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NOTES


ABOUT THIS ISSUE

This publication brings together statistics and indicators for deaths, including perinatal deaths, registered in Australia in 2004. These statistics have been compiled from data made available to the Australian Bureau of Statistics (ABS) by the Registrar of Births, Deaths and Marriages in each state or territory.

All deaths registered in 2004 have been coded using the tenth revision of the International Classification of Diseases and Related Health Problems (ICD-10) as released by the World Health Organisation.

CHANGES TO THIS ISSUE

This publication now includes indirect standardised death rates for underlying cause of death by selected countries of birth (table 1.9). These were previously released in Deaths, Australia (3302.0). From the 2004 collection and onwards, they will be released as part of this publication.

CAUTION

The quality of cause of death coding is affected by a range of factors including delays in finalising coronial processes. Paragraphs 22 to 29 of the Explanatory Notes explain some recent improvements in the quality of cause of death coding as well as highlighting areas where both the level of recorded deaths attributed to certain causes, and observed changes over time in those causes, are likely to have been affected by delays in finalising a cause.

INQUIRIES

For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 070.

UNDERLYING CAUSE OF DEATH


INTRODUCTION

All deaths registered in 2004 have been coded using the tenth revision of the International Classification of Diseases and Related Health Problems (ICD-10) as released by the World Health Organization.

CAUSES OF DEATH

There were 132,508 deaths registered in 2004, a higher number of deaths than the 132,292 registered in 2003. However, the standardised death rate recorded in 2004 was 626 deaths per 100,000 population, lower than the standardised death rate of 642 deaths per 100,000 population for 2003 and 1994 (813 deaths per 100,000 population).

Males accounted for 68,395 (51.6%) deaths registered in 2004, similar to the proportions in previous years with 68,330 (51.7%) in 2003 and 68,885 (51.5%) in 2002. Female deaths totalled 64,113 (48.4%) in 2004, 63,962 (48.3%) in 2003 and 64,822 (48.5%) in 2002.

The standardised death rate for males in 2004 was 770 deaths per 100,000, a decrease from 792 per 100,000 in 2003 and 1034 deaths per 100,000 in 1994. Over the same period, female standardised death rates have also decreased from 646 per 100,000 population in 1994 and 523 in 2003, to 511 per 100,000 in 2004.

The Northern Territory recorded the highest standardised death rate (822 deaths per 100,000 population) in 2004, while the ACT recorded the lowest rate (562 deaths per 100,000 population). While the Northern Territory had the highest death rate, it also experienced the largest declines of any state or territory from 892 deaths per 100,000 population in 2003 and from 1,227 deaths per 100,000 population in 1994.

Malignant neoplasms were the main underlying cause for 37,989 deaths, accounting for 28.7% of all deaths in 2004. This was a slight increase from the 37,558 (28.4%) deaths with Malignant neoplasms as the main underlying cause in 2003. Ischaemic heart disease was the underlying cause of 24,576 deaths in 2004, and 25,439 deaths in 2003. This represents 18.5% and 19.2% of all deaths in 2004 and 2003 respectively. As the graph below shows, the gap between the proportion of deaths due to Malignant neoplasms and Ischaemic heart disease continues to widen. Since 1994, the proportion of deaths due to Ischaemic heart disease has consistently decreased from 24.1% to 18.5%, while the proportion of deaths due to Malignant neoplasms has increased from 26.6% to 28.7%.

Deaths from cancers of the Digestive organs fell from 59 deaths per 100,000 population in 1994 to 50 per 100,000 in 2004. More specifically, the largest decrease was for Colon cancer, which fell from 22 deaths per 100,000 in 1994 to 13 deaths per 100,000 population in 2004.

The standardised death rate increased 3 to 4 per 100,000 for cancer of the Liver and intrahepatic bile ducts from.

The standardised death rate for males from Malignant neoplasms decreased from 279 to 231 per 100,000 population between 1994 and 2004. The corresponding decrease for females was from 161 per 100,000 in 1994 to 143 per 100,000 in 2004.

There were other major decreases in the standardised death rate in particular types of cancers for males between 1994 and 2004. Deaths from cancers of the Digestive organs fell from 75 to 62 deaths per 100,000 population between 1994 and 2004. The standardised death rate from Prostate cancer fell from 43 per 100,000 in 1994 to 32 per 100,000 in 2004.

There was also a major decrease in male deaths from Trachea, bronchus and lung cancers, which fell from 67 per 100,000 in 1994 to 50 per 100,000 in 2004.

There were increases in the standardised death rate in particular types of cancers for males between 1994 and 2004. These include cancer of the Liver and intrahepatic bile ducts from 5 to 6 per 100,000 and Melanoma of skin from 8 to 9 per 100,000.

For females there was a decrease in deaths from Breast cancer, which fell from 31 deaths per 100,000 of the female population in 1994 to 23 deaths per 100,000 in 2004. Female deaths from cancers of the Digestive organs fell from 46 to 39 per 100,000 population between 1994 and 2004.

For females, the standardised death rate increased for Liver and intrahepatic bile ducts from 2 to 3 per 100,000, Bladder from 2 to 3 per 100,000 and Trachea, bronchus and lung from 21 to 22 per 100,000.

The standardised death rate for Acute myocardial infarction, which in 2004 accounted for 51.9% of all Ischaemic heart disease deaths, fell from 124 deaths per 100,000 population in 1994 to 60 deaths per 100,000 in 2004.

The percentage decreases for males and females over this period were very similar but the standardised death rates were different. In 2004, there were 151 male deaths per 100,000 males and 86 per 100,000 females. This compares to the standardised death rates in 1994 which were 262 per 100,000 for males and 152 per 100,000 for females.

EXTERNAL CAUSES

External causes relate to deaths from accidents, poisonings and violence. In 2004, External causes accounted for 7,966 deaths, or 6.0% of all registered deaths. This was a slight increase from 2003 when 7,749 deaths (5.9%) were attributed to external causes. The standardised death rate was 39 per 100,000 of population in 2004, a decrease from the corresponding rate for 1994 (42 per 100,000) .

Taking into account issues surrounding the coding of Intentional self-harm (see Explanatory Note 27), there were 2,098 deaths attributed to Intentional self-harm (suicide) in 2004, less than the 2,213 deaths in 2003. The standardised death rate from suicide in 2004 was 17 per 100,000 males and 4 per 100,000 females, which were both decreases from the respective rates recorded in 2003.

DEATHS OF INDIGENOUS PEOPLE

While data on deaths of Aboriginal and Torres Strait Islander Australians are considered to be affected by underenumeration (see Explanatory Notes, paragraph 23, for further information), a comparison of causes of Indigenous deaths with non-Indigenous deaths highlights some major differences.

Indigenous and non-Indigenous persons have the same two leading causes of death, although they are proportionally different. In 2004, Ischaemic heart diseases were the main cause of 16.3% of all Indigenous deaths compared to 18.6% of non-Indigenous deaths. Malignant neoplasms were the cause of 16.6% of all indigenous deaths and 29.0% of all non-Indigenous deaths.

Deaths due to Diabetes mellitus were higher among Indigenous persons (7.3%) than among non-Indigenous persons (2.6%). External causes accounted for 14.3% of Indigenous deaths compared with 5.8% of non-Indigenous deaths, with Intentional self-harm contributing 4.2% of all Indigenous deaths compared with 1.5% of all non-Indigenous deaths. (see Explanatory Note 31 for more information on coding of Intentional self-harm in 2004)

YEARS OF POTENTIAL LIFE LOST (YPLL)

Years of potential life lost is a measure of premature mortality for deaths occurring between the ages of 1 year and 78 years inclusive. (Refer to the Technical Note for further detail). In 2004, the estimates of years of potential life lost (YPLL) were 615,527 years for males and 339,226 years for females for all causes of death. This represents a decrease from 2003 for both males and females, when the estimated YPLL was 637,067 and 349,445 respectively.

There was a slight increase in the proportion of the YPLL from Malignant Neoplasms from 30.1% for males in 2003 to 30.4% in 2004. In contrast, the proportion of the YPLL from Malignant Neoplasms for females decreased slightly from 44.2% in 2003 to 43.6% in 2004. The proportion of the YPLL from Ischaemic heart disease for males was 13.4% for both 2003 and 2004 however there was a slight decrease for females from 7.0% in 2003 to 6.5% in 2004.

As years of potential life lost takes age at death into account, the proportion of YPLL for particular causes will vary compared to those causes as a proportion of deaths in the 1-78 years age group. Major contributors to YPLL are deaths in younger age groups and large numbers of deaths in older age groups within the 1-78 years group.

For males there is a difference between the proportion of the YPLL from Malignant Neoplasms (30.4%) and the proportion of all male deaths aged 1-78 years from the same underlying cause (37.5%). There is very little difference for females between the proportion of years of potential life lost (43.6%) and the proportion of all female deaths aged 1-78 years with Malignant neoplasms as the underlying cause (43.5%).

There were also significant variations when specific types of cancer are considered. Prostate cancer represented only 1.6% of the YPLL for males aged 1-78 years but was reported as the underlying cause in 3.3% of all male deaths within that age range. The majority (65.2%) of Prostate cancer deaths are among males aged 70 years or over and only 7.3% are under 60 years.

For females, Breast cancer represented 10.0% of YPLL while it was reported as the underlying cause in 8.1% of all female deaths. Almost half of breast cancer deaths among females were aged under 60 years old. (47.3%)

NUMBER OF MULTIPLE CAUSES

For the 132,508 deaths registered in 2004, there were 404,366 causes reported giving a mean of 3.1 causes per death. In 19.4% of all deaths, only one cause was reported, whereas 56.3% of deaths were reported with three or more causes. The mean number of causes reported per death varies with age, sex and underlying cause of death.

SELECTED MULTIPLE CAUSES

In 2004, Malignant neoplasms represented 28.7% of all underlying cause of death. When associated causes were included it contributed 39.4% of all deaths as an underlying or associated cause. Similarly, 18.5% of all deaths had Ischaemic heart diseases as the underlying cause, but it was found to contribute to 35.5% of all deaths as either an underlying or associated cause. The following table lists the top ten multiple causes of death (underlying and associated causes) appearing on death certificates for deaths registered in 2004, and their corresponding ranking in terms of underlying causes.

SELECTED MULTIPLE CAUSES OF DEATH
	Multiple causes(a)			Underlying cause
Cause of death and ICD code	no	%	rank	%	rank
Malignant neoplasms (C00-C97)	52 217	39.4	1	28.7	1
Ischaemic heart disease (I20-I25)	46 985	35.5	2	18.5	2
Cerebrovascular diseases (I60-I69)	23 359	17.6	3	9.1	3
Influenza and pneumonia (J10-J18)	18 305	13.8	4	2.6	7
Heart Failure (I50)	16 837	12.7	5	1.7	10
Hypertensive diseases (I10-I15))	15 605	11.8	6	1.0	16
Renal failure (N17-N19)	15 235	11.5	7	1.4	12
Chronic lower respiratory diseases (J40-J47)	14 190	10.7	8	4.4	4
Organic, including symptomatic, mental disorders (F00-F09)	11 843	8.9	9	2.2	8
Diabetes mellitus (E10-E14)	11 749	8.9	10	2.7	6
Deaths from all causes	132 508	100.0	-	100.0	-
- nil or rounded to zero (including null cells)
(a) Number of deaths and percentages may add to more than totals because a death certificate can report more than one leading multiple cause.

RELATIONSHIP OF CAUSES

The following table illustrates relationships between the various causes of death in 2004. Malignant neoplasms, the most prevalent underlying cause (37,989 deaths), was reported alone in 37.5% of cases and is less likely to be reported with other more prevalent causes. In contrast, Renal failure was reported alone as the underlying cause in only 8.8% (1,895) of deaths attributed to this cause. It was reported more frequently with associated causes of Ischaemic heart diseases and Heart failure.

Selected underlying causes with associate cause(a)
	Selected underlying cause		Reported with selected associated cause
	Total no of deaths	Reported alone	Malignant neoplasms (C00-C97)	Ischaemic heart diseases (I20-I25)	Cerebro- vascular diseases (I60-I69)	Chronic lower respiratory diseases (J40-J47)	Influenza and pneumonia (J10-J18)	Heart failure (I50)	Renal failure (N17-N19)
	no.	%	%	%	%	%	%	%	%
Malignant neoplasms (C00-C97)	37 989	37.5	-	7.9	3.8	6.0	7.9	3.6	6.2
Ischaemic heart diseases (I20-I25)	24 576	11.6	6.0	-	10.0	10.1	5.7	23.5	10.9
Cerebrovascular diseases (I60-I69)	12 041	15.3	4.9	10.8	-	3.6	15.8	5.0	4.5
Chronic lower respiratory diseases (J40-J47)	5 785	7.2	8.3	19.4	5.5	-	32.5	15.4	8.0
Influenza and pneumonia (J10-J18)	3 381	31.3	0.9	15.6	2.2	1.4	-	10.9	9.8
Heart failure (I50)	2 279	12.7	5.5	-	9.6	11.8	23.7	-	20.9
Renal failure (N17-N19)	1 895	8.8	4.9	27.7	8.7	6.6	13.5	28.8	-
- nil or rounded to zero (including null cells)
(a) This table presents data for selected causes only. Therefore numbers and percentages due to reporting of underlying cause with selected associated causes doe not add to totals.

EXTERNAL CAUSES

In 2004, there were 7,966 deaths due to External causes, with an average of 3.3 causes coded per each of these deaths. The average number of multiple causes coded due to Accidental Falls was 4.2 and reflects the number of injuries sustained. In 2004, Transport accidents accounted for 24.3% of all injuries due to External causes, with 42.7% of these injuries being to the head or thorax. Intentional self-harm accounted for 23.3% of total injuries due to External causes, and of these injuries, Asphyxiation was the most common (39.8%).

PERINATAL DEATHS

INTRODUCTION

Perinatal deaths comprise stillbirths (fetal deaths) and deaths of infants within the first 28 days of life (neonatal deaths). In this publication (and in previous editions since 1997), these deaths are defined to include infants and fetuses weighing at least 400 grams or having a gestational age of 20 weeks.

The exception to this is Table 3.1, which is based on the World Health Organisation recommended definition and includes infants and fetuses weighing at least 500 grams or having a gestational age of 22 weeks. Refer to Explanatory Notes, paragraphs 4-8 for further information on perinatal death statistics. Further tables based on either definition are available from the ABS.

TRENDS IN PERINATAL DEATHS

In 2004, there were 2,048 perinatal deaths registered in Australia, compared with 2,020 registered in 2003. The number of fetal deaths in 2004 was 1,347, an increase of 4.6% on the number registered in 2003 (1,288). Neonatal deaths have decreased from 732 in 2003 to 701 in 2004. Since 1994, the number of registered perinatal deaths has decreased by 13.3% (314). The proportion of perinatal deaths where birth weight was less than 1000 grams was 49.4% in 2004, while 47.5% of deaths had a gestational period of less than 28 weeks.

In 2004, the sex ratio of male perinatal deaths for every 100 female perinatal deaths was 128, compared with a ratio of 123 recorded in 2003.

The perinatal death rate remained constant between 2003 and 2004 at 8.0 deaths per 1,000 total relevant births (see Glossary, death rates for further information). Between 1994 and 2004, the perinatal death rate declined from 9.1 to 8.0 deaths per 1,000 total relevant births. In the same period, the fetal rate declined from 5.4 to 5.3 per 1,000 total relevant births, while the neonatal rate fell to the lowest ever recorded (2.8 per 1,000 total relevant births). This low rate was strongly influenced by the decrease in the female neonatal death rate from 3.1 in 1994 to 2.3 per 1,000 total relevant births in 2004.

AGE OF MOTHER

While the overall perinatal death rate has decreased over the last ten years, this is not consistent across all age groups. In particular, the perinatal death rate of 17.6 per 1,000 total relevant births in 2004 for mothers aged less than 20 years is higher than the 2003 rate of 14.5 per 1000 total relevant births and the 1994 rate of 12.0 per 1,000 total relevant births.

CONDITION IN FETUS/INFANT

In 2004, 28.8% of perinatal deaths were not assigned a specific cause of death in the fetus/infant. Medical certifiers are often unable to provide an accurate cause of death without the assistance of an autopsy. The absence of a specific cause of death largely affects fetal deaths. While 42.3% of all fetal deaths registered in 2004 reported no specific cause, the corresponding figure for neonatal deaths was 2.9%.

Respiratory and cardiovascular disorders, specific to the perinatal period, accounted for 15.6% of perinatal deaths, while Disorders related to length of gestation and fetal growth contributed a further 12.1%.

Conditions reported in fetal deaths registered in 2004 include Respiratory and cardiovascular disorders specific to the perinatal period (14.8%), Interuterine hypoxia (14.1%), Congenital malformations, deformations and chromosomal abnormalities (13.9%), and Disorders related to length of gestation and fetal growth (7.9%). In comparison, Disorders related to length of gestation and fetal growth accounted for 20.3% of neonatal deaths registered in 2004 while Congenital malformations, deformations and chromosomal abnormalities (31.4%) , Extremely low birth weight (19.5%), and Respiratory and cardiovascular disorders, specific to the perinatal period (17.3%) were the other major causes.

Condition in mother

Perinatal deaths differ from general deaths because a condition may be reported in the record for the fetus/infant, the mother, or for both. A maternal condition was reported in 1,247 (60.9%) of the 2,048 perinatal deaths registered in 2004. Complications of placenta, cord and membranes was the most frequently reported maternal cause, accounting for 491 or 24.0% of all perinatal deaths, followed by Maternal complications of pregnancy (297 or 14.5% of perinatal deaths).

YEAR OF OCCURRENCE

INTRODUCTION

Information contained in the preceding sections of this publication refer to deaths registered during the 2004 calendar year. In this section, death statistics are based on a year of occurrence, i.e. the year in which the death actually occurred.

Some countries publish death statistics on a year of registration basis, some on a year of occurrence basis, and others on both. Although some deaths can be registered many years after their date of occurrence, the international standard for publishing on a year of occurrence basis is to include deaths registered within the relevant occurrence year and the year immediately following. Accordingly, this practice has been adopted for the presentation of year of occurrence data in this publication to facilitate international comparisons. Analysis of deaths in Australia has shown that the number of deaths registered after the second year are not significant (less than 0.1%).

Year of occurrence data allow for seasonal analysis, and data are not distorted by the effects of late registrations or changes in time lags in processing registrations. In those countries where registration systems are complete and timely, there is not a significant difference between the number of deaths derived on a registration basis and those on a year of occurrence basis. For Australia. approximately 95% of deaths occurring in a particular year are registered in that year. However, variations can occur in certain subsets of the population and for particular causes of death. For instance, while 96.0% of the total 131,784 deaths that occurred in 2003 were registered in 2003, only 88.8% of the 2,015 Indigenous deaths and 93.5% of deaths due to External causes that occurred in 2003 were registered in that year. More detailed data for specific causes or population groups are available from the ABS on request.

COMPARISON OF SELECTED UNDERLYING CAUSES IN 2003

The following table shows that the percentage differences between selected underlying causes of death presented on a year of occurrence and year of registration basis in 2003 are small. The biggest difference occurred with Intentional self harm (see Explanatory Note 27 for issues surrounding coding of this cause for 2004), followed by Diabetes mellitus and Chronic lower respiratory diseases.

SELECTED UNDERLYING CAUSES OF DEATH
	YEAR OF REGISTRATION	YEAR OF OCCURRENCE(a)
	2003	2003	Difference(b)
Cause of death and ICD code	no	no	%
All Causes	132 292	131 784	-0.4
Malignant neoplasms (cancer) (C00-C97)	37 558	37 445	-0.3
Ischaemic heart diseases (I20-I25)	25 439	25 295	-0.6
Cerebrovascular diseases (stroke) (I60-I69)	12 240	12 209	-0.3
Chronic lower respiratory diseases (including asthma, emphysema and     bronchitis (J40-J47)	5 985	5 925	-1.0
Accidents (V01-X59)	4 865	4 875	0.2
Diabetes mellitus (E10-E14)	3 389	3 425	1.1
Influenza and pneumonia (J10-J18)	3 566	3 561	-0.1
Diseases of arteries, arterioles and capillaries (including atherosclerosis and      aortic aneurysm (I70-I79)	2 542	2 532	-0.4
Heart failure (I50)	2 432	2 432	-
Intentional self-harm (X60-X84)	2 213	2 155	-2.7
All other causes	32 063	31 930	-0.4
- nil or rounded to zero (including null cells)
(a) Deaths occurring in 2003, registered in 2003 and in 2004
(b) A positive percentage difference indicates that more deaths occurred than were registered in the calender year.