname: Parrish
authors.forename: J H
authors.initials: JH
authors.lastname: Davis
mesh_terms: D001344:Autopsy / Q000379:methods; D002423:Cause of Death; D004190:Disasters / Q000145:classification* / Q000706:statistics & numerical data; D006801:Humans; D009026:Mortality; D015203:Reproducibility of Results; D014481:United States