EXPLANATORY NOTES
INTRODUCTION
1 This publication contains summary statistics on causes of death for the general population, together with selected statistics on perinatal deaths. The registration of deaths is the responsibility of the individual state and territory Registrars of Births, Deaths and Marriages. As part of the registration process, information about the cause of death is supplied by the medical practitioner certifying the death or by a coroner. Other information about the deceased is supplied by a relative or other person acquainted with the deceased, or by an official of the institution where the death occurred. This information is provided to the Australian Bureau of Statistics (ABS) by individual Registrars for coding and compilation into aggregate statistics shown in this publication. In addition, the ABS supplements this data with information from the National Coroners Information Service (NCIS). Statistics of perinatal deaths for years prior to 1994 were published separately in Perinatal Deaths, Australia (cat. no. 3304.0).
SCOPE AND COVERAGE
2 The statistics in sections 1, 2 and 3 relate to the number of deaths registered, not those which actually occurred, in the years shown. About 4% to 6% of deaths occurring in one year are not registered until the following year or later. Statistics in section 4 relate to deaths by year of occurrence.
Tourism Related Deaths
3 The ABS deaths collection includes all deaths that occurred and were registered in Australia including deaths of persons whose usual residence is overseas. Deaths of Australian residents that occurred outside Australia may be registered by individual Registrars, but are not included in ABS statistics.
Perinatal death statistics
4 The perinatal death statistics contained in this publication, unless otherwise stated, include all fetuses and infants delivered weighing at least 400 grams or (when birthweight is unavailable) the corresponding gestational age (20 weeks), whether alive or dead. This definition recognises the availability of reliable 400 grams/20 weeks data from all state and territory Registrars of Births, Deaths and Marriages. The ABS has adopted the legal requirement for registration of a perinatal death as the statistical standard as it meets the requirements of major users in Australia.
5 For 1996 and previous editions of this publication, data relating to perinatal deaths were based upon the World Health Organization (WHO) recommended definition for compiling national perinatal statistics. The WHO definition of perinatal deaths included infants and fetuses weighing at least 500 grams or having a gestational age of 22 weeks or body length of 25 centimetres crown-heel.
6 The birth statistics used to calculate the perinatal and neonatal death rates in this publication are shown in Appendix 3. Appendix tables A3.1-A3.3 detail registered live birth statistics and stillbirth statistics adjusted to exclude infants who are known to have weighed under 400 grams. Such births are identified from the medical certificate of perinatal death, which records birthweight. Appendix table A3.4 shows similar adjusted information but it is based on the 500 grams definition.
7 The adjusted birth statistics differ from the birth statistics used to derive the infant death rates in this publication. The statistics used to calculate infant death rates include all registered live births regardless of birthweight. These statistics are shown in tables A2.1 of Appendix 2.
8 The adjusted birth statistics also differ from the statistics published in Births, Australia (cat. no. 3301.0), which are unadjusted for birthweight, i.e. have not had births known to have weighed less than 400 grams excluded. For years 1993 to 1996, births which occurred in Other Territories were excluded from adjusted live births used in calculating perinatal rates.
STATISTICS FOR STATES AND TERRITORIES
9 Cause of death statistics for states and territories in this publication have been compiled in respect of the state or territory of usual residence of the deceased, regardless of where in Australia the death occurred and was registered. The state or territory of usual residence for a perinatal death is determined by the state or territory of usual residence of the mother.
10 Statistics compiled on a state or territory of registration basis are available on request.
11 The Australian Standard Geographical Classification versions used since 1993 have a category 'Other Territories' comprising Jervis Bay, Christmas Island and Cocos (Keeling) Islands. In the past, Jervis Bay was included with Australian Capital Territory and the two island Territories were included in Off-Shore Areas and Migratory. From 1997, statistics for 'Other Territories' are included in the Australian totals.
CAUSE OF DEATH CLASSIFICATION USED
12 The tenth revision of the International Classification of Diseases and Health Related Problems (ICD-10) was adopted for Australian use for deaths registered from 1 January 1999. However, to identify changes between the ninth and tenth revisions, deaths for 1997 and 1998 were coded to both revisions.
13 The extensive nature of the ICD enables classification of causes of death at various levels of detail. For the purpose of this publication, two summary classifications are used. They are:
- the ICD at the chapter level (with further disaggregation for major causes of death).
- selected Causes of Death for age groups.
14 Tables 1.1, 1.3, 2.2, 2.3 and 4.1 present statistics at the ICD chapter level with further disaggregation for major causes of death. Background on this summary classification is given in Volume 1 of the ICD.
15 Tables 1.2 and 1.4 present data for main causes of death for age groups. For each age group, a summary classification of the selected causes of death relevant to the age group has been used. These consist of causes of death significant in that age group, at the chapter level, with further disaggregation below the chapter level where appropriate.
16 To enable the reader to see the relationship between the various summary classifications used in this publication, all tables show in brackets the ICD codes which constitute the causes of death covered.
17 As ICD-9 did not directly accommodate the coding of Acquired Immune Deficiency Syndrome (AIDS) and AIDS-related deaths, cases where AIDS was the underlying cause were coded to ICD-9 deficiency of cell-mediated immunity (279.1), from 1988 to 1995. In 1996, ABS adopted ICD-9 Clinically Modified (CM) for coding of AIDS and AIDS-related deaths. Hence, for 1996 to 1998, all AIDS-related deaths (i.e. deaths where AIDS was mentioned in any place on the death certificate) were coded to HIV infection (042-044). ICD-10 adopted from 1999 allows for the coding of AIDS and AIDS-related deaths (B20-B24).
18 All data in this publication refer to AIDS-related deaths rather than only those deaths where AIDS is the underlying cause. Hence in table 1.1 and 1.3, AIDS-related deaths differ from the data provided for all other causes in that table since for all other causes, only data for underlying cause are given.
Perinatal statistics
19 For perinatal deaths, both the main condition in the fetus/infant, and the main condition in the mother are coded to the full four-digit level of the tenth revision of ICD. Causes selected for publication in this issue are those categories which were responsible for a significant proportion of perinatal deaths.
EXTERNAL CAUSES OF DEATH
20 Deaths that are classified as External Causes are generally of the kind that are reported to coroners for investigation. Although what constitutes a reportable death varies across jurisdictions, they are generally reported in circumstances such as:
- Where the person died unexpectedly and the cause of death is unknown;
- Where the person died in a violent or unnatural manner;
- Where the person died during or as a result of an anaesthetic;
- Where the person was 'held in care' or in custody immediately before they died; and
- Where the identity of the person who has died is unknown.
21 Where an accidental or violent death occurs, the underlying cause is classified according to the circumstances of the fatal injury, rather than the nature of the injury which is coded separately.
DATA QUALITY
22 In compiling causes of death statistics, the ABS employs a variety of quality control measures which include:
- providing certifiers with certification booklets for guidance in reporting cause of death on medical certificates;
- seeking additional information, where necessary, from medical practitioners, from coroners and from the National Coroners Information Service (NCIS);
- check-coding of cause of death; and
- editing checks at the individual record and aggregate levels.
23 The quality of causes of death coding can be affected by changes in the way information is reported by certifiers, by lags in completion of coroner cases and the processing of the findings. While changes in reporting and lags in coronial processes can affect coding of all causes of death, those coded to Chapter XX: External causes of morbidity and mortality are more likely to be affected because the code assigned within the chapter may vary depending on the coroner's findings.
Specific Issues for 2004 data
24 Care should be taken in interpreting results in recent years for the following areas within Chapter XX: External causes of morbidity and mortality. In regard to the impacts on quality resulting from lags in finalising coronial processes, ABS is investigating options for revising deaths data to capture more complete cause of death information.
Recent improvements
25 Falls (W00-W19) - To reduce risk factors for falls in nursing homes in Victoria, all deaths where the medical certificate mentions falls are now referred to the coroner for verification, and the Coroner Clinical Liaison Service implemented a falls awareness campaign mid 2003. The number of deaths due to falls recorded in Victoria increased significantly in 2003 (up 50%) and again in 2004 (more than double the 2003 recorded level), whereas in previous years the deaths may have been attributed to other causes such as hypostatic pneumonia.
Analysing small numbers
26 Perinatals (P00-P96) - There is some variability over time across a range of the perinatal death categories and where the numbers are small, caution should be applied in drawing inferences about change over time. In particular, the number of deaths coded to Disorders related to short gestation and low birth weight, not elsewhere classified (P07) more than doubled between 2003 and 2004.
Quality affected by delays
27 Suicide (X60-X84) - There has been an increase in recent years in the number of open coroners' cases. Where cases are not finalised and the findings are not available to the ABS in time for publication of causes of death statistics, deaths are coded to other accidental, ill-defined or unspecified causes rather than suicide. The causes of death statistics are not revised once a coronial enquiry is finalised.
28 The number of deaths coded to Intentional self-harm (suicides) has declined in recent years which may in part reflect the increase in open coroners' cases when the statistics were finalised.
29 Assault (X85-Y09) - The increase in the number of coroners' cases not closed at the time the ABS finalised the 2004 deaths file is expected to have contributed significantly to the 41% decline in the number of deaths coded as due to assaults in 2004.
Indigenous deaths
30 All states and territories have provision for the identification of Indigenous deaths on their death registration forms. However, the coverage of deaths identified as Indigenous varies across states and territories and over time. This publication presents in table 1.6, Indigenous deaths data for 2004 for all states and territories except Victoria, Tasmania and the Australian Capital Territory, which are not separately published due to a combination of comparatively small numbers, and relatively low coverage, of reported Indigenous deaths. A higher proportion of Indigenous deaths are due to external cause than non-indigenous deaths. It is advised that users should refer to Explanatory note 20 when interpreting 2004 data.
Confidentialisation
31 In fulfilling its functions the ABS collects information in pursuance of sections 10 and 11 of the Census and Statistics Act. Once supplied to the ABS this information is deemed to have been "furnished in pursuance of the Act" and is protected by the secrecy provisions of section 19 of the Act.
32 The provisions of subsection 12(2) of the Act place a requirement on the Statistician to publish and disseminate statistics but not in a manner that is likely to enable the identification of a particular person or organisation
33 To maintain the confidentiality of individuals, affected cells are replaced with np.
BIRTHS DATA
34 Appendix 2 provides details of the number of live births registered which have been used to calculate the infant death rates shown in this publication. Appendix 3 provides data on adjusted births used for calculating perinatal death rates. These also enable further rates to be calculated.
ACKNOWLEDGMENT
35 The ABS publications draw extensively on information provided freely by individuals, businesses, governments and other organisations. Their continued cooperation is very much appreciated: without it, the wide range of statistics published by the ABS would not be available. Information received and collected by the ABS is treated in strict confidence as required by the Census and Statistics Act 1905.
RELATED PRODUCTS
36 Other ABS products which may be of interest include:
Statistics - electronic data available at www.abs.gov.au.
Australian Social Trends, cat. no. 4102.0 - issued annually
Births, Australia, cat. no. 3301.0 - issued annually
Causes of Deaths, Australia: Summary Tables cat. no. 3303.0.55.001 - issued irregularly
Causes of Infant and Child Deaths, Australia, 1982-96, cat. no. 4398.0 - issued irregularly - discontinued
Deaths, Australia, cat. no. 3302.0 - issued annually
Deaths due to Diseases and Cancers of the Respiratory System, Australia, 1979-1994, cat. no. 3314.0 - issued irregularly
Drug Induced Deaths, cat. no. 3321.0.55.001 - single issue
Information Paper: Drug-induced Deaths - A Guide to ABS Causes of Death Data, cat. no. 4809.0 - single issue
Information Paper: Multiple Cause of Death Analysis, cat. no. 3319.0.55.001 - issued irregularly
Mortality Atlas Australia 1997-2000, cat. no. 3318.0 - single issue
Suicides, Australia, 1921-1998, cat. no. 3309.0 - issued irregularly
Suicides: Recent Trends Australia, 1993-2003 cat. no. 3309.0.55.001 - issued irregularly
37 The ABS has a web based information service called Statistics (previously known as AusStats) which provides the ABS full standard product range on line. It allows you to conveniently access a large range of ABS statistical and reference information, free of charge. It also includes companion data in multidimensional datasets in SuperTable format, and time series spreadsheets.
38 Current publications and other products released by the ABS are listed in the Catalogue of Publications and Products (cat. no. 1101.0). The catalogue is available from any ABS office or the ABS web site at <https://www.abs.gov.au>. The ABS also issues a daily Release Advice on the web site which details products to be released in the week ahead.
39 As well as the statistics included in this and related publications, additional information is available from the ABS web site at <https://www.abs.gov.au> by accessing Themes/Health.
DATA AVAILABLE ON REQUEST
40 More detailed cause of death information is available upon request from the ABS. This information can comprise standard tables (see Appendix 1) or customised tabulations (by hardcopy or electronic media). Unit record files are available to approved users upon application. Generally, a charge is made for providing information upon request.
41 Perinatal tabulations for Australia based on national (see Explanatory Notes, paragraph 4 and 5) and international definitions are available upon request. The WHO international definition comprises all fetuses and infants (who die within seven days of birth) weighing at least 1,000 grams or (when birthweight is unavailable) having the corresponding gestational age (28 weeks) or body length (35 centimetres crown-heel). A charge is made for providing this information.
42 For more information about cause of death statistics or data concepts contact the National Information Service on 1300 135 070.
EFFECTS OF ROUNDING
43 Where figures have been rounded, discrepancies may occur between totals and sums of the component items.
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