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Dr. Christopher Gulledge, right, with Investigator Autumn Quinn on Tuesday. Gulledge’s office has released its annual report, which highlights the causes of death attributed to those examined by forensic technicians and other personnel.

MARIETTA — Cobb saw fewer deaths as a result of homicide and opioid use in 2018 as compared to 2017, but the county’s biggest killer, cardiovascular disease, claimed more lives than those two causes combined.

Those are among the findings of the Cobb County Medical Examiner’s 2018 annual report, released last month.

“There’s been a lot of push in recent years for data-driven policing, for data-driven interventions with medical and public health, and so in the absence of the data, then everybody’s sort of shooting in the dark to try and make changes,” said Dr. Christopher Gulledge, the county’s medical examiner. “As part of what we feel our job is, as the medical examiner’s office, which is to generate and create and understand this data, we have to make it part of the public domain so that other individuals can take this information and use it for their purposes.”

While Gulledge said the annual reports are crucial to government department, from those focused on public health to the cities’ and county’s police departments, he said the data is also something the general public should be able to access.

“The reality is that medical examiners’ offices do a really good job of generating data, but if we don’t compile it and put it out for public review, then it doesn’t do much good,” Gulledge said.

What data points does Gulledge want the public to notice?

“If you look at some of our big numbers, the numbers that definitively we see lots of, we see lots of drug overdoses, and obviously there’s been a lot of focus on that in recent years, and rightfully so, because we are at a very high level of drug overdose and drug overdose deaths,” he said. “We do see a fair number of motor vehicle fatalities, and I think that’s something the county, (Department of Transportation), police, are all very actively involved in.”

But the biggest number falls in the category of natural deaths.

Cardiovascular diseases claimed the lives of 134 people whose deaths were investigated in Cobb County in 2018. The number trends with the rest of the country, Gulledge said, as it remains the No. 1 killer among natural causes.

Of the cardiovascular death cases investigated by the county year to year, Gulledge said the number of men well outweigh the number of women.

“Women tend to get health care through their 20s and 30s and into their 40s, frequently, every year or every other year,” Gulledge said. “Men tend to go once when they’re 18 and once when they’re 50, and then they find out at 50 that maybe they should have been going before then, so for a lot of men, regular doctor visits — just showing up, getting your blood pressure checked, cholesterol checked, those really simple things are huge interventions.”

Gulledge says of those cardiovascular cases, his office is seeing a younger age population or a population that’s not seeing a physician. A lot of those deaths, he adds, aren’t necessarily preventable but can be delayed.

“Instead of someone coming to see me at 46, dying of their cardiovascular disease, they could’ve died with their family at 76 because they were treating it, and they’re not,” he says.

HOMICIDES DOWNCobb reported 18 homicides in 2018, almost half of the 35 counted in 2017 and the lowest in a given year spanning back to at least 2003, the earliest year for which data was provided in the annual report. The 18 homicides resulted in a countywide homicide rate of 2.4 per 100,000 people, which was the lowest among the 16 years of data presented.

The overall number of homicides and the homicide rate have trended downward since 2003, though both metrics fluctuate from year to year, beginning with a peak of 40 homicides and a rate of 6.2 per 100,000 people in 2003.

In 2018, firearms were involved in 72% of homicides, with 72% of victims being men. No person under the age of 18 died by homicide last year, the report noted.

As for an attributable reason why the average is trending down, Gulledge said he’s not the one to explain why.

“That I put squarely at the hands of law enforcement. I have no idea,” he said. “We don’t know why they do it, we just know that they do it.”

SUICIDES DOWN, BUT PART OF UPWARD TREND“Suicides are even harder (to attribute), because there are so many different aspects that come into suicides, whether it be mental illness, whether it be sort of emotional immaturity, whether it be culture and beliefs,” added Gulledge. “We get so many different psychiatric, sociocultural, all sorts of belief systems wrapped up around the word ‘suicide,’ which just at its fundamental level means you caused your own death in a deliberate manner. Even though to me there are different types of suicides, they all get categorized sort of as the same thing.”

Ninety-one suicides were reported in 2018, down from 96 in each of the two previous years. But the past 16 years of data show the numbers trending upward. The county reported 63 suicides in 2003 and saw higher numbers in 10 of the following 15 years. The 2018 suicide rate of 12 per 100,000 dipped below the rate of 12.8 reported in 2016 and 2017’s rate of 12.7.

In 2018, firearms were the most common method of suicide, with 76% of victims being male. The greatest number of suicides were in the 18-to-29-year-old age bracket.

OPIOID DEATHS TREND DOWNWARDIn May, then-acting Cobb District Attorney John Melvin announced that a federal grant totaling nearly $900,000 would fund a new program through his office that aims to address the opioid crisis. The grant will fund the Cobb Opioid Fatality Review Project, which includes a dedicated case worker and investigator who will work on opioid-related cases.

“Cobb County has dramatically and negatively been affected by the opioid crisis,” Melvin said at a press conference announcing the grant. “In 2017, we led the state and other larger counties in the reported number of overdose deaths. And in the two years previous to that, we saw a 49% increase in deaths associated with opioid use over those years.”

Cobb’s latest figures related to accidental deaths due to opioids decreased in 2018 to 82 as compared to the previous year’s 121.

“The problem is one change in data doesn’t make a trend. … we’ve got to see how that continues,” Gulledge said.

As for whether Cobb will continue to lead the state, he said it’s too early to tell despite having the county’s statistics. Statewide, he says, the data is collected by Georgia Public Health through death certificates, so updated numbers have yet to be compiled.

MOTOR VEHICLE DEATHS SEE SLIGHT INCREASECobb in 2018 saw a total of 64 motor vehicle-related deaths, including 12 pedestrians struck by a motor vehicle.

The total was higher than the previous two years, but not by much, with Gulledge’s office tallying 60 and 59 deaths in 2016 and 2017, respectively.

Of the 52 non-pedestrians killed in 2018, 37 had been driving while 15 were passengers. Nine deaths were motorcyclists.

ALCOHOL A FACTORRelated to the number of motor vehicle deaths is alcohol use, and of the 64 motor vehicle deaths tallied in the county, including pedestrians struck by a vehicle, alcohol was involved in 24 out of 53 of them; in the 11 remaining death cases, documentation made available to the medical examiner’s office could not lead to a determination if alcohol was involved, such as a delayed reporting of a death or a driver who was not tested for alcohol.

Seven of the 12 pedestrians killed tested above the legal limit for alcohol.

“It’s not only not safe to drink and drive, it’s kind of not safe to drink and walk,” Gulledge said. “There’s a lot of bad decisions that can come from alcohol.”

Nine of 37 deceased drivers of motor vehicles tested above the legal limit for alcohol. The report also notes that six motor vehicle deaths had been the result of a surviving driver who was shown to have tested above the legal limit for alcohol.

But alcohol also appears as a factor in other deaths.

“Alcohol actually appears in multiple places in our report, both as the natural sequela of the disease of alcoholism and then also we look at it in people who have it in non-natural deaths (such as) motor vehicle accidents,” said Cassie Boggs, the county’s deputy chief medical examiner.

Chronic alcoholism, Boggs says, is the county’s No. 2 cause of natural death, with 34 deaths in 2018 attributed to it.

“They’ve manifested the end-organ damage. They have the cirrhotic liver, they have the cardiac changes,” Boggs said, citing two of the possible fatal conditions.

It’s natural causes such as those that the general public can be aware of, Gulledge said, and should pay greater heed to on a day-to-day basis.

“It’s something that individuals can recognize, that you’re far more likely to die of your heart than you are of a car wreck or homicide, suicide or drug overdose,” he said. “If you don’t do drugs, you don’t have to worry about dying of a drug overdose, but on the other hand, not going to the doctor, not getting regular checkups … those are some of the real tragedies we see, the people who could’ve lived much longer.”

Follow Jon Gargis on Twitter at https://twitter.com/JonGargis.

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