Causes of Death, Australia: Doctor Certified Deaths, Summary Tables

This publication contains summary information on causes of death for deaths certified by a doctor in Australia in 2019.

Deaths certified by a doctor represent only a subset of all deaths. Data in this report are therefore not comparable with those presented in the Deaths, Australia (cat. no. 3302.0) and Causes of Death, Australia (3303.0) publications.

Deaths are either certified by a medical practitioner (doctor certified) or a coroner (coroner certified). In Australia, approximately 86%-89% of deaths in any given year are certified by a doctor. Deaths certified by a doctor are usually the result of natural causes, such as cancer or circulatory diseases. Coroners certify the majority of deaths which occur by unknown and external causes (accidents, assaults and suicides). As such, deaths from external causes are not covered in this report.

A complete causes of death dataset for 2019 including both doctor and coroner certified deaths will be published in Causes of Death Australia, 2019 (cat. no. 3303.0). It will contain the full standard set of tables including details on both underlying causes of death and multiple causes of death.

This publication contains summary information on causes of death for all doctor certified deaths for Australia in 2019.

It is a legal requirement of each state and territory that all deaths are registered. Registration is the responsibility of the eight individual state and territory Registrars of Births, Deaths and Marriages. In order to complete a death registration, the death must be certified by either a doctor or a coroner.

Doctor certified deaths are certified using the Medical Certificate of Cause of Death (for general deaths) or the Medical Certificate of Cause of Perinatal Death (for perinatal deaths). Approximately 86% to 89% of deaths in any given year are certified by a doctor.

As part of the registration process, for deaths certified by a doctor, information about the cause of death is supplied by the medical practitioner certifying the death. 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 (on a Death Registration Form). The information is provided to the Australian Bureau of Statistics in monthly electronic files by individual Registrars for coding and compilation into aggregate statistics. The flow chart below shows the process undertaken in producing cause of death statistics for doctor certified deaths for Australia.

The flow chart begins with a death event. There are two arrows under a death event. When a death occurs a funeral director assists the family in filling out a death registration statement and this is lodged with the Registry of Births, Deaths and Marriages. This pathway is outlined under the first arrow in the diagram under death event. All deaths must be certified with a cause of death. The second pathway under death event reflects this process. A decision must be made as to whether the death is reportable or not. If no, a death that is not reportable will be certified by a doctor then registered with the Registrar of Births, Deaths and Marriages. If yes, a death that is reportable is referred to a coroner for investigation. These deaths are out of scope of this report. The flowchart then progresses to show how the ABS receives and works with mortality information. The ABS receives monthly files from the Registrars containing information about the deaths that were registered each month. The ABS then amalgamates and checks the records, assigns cause of death codes to each record, validates the dataset and produces statistical output.

The balance are coroner certified deaths. Although there is variation across jurisdictions in what constitutes a death that is reportable to a coroner, 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
• where the identity of the person who has died is unknown.
   

Reportable deaths that were certified by a coroner will be included in the full Causes of Death, Australia, 2019 publication, to be released later in 2020. This release will present causes of death for all deaths in 2019, whether certified by a doctor or coroner.

In the full Causes of Death dataset the pattern of cause distribution differs by certifier type. The table below presents the number and proportion of deaths by cause (at the ICD-10 chapter level) that were certified by a doctor in 2018.

Ideally, the number of deaths should be those which occurred within a given reference period, such as a calendar year. However, there can be lags in the registration of deaths with the state or territory registries, so not all deaths are registered in the year in which they occur. There may also be further delays to the ABS receiving notification of the death from the registries due to processing or data transfer lags. There are three dates that apply to each death record:

• a date on which the death occurred (the date of occurrence);
• a date on which the death is registered with the state and territory registry (date of registration); and
• a date on which the registered death is lodged with the ABS.
   

All deaths referred to in this publication relate to the number of deaths registered in 2019, not those which actually occurred in 2019.

The scope for each reference year of the death registrations includes:

• deaths registered in the reference year and received by the ABS in the reference year;
• deaths registered in the reference year and received by the ABS in the first quarter of the subsequent year; and
• deaths registered in the years prior to the reference year but not received by ABS until the reference year or the first quarter of the subsequent year, provided that these records have not been included in any statistics from earlier periods.
   

Death records received by the ABS during the March quarter of 2020 which were initially registered in 2019 and received by the ABS before April 2020 have been assigned to the 2019 reference year. Any registrations relating to 2019 which were received by the ABS from April 2020 onwards will be assigned to the 2020 reference year. Approximately 4% to 7% of deaths occurring in one year are not registered until the following year or later.

The ABS Causes of Death - Doctor Certified collection includes all doctor certified deaths that occurred and were registered in Australia, including deaths of persons whose usual residence was overseas. Deaths of Australian residents that occurred outside Australia may be registered by individual Registrars, but are not included in ABS deaths or causes of death statistics.

The current scope of the ABS death statistics includes:

• all deaths being registered for the first time;
• deaths in Australia of temporary visitors to Australia;
• deaths occurring within Australian Territorial waters;
• deaths occurring in Australian Antarctic Territories or other external territories;
• deaths occurring in transit (i.e. on ships or planes) if registered in the State of 'next port of call';
• deaths of Australian Nationals overseas who were employed at Australian legations and consular offices (i.e. deaths of Australian diplomats while overseas) where able to be identified; and
• deaths that occurred in earlier reference periods that have not been previously registered (late registrations).
   

The scope of the ABS death statistics excludes:

• repatriation of human remains where the death occurred overseas;
• deaths overseas of foreign diplomatic staff (where these are able to be identified); and
• stillbirths/fetal deaths (these will be included in the perinatal dataset in the full Causes of Death, Australia, 2019 publication, to be released later this year).
   

The International Classification of Diseases (ICD) is the international standard classification for epidemiological purposes and is designed to promote international comparability in the collection, processing, classification, and presentation of causes of death statistics. The classification is used to classify diseases and causes of disease or injury as recorded on many types of medical records as well as death records. The ICD has been revised periodically to incorporate changes in the medical field. Currently the ICD 10th revision is used for Australian causes of death statistics.

The ICD-10 is a variable-axis classification meaning that the classification does not group diseases only based on anatomical sites, but also on the type of disease. Epidemiological data and statistical data are grouped according to:

• epidemic diseases;
• constitutional or general diseases;
• local diseases arranged by site;
• developmental diseases; and
• injuries.
   

For example, a systemic disease such as sepsis is grouped with infectious diseases; a disease primarily affecting one body system, such as a myocardial infarction, is grouped with circulatory diseases; and a congenital condition, such as spina bifida, is grouped with congenital conditions.

For further information about the ICD refer to WHO International Classification of Diseases (ICD).

The versions of the ICD 10th Revision are available online.

The Update and Revision Committee (URC), a WHO advisory group on updates to ICD-10, maintains the cumulative and annual lists of approved updates to the ICD-10 classification. The updates to ICD-10 are of numerous types including the addition and deletion of codes, changes to coding instructions and modification and clarification of terms.

The ABS uses Iris, an automated coding system, for coding causes of death. It assigns ICD-10 codes to the diseases and conditions listed on the death certificate and then applies decision tables to select the underlying cause of death. The 2019 data presented in this publication were coded using version 5.6.0 of Iris software, which used the 2019 version of the WHO ICD updates. For more information on the Iris product see Technical Note Updates to Iris coding software: Implementing WHO updates and improvements in coding processes, in the Causes of Death, Australia, 2018 (cat. no. 3303.0) publication.

The cumulative list of ICD-10 updates can be found online.

Doctor certified neonatal deaths with no cause of death information are coded to Conditions originating in the perinatal period, unspecified (P969). As these deaths have been certified by a doctor, the assumption is made that the neonate died of natural causes.

In compiling causes of death statistics for doctor certified deaths, the ABS employs a variety of measures to improve quality. Non-sampling errors are the main influence on accuracy in datasets such as this, which are a complete census of a population rather than a sample. Non-sampling errors arise from inaccuracies in collecting, recording and processing of data. Every effort is made to minimise error by working closely with data providers, undertaking quality checks throughout the data processing cycle, training processing staff, and by implementing efficient data processing procedures. The ABS also provides certifiers with certification booklets for guidance in reporting causes of death on medical certificates, see Information Paper: Causes of Death Certification Australia, 2008 (cat. no. 1205.0.55.001).

Specific data quality issues for causes of death data include:

• completeness of the dataset, e.g. impact of registration lags, processing lags and duplicate records
• extent of coverage of the population, i.e. while all deaths are legally required to be registered some cases may not be registered for an extended time
• inconsistent application of questions or forms used by administrative data providers
• specificity and completeness on the Medical Certificate of Cause of Death
• errors in the coding of the causes of a death to ICD-10. The majority of cause of death coding is undertaken through an automated coding process, which is estimated to have a very high level of accuracy. Human coding can be subject to error, however the ABS mitigates this risk through rigorous coder training, detailed documentation and instructions for coding complex or difficult cases, and extensive data quality checks.
   

The ABS observes strict confidentiality protocols as required by the Census and Statistics Act (1905). This may restrict access to data at a very detailed level.

A national causes of death unit record file can be obtained through the Australian Coordinating Registry (which is housed at the Queensland Registry of Births, Deaths and Marriages) by sending an email to BDM.CODURF@justice.qld.gov.au (data available on application for legitimate research purposes only).

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This release previously used catalogue number 3303.0.55.001