Original ArticlesCharacteristics of Deaths With Evidence of Pathological Hoarding in Cook County 2017 to 2018Waters, David Michael MD∗; Eckhardt, Michael MD∗; Eason, Eric August MD∗,† Author Information From the ∗Pathology Division, Cook County Medical Examiner's Office, Chicago, IL †Pathology Division, Eason Forensic Pathology Services, LLC, Charleston, SC. Manuscript received March 18, 2021; accepted May 19, 2021. The authors report no conflict of interest. Reprints: David Michael Waters, MD, Pathology Division, Cook County Medical Examiner's Office, 2121 W Harrison St, Chicago, IL 60612. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: March 2022 - Volume 43 - Issue 1 - p 2-6 doi: 10.1097/PAF.0000000000000702 Buy Metrics Abstract Hoarding disorder was recently recognized as an independent diagnosis; it is characterized by the accumulation of objects causing a functional impairment and is commonly associated with increased risk of injury or death. Limited data exist about deaths of persons found in hoarding environments. This study investigated the characteristics and circumstances surrounding deaths found in “hoarding” environments. Using the electronic record management system, a search for the term “hoard” from 2017 to 2018 identified 138 cases. The mean age was 67 years, 56% were male, 76% were White, and 86% of decedents lived alone. Decomposition was noted in 61% of cases. A full autopsy was performed in 36 cases (26%); natural was the most common manner of death (80%), followed by accident (14%). Cases in which hoarding was thought to be contributory to the cause of death occurred in 5 cases. A qualitative hoard evaluation was done on 29 cases (21%) with available photographs. A hoarding level was assigned using the Clutter Hoarding Scale with an average of 3.39/5. Overall, the analysis showed deaths in pathological hoarding environments appeared to impact all socioeconomic groups and was associated with increased risk of accidental death and being found in a state of decomposition. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.