Causes of Death, Australia

There were 158,493 registered deaths in Australia in 2018. This paper outlines the leading causes of those deaths with a particular focus on age and sex.

The table below shows the top 20 leading causes of mortality for 2018 compared with 10 years ago (2009) and 5 years ago (2013). Key points include:

• The leading cause of death was Ischaemic heart disease. The standardised death rate from Ischaemic heart disease has decreased by 22.4% since 2009, with declines in heart disease mortality observed now for more than 50 years.
• Dementia, including Alzheimer's disease, remained the second leading cause of death. Deaths due to dementia have increased by 68.6% since 2009.
• Cerebrovascular diseases, Cancer of the trachea, bronchus and lung and Chronic lower respiratory diseases round out the top five leading causes of death.
• The top five leading causes of death account for more than one-third of all registered deaths.
• Influenza and pneumonia was the 12th leading cause of death. The number of influenza deaths is strongly linked to the severity of flu seasons and this can drive changes in ranking for this leading cause group.
• Intentional self-harm was the 14th leading cause of death. It has the lowest median age at death among the top 20 leading causes, at 44.4 years of age.
   

In order to measure and compare changes in leading causes over time, standardised death rates for the top five leading causes of death are presented in the graph below.

Key findings include:

• Ischaemic heart disease decreased from 91.4 deaths per 100,000 in 2009, to 54.6 in 2018. This was largest rate decrease within the top 5 leading causes.
• Dementia, including Alzheimer's disease increased from 32.3 deaths per 100,000 people in 2009 to 41.2 in 2018.
• Death rates for Cerebrovascular diseases continue to decrease, with a rate reduction of 14.2 deaths, from 44.9 in 2009 to 30.7 in 2018.
• Decreases in cardiovascular disease mortality have been recorded since 1968. These decreases and the advancements in treatment which have enabled them to happen are covered in the article Changing Patterns of Mortality in Australia, 1968-2017
• The decrease in cardiovascular disease mortality and increases in Dementia, including Alzheimer's disease mortality constitute the largest changes in leading causes of death in Australia. Dementia, including Alzheimer's disease replaced Cerebrovascular diseases as the second leading cause in 2013 and on current trend will become the leading cause of death in coming years.
• The death rate from Malignant neoplasms of trachea, bronchus and lung has decreased from 33.2 deaths per 100,000 in 2009 to 28.4 in 2018. Decreases in smoking rates have been observed over many decades and are eventually resulting in decreased rates of lung cancer mortality.
   

Years of potential life lost is a measure of premature mortality which weights age at death to gain an estimate of how many years a person would have lived had they not died prematurely. When considered in terms of premature mortality, the leading causes have a notably different profile. This is in part because of the high median ages at death for many leading causes (see Leading causes of death, Australia - selected years - 2009, 2013, 2018 above).

The graph below shows the number of Years of Potential Life Lost for the top 20 leading causes of death.

Key findings include:

• Suicide accounted for the highest number of years of potential life lost, despite being the 14th leading cause overall. The median age at death is 44.4 years of age, which is considerably lower than any of the other top 20 leading causes. Suicide accounted for approximately 105,730 years of potential life lost in 2018.
• Ischaemic heart disease accounted for the second highest number of years of potential life lost (68,532). It has both the highest number of deaths and the highest number of premature deaths (more than 6,000), but it has a considerably higher median age at death at 84.7 years of age.
• Dementia, including Alzheimer's disease accounts for only 6,680 years of life lost, despite being the second leading cause of death. Dementia is predominantly a disease that affects the very elderly and has a median age at death of 89.0.
• Some types of neoplasms can affect people at a broad range of ages. Lung cancer, Colon cancer and Breast cancer are the third, fourth and fifth leading causes of potential life lost and have median ages at death of 73.6, 77.0 and 71.7, respectively.
   

In 2018 there were 82,320 male deaths and 76,173 female deaths. The table below shows the top 20 leading causes of death for males and females.

Key findings include:

• The top five leading causes are the same for both males and females, although the ranking of those causes differs.
• Ischaemic heart disease was the leading cause of death for males (10,269 deaths). Dementia, including Alzheimer’s disease was the leading cause of death for females (8,973 deaths).
• Changes in the top five leading causes for both males and females are being driven by decreases in deaths from cardiovascular diseases (Ischaemic heart disease and Cerebrovascular diseases) and increases in deaths from Dementia, including Alzheimer's disease.
• Lung cancer is the leading cause of cancer-related death for both males and females. It is the second leading cause of death overall for men and the fifth for women.
• The sex specific cancers (Malignant neoplasm of prostate and Malignant neoplasm of breast) were the sixth leading causes for males and females respectively. Prostate cancer was the cause of 3,264 male deaths while breast cancer caused 2,999 female deaths in 2018.
• Colon cancer was the seventh ranked leading cause for both males and females.
• External causes include deaths from accidents, assaults and suicide. Suicide is the top ranked external cause of death among males (ranked 10th), while accidental falls are the highest ranked for females (ranked 14th).
   

The graph below depicts the causes with the largest sex ratios, within the top 20 leading causes of death in Australia in 2018 (excluding sex-specific causes such as prostate and breast cancer).

Key findings include:

• The largest male to female ratio was observed in deaths from Intentional self-harm. More than three-quarters of intentional self-harm deaths occur in males.
• The largest female to male ratio was observed in deaths from Dementia, including Alzheimer's disease.
• Other diseases with a high male to female ratio include skin cancers, liver cancers and blood cancers.
• Other diseases with a high female to male ratio include hypertension, cardiac arrythmias and cerebrovascular diseases.
   

There were 3,218 deaths of Aboriginal and Torres Strait Islander people in 2018 (1,780 males and 1,438 females). The median age at death was 60.7 years of age, increasing from 56.1 years of age recorded in 2009.

The standardised death rate in 2018 was 927.1 deaths per 100,000 persons. This compares to a death rate of 933.2 deaths per 100,000 ten years ago in 2009. Rates have fluctuated for both males and females over the past decade, but there has been little change overall. The mortality rate for Aboriginal and Torres Strait Islander people for 2009 to 2018 are presented in the graph below.

Data reported in this article are compiled by jurisdiction of usual residence for New South Wales, Queensland, Western Australia, South Australia and the Northern Territory only. Data for Victoria, Tasmania and the Australian Capital Territory have been excluded in line with national reporting guidelines. For further information see Explanatory Notes 63-75.

The top five leading causes of death for Aboriginal and Torres Strait Islander males, females and persons can be seen in the table below. Five year aggregate death rates for the periods 2009-2013 and 2014-2018 are included to better enable comparison of rates over time.

The leading cause of death for Aboriginal and Torres Strait Islander people in 2018 was Ischaemic heart disease, accounting for 390 deaths (12.1% of all deaths). Between the five year periods 2009-2013 and 2014-2018 the Ischaemic heart disease death rate decreased by 11.2%, from 133.2 to 118.3 deaths per 100,000 people. Decreases among both males and females have occurred since 2009 at 12.2% and 10.5%, respectively.

Diabetes was the second leading cause of death, accounting for 232 deaths at a rate of 72.1 deaths per 100,000 in 2018. The death rate from diabetes has decreased by 7.0% between 2009-2013 and 2014-2018. Diabetes is the third leading cause for both males and females.

Four of the top five leading causes are the same for both males and females, although they have different rankings. Intentional self-harm is the second leading cause for males, but is ranked seventh for females. Approximately three-quarters of intentional self-harm deaths are of males. Dementia, including Alzheimer's disease is the fifth ranked cause among Aboriginal and Torres Strait Islander females, but is ranked 12th for males.

Both Chronic lower respiratory diseases and Malignant neoplasms of the trachea, bronchus and lung feature in the top five leading causes for Aboriginal and Torres Strait Islander males, females and persons. Both have recorded increased death rates between 2009-2013 and 2014-2018, with the largest increase recorded for Chronic lower respiratory disease. In 2014 to 2015 it was estimated that 45.0% of the Aboriginal and Torres Strait Islander population aged 18 years and over were current smokers, with the prevalence being as high as 54.0% in remote areas (ABS, 2017). Although smoking rates have decreased over time for Aboriginal and Torres Strait Islander people, the development of smoking related illnesses can have delayed onset from smoking initiation (ABS, 2017).

Measures of mortality relating to Aboriginal and Torres Strait Islander people are key inputs into the Closing the Gap strategy, led by the Council Of Australian Governments (COAG) in partnership with the National Coalition of Aboriginal and Torres Strait Islander Peak Organisations. This government initiative sees work undertaken with Aboriginal and Torres Strait Islander communities to reduce disadvantage across areas such as life expectancy, mortality, education and employment.

The table below shows the number of deaths and death rate for the top 20 leading causes in Aboriginal and Torres Strait Islander and non-indigenous people in 2018. Death rates for Aboriginal and Torres Strait Islander people are generally higher than for non-indigenous people, with only Malignant neoplasms of lymphoid, haemopoietic and related tissue (C81-C96) having a lower death rate across the top 20 leading causes. The largest rate ratios are seen for deaths from Diabetes, Cirrhosis and other diseases of the liver and Chronic lower respiratory diseases, with death rate ratios of 4.7, 3.5 and 3.0 times higher in the Aboriginal and Torres Strait Islander population, respectively. The death rate from Intentional self-harm is 1.9 times higher in Aboriginal and Torres Strait Islander people.

Injury-related deaths in the Aboriginal and Torres Strait Islander people have increased over the last decade, despite a decrease in the death rate for all causes. Injury-related deaths are those in which an injury is incurred as a result of an external cause, leading to death. Examples of injuries can include fractures and dislocations, cuts and lacerations, burns and poisonings. External causes are classified by intent, describing whether the injury resulted from an accident, assault, suicide or the intent could not be determined. In mortality statistics, the external cause is considered to be the underlying cause of death.

Between 2009-2013 and 2014-2018 the number of deaths from external causes increased by 20.4%, with the death rate increasing from 69.8 to 78.2 deaths per 100,000 people. Males were more likely to die from external causes than females, with 2.0 male deaths for every female death. In 2018, injury-related deaths made up over 20.0% of the total premature mortality among Aboriginal and Torres Strait Islander people.

The most common intent for deaths from external causes among Aboriginal and Torres Strait Islander people was accident (50.5%), with transport accidents accounting for the largest number of deaths (429 in 2009-2013 and 423 in 2014-2018). Accidental drug overdoses accounted for the second largest number of accidental deaths, and also recorded the largest increase in rate from 7.8 to 11.6 deaths per 100,000 between the two five year periods.

The table below shows the number and rate of external cause deaths among Aboriginal and Torres Strait Islander people and non-Indigenous people the five year period from 2014-2018. The rate of death from external causes for Aboriginal and Torres Strait Islander people was 2.0 times higher than for non-Indigenous people during this period.

Deaths from assault had the highest disparity in death rate between Aboriginal and Torres Strait Islander and non-Indigenous people, with death rates of 5.8 and 0.9 deaths per 100,000, respectively.

The death rate from intentional self-harm among Aboriginal and Torres Strait Islander people was 1.9 times higher than that for non-Indigenous people. For further information, see the article 'Intentional self-harm in Aboriginal and Torres Strait Islander people' in this publication.

The death rate from accidents among Aboriginal and Torres Strait Islander people was 1.8 times higher than non-Indigenous people. The largest rate ratio among causes of accidental death is for Accidental poisoning by alcohol and other noxious substances, which is 4.0 times higher among Aboriginal and Torres Strait Islander people. Over three-quarters of deaths in this category are due to alcohol toxicity. The rate of death for Transport accidents and Accidental drug overdoses was 2.4 times higher than that for non-Indigenous people.

External causes contribute considerably to premature mortality among Aboriginal and Torres Strait Islander people, with a median age at death of 35.5 years. The table below shows Years of Potential Life lost (YPLL) to external causes by intent type for 2018. It is presented as an average number of years lost for deaths in each category as opposed to a total number of years of life lost.

Aboriginal and Torres Strait Islander people lose on average 45.6 years of life for every death from an external cause, 12.5 years more than for non-Indigenous people. The average years of life lost to deaths from external causes are also consistently higher across all intents. Assault deaths have the highest average YPLL for Aboriginal and Torres Strait Islander and non-Indigenous persons (48.6 and 39.5 average years of life lost per death). The largest difference in premature mortality occurred in deaths from Accidents, where Aboriginal and Torres Strait Islander people lost 44.1 years of life on average, compared to 30.8 for non-Indigenous people.

There were 3,046 registered deaths of people who died due to intentional self-harm (suicide) in Australia in 2018. Suicide is the leading cause of death among people aged 15-44 in Australia, and is a focal point of government from a policy and prevention perspective. The fifth National Mental Health and Suicide Prevention Plan provides details of strategies aimed at reducing the impact of suicide in Australia.

The standardised death rate in 2018 was 12.1 deaths per 100,000 people. Death rates recorded over the five years from 2014 to 2018 have been between 11.9 (2016) and 12.9 (2015) deaths per 100,000 people. This contrasts with rates of between 10.5 (2011) and 11.2 (2010 and 2012) in the five years from 2009 to 2013.

Intentional self-harm was the 14th ranked leading cause of death in 2018.

Suicide rates for males and females differ considerably with males consistently accounting for approximately three-quarters of suicide deaths. Of the 3,046 registered suicide deaths, 2,320 were of males and 726 were of females with standardised death rates of 18.6 and 5.7 respectively.

The graph below shows the standardised death rates for suicide over the last decade for males, females and persons. To help interpret changes in rates over time, the graph includes upper and lower bounds for data points. These bounds provide an insight into the variability associated with the recorded suicide rates and help to show whether differences in recorded rates are statistically significant.

The suicide rate for both males and females in 2018 decreased slightly compared to 2017 (0.5 deaths per 100,000 for both sexes), but for both sexes rates have remained comparable over the past five years (2014 to 2018).

Suicide is the tenth leading cause of death for males and the 23rd leading cause for females. While the death rate between sexes is notably different, the median age of death due to suicide is similar at 44.3 years of age for males and 44.7 years of age for females.

All states and territories except New South Wales recorded small decreases in the number of registered deaths due to intentional self-harm from 2017 to 2018 (see table below). The three most populous states of New South Wales, Victoria and Queensland accounted for close to three quarters of those deaths.

When considering changes in counts or rates of suicide deaths it is important to understand the range of administrative factors which can influence data for a particular reference year. Factors such as changes in processing rates for death registrations can influence the count of deaths, while the flow of information between Coroners courts, Registries, the National Coronial Information System and the ABS can influence what information is available to specify a particular cause of death. For further information on an emerging administrative issue relating to Victorian data, see Explanatory Note 111.

The table below presents a ten year time series of standardised death rates for Australian states and territories. Standardised death rates enable better comparisons both between states and territories and over time.

Death rates for most states and territories decreased from 2017 to 2018 with the exception of New South Wales which recorded a death rate of 11.1 per 100,000 people in 2018, compared with 10.9 in 2017.

In 2018, the Northern Territory recorded the highest suicide death rate at 19.5 suicide deaths per 100,000 population.

The following sections cover various age and sex breakdowns of suicide deaths. Suicide can impact different demographics in different ways and understanding those differences can assist in targeting policies and prevention activities.

The graph below shows the age distribution of suicide deaths and provides an insight into the proportion of those deaths that occurred within each age cohort. The age distribution of suicide deaths for both males and females is very similar despite there being considerable difference in the number of suicide deaths for each sex.

The highest proportion of suicide deaths occur among young and middle aged people, while the proportion decreases in progressively older age cohorts. More than half of all suicide deaths in 2018 (54.8%) occurred between the ages 30 and 59. The median age at death for suicide was 44.4 years of age, compared to 81.7 years of age for all deaths.

Age-specific death rates show how suicide manifests across age cohorts by relating the number of deaths to the size and structure of the underlying population. The graph below shows that age-specific death rates for males are consistently higher than those for females. This is due to the high proportion of suicide deaths that occur among males.

Age-specific death rates are high between the ages of 35 and 59 for both males and females. For males in 2018, the highest rate (32.9 deaths per 100,000 males) is for those aged 85 years and older, in part reflecting a smaller underlying population in this age cohort. Males aged 85 and over accounted for 2.7% of male suicide deaths, while males aged 45-49 (the second highest age-specific rate) accounted for 9.9%.

Intentional self-harm is a significant cause of premature mortality in Australia. It is the leading cause of death for people aged between 15-44 and the second leading cause of death for those aged between 45-54. One measure of premature mortality is years of potential life lost, which weights age at death to gain an estimate of how many years a person would have lived had they not died prematurely (see Explanatory Notes 42 to 45). Suicide accounts for the highest number of years of potential life lost among leading cause groups of conditions. Other conditions such as heart disease account for more premature deaths, but less years of potential life lost. In 2018, suicide accounted for over one-third of deaths (38.4%) among people 15-24 years of age and 29.4% of deaths among people 25-34 years of age. In 2018, there were 105,730 years of life lost to suicide. On average, a person who died by suicide in 2018 lost 36.7 years of life.

Deaths of children from suicide is an extremely sensitive issue. The number of deaths of children attributed to suicide can be influenced by coronial reporting practices. Reporting practices may lead to differences in counts across jurisdictions and this should be taken into account when interpreting data. For more information on issues associated with the compilation and interpretation of suicide data, see Explanatory Notes 91 to 100. For the purposes of the following analysis, children are defined as those aged between 5 and 17 years of age. The ABS is not aware of any recorded suicide deaths of children under the age of 5 years.

The table below provides information on suicide deaths among children over the last five years. In 2018, there were 100 recorded child suicide deaths and suicide remained the leading cause of death among Australian children. The suicide rate among children 5-17 years of age in 2018 was 2.5 deaths per 100,000 children.

Similar to suicide in other age groups, the suicide count and rate in male children is substantially higher than for females. In 2018, the death rate among male children was 3.0 per 100,000 people (61 deaths), while for females it was 2.0 per 100,000 (39 deaths).

More than three-quarters of child suicides in 2018 were between the ages 15 to 17 (78.0%). When all child suicide deaths are combined for years 2014 to 2018, the Northern Territory reported the highest jurisdictional rate of child deaths due to suicide, with 12.5 deaths per 100,000.

The sex ratio for suicide deaths, defined as the number of male suicide deaths per female suicide death, are provided in the graph below for child suicide deaths and all suicide deaths from 2009 to 2018. The sex ratio is consistently lower for child suicide deaths showing there is less difference in the number of male and female deaths among children. In 2018, the sex ratio for child suicide was 1.6 male deaths for every female death, while for all ages combined it was 3.2 male deaths for every female suicide death.

It is well documented that the circumstances relating to suicide deaths are complex. Co-morbidities like mental health conditions, chronic diseases and/or drug addiction can provide critical contextual information regarding these circumstances. Mood disorders, including depression, were the most commonly mentioned co-morbidity across all 3,046 suicide deaths (mood disorders were present in 43.9% of these deaths). This was followed by problems related to substance use, which includes abuse of alcohol and drugs (like heroin and methamphetamine), but also intoxication due to excessive use of a given substance at the time of death. Problems related to substance use were present in over one quarter of suicide deaths (29.4%).

The profile of common co-morbidities in suicide deaths varies in critical ways when examined by age group (see tabulation below). Chronic diseases and complex health conditions are more likely to be identified as co-morbidities among older age groups. For instance, cancer was mentioned in 13.4% of suicide deaths among those aged 65 to 84, and 11.5% among those aged 85 and over. Substance use is more commonly identified as a co-morbidity among younger people, as is the related finding of drugs and other substances in the blood.

It is recognised that many antecedent factors related to a suicide death are not diagnosable health conditions. These factors have not been traditionally captured in ABS cause of death coding within the scope of the International Classification of Diseases. The ABS recently released the results of a pilot study based on 2017 coroner-referred deaths which captured information on certain psychosocial factors alongside other associated causes. This pilot highlighted key factors such as past history of self-harm, relationship issues, legal and financial concerns and disability as being most commonly associated with suicide deaths, while also highlighting the strengths and limitations of this work. Information on psychosocial factors are not part of this publication, but findings from the pilot study can be found in the Research Paper: Psychosocial risk factors as they relate to coroner-referred deaths in Australia, 2017. The ABS is working towards embedding these additional factors in future mortality datasets in collaboration with key stakeholders

Lifeline: 13 11 14
Suicide Call Back Service - 1300 659 467
Kids Helpline (for young people aged 5 to 25 years): 1800 55 1800

This release previously used catalogue number 3303.0.