Joan Rivers, the raspy loudmouth who pounced on America’s obsessions with flab, face-lifts, body hair and other blemishes of neurotic life, including her own, in five decades of caustic comedy that propelled her from nightclubs to television to international stardom, died on Thursday in Manhattan. She was 81.

Her daughter, Melissa, confirmed her death.

Ms. Rivers died at Mount Sinai Hospital, where she was taken last Thursday after reportedly losing consciousness while undergoing a procedure on her vocal cords at a doctor’s office on the Upper East Side. Doctors at the hospital placed her in a medically induced coma. On Tuesday, her daughter said she was on life support; on Wednesday, she said she had been moved out of intensive care:

The State Health Department is investigating the circumstances that led to her death, a state official said Thursday.

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She was one of America’s first successful female stand-up comics in an aggressive vein that had been almost exclusively the province of men like Don Rickles and Lenny Bruce. And she was a role model and an inspiration for tough-talking comedians like Roseanne Barr and Sarah Silverman.