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Essays on rising mortality in England and Wales – a MEDLINE search is not infallible

The two recent essays in the JRSM regarding highly concerning increases in mortality in England and Wales during a period of financial austerity are welcome attempts to unravel a complex issue. It is unfortunate that their literature search (based on MEDLINE) has omitted to detect a large body of work investigating anomalous trends in death over many years, and across multiple countries. It is always essential that authors conduct literature searches using both MEDLINE and CINAHL. With the plethora of new entrant journals, it is nowadays essential that a Google Scholar search also be conducted. Given the pressure on space in established medical journals, it should not be surprising that research into such curious behaviour may be published in less obvious places. These same curious events affecting deaths have been documented in all European Union countries, Australia, New Zealand, Arizona (USA). The impact of these events on Alzheimer and dementia deaths has also been the subject of several studies. The devil lies hidden in the detail of very small area movement at sub-local authority level. A centrally important observation in their first essay is that of single-year-of-age saw-tooth patterns in mortality rates. Identical patterns have been repeatedly observed for both medical admissions and deaths. Had the authors searched for all sources of information they may well have reached a different conclusion, or at least been less biased to their preliminary conclusion.