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

Statistics on doctor certified death registrations

Reference period
2019
Released
24/06/2020
Next release Unknown
First release

Doctor certified mortality data

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.

Explanatory notes

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

Cause of death - certifier type

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.

Data flow for doctor certified deaths

Data flow for doctor certified deaths

Data flow for doctor certified deaths

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.

Selected underlying causes of death, 2018

  2018(a) 
 TotalDoctor certifiedProportion
Cause of death by ICD-10 Chapterno.no.%
Certain infectious and parasitic diseases (A00-B99)
2,413
2,291
94.9
Neoplasms (C00-D48)
47,802
47,123
98.6
Blood and immunity disorders (D50-D89)
495
465
93.9
Endocrine, nutritional and metabolic diseases (E00-E90)
6,574
6,076
92.4
Mental and behavioural disorders (F00-F99)
10,154
9,911
97.6
Diseases of the nervous system (G00-G99)
9,245
8,929
96.6
Diseases of the eye and adnexa (H00-H59)
8
8
100.0
Diseases of the ear and mastoid process (H60-H95)
18
17
94.4
Diseases of the circulatory system (I00-I99)
41,849
36,617
87.5
Diseases of the respiratory system (J00-J99)
14,527
13,764
94.7
Diseases of the digestive system (K00-K93)
5,936
5,349
90.1
Diseases of the skin and subcutaneous tissue (L00-L99)
599
572
95.5
Diseases of the musculoskeletal system and connective tissue (M00-M99)
1,344
1,254
93.3
Diseases of the genitourinary system (N00-N99)
3,500
3,423
97.8
Pregnancy and childbirth (O00-O99)
15
2
13.3
Conditions originating in the perinatal period (P00-P96)
547
511
93.4
Congenital and chromosomal abnormalities (Q00-Q99)
637
530
83.2
Ill-defined causes (R00-R99)
2,019
814
40.3
External causes (V01-Y98)
10,811
1,976
18.3
Total doctor certified deaths
..
139,632
..
Total coroner certified deaths
18,861
..
..
Total deaths
158,493
..
..
.. not applicable
a. Causes of death data for 2018 are preliminary and subject to a revisions process. See Explanatory Notes in Causes of Death, Australia, 2018 (cat. no. 3303.0).
 

Scope and coverage

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).
     

International Classification of Diseases (ICD)

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.

Updates to ICD-10 and automated coding

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.

Coding of perinatal deaths

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.

Data quality of doctor certified deaths

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.
     

Confidentialisation of data

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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Glossary

Show all

Cause of death

The causes of death to be entered on the Medical Certificate of Cause of Death are all those diseases, morbid conditions or injuries that either resulted in or contributed to death and the circumstances of the accident or violence that produced any such injuries.

Certifier type

Deaths may be certified by either a medical practitioner, using the Medical Certificate of Cause of Death, or a coroner. Natural causes are predominantly certified by doctors, whereas external and unknown causes are usually certified by a coroner. However, some deaths for natural causes are referred to coroners for investigation, for example, unaccompanied deaths.

Coroner certified deaths

Deaths that were certified by a coroner. Deaths certified by a coroner represent 11-14% of all deaths each year. Coroner cases remain open while cause of death investigations are undertaken, and are closed when coronial investigations are complete. Following completion, causes of death information is passed to the Registrar of Births, Deaths and Marriages, as well as to the National Coronial Information System (NCIS). All coroner certified deaths registered after 1 January 2006 will be subject to a revision process. For more information see the Explanatory Notes in Causes of Death, Australia (cat. no. 3303.0) and the Causes of Death Revisions, 2013 Final Data Technical Note in Causes of Death, Australia, 2015.

Data cubes

Data cubes are a series of spreadsheets which present Causes of Death data. Data cubes can be found in this publication in the Data downloads section.

Death

Death is the permanent disappearance of all evidence of life after birth has taken place. The definition excludes all deaths prior to live birth. For the purposes of the Deaths and Causes of Death collections of the Australian Bureau of Statistics, a death refers to any death that occurs in, or en route to, Australia and is registered with a state or territory Registry of Births, Deaths and Marriages.

Doctor certified deaths

Deaths that were certified by a doctor or medical practitioner, which were not required to be referred on to a coroner. Deaths certified by a doctor represent around 86%-89% of all deaths each year. Doctor certified deaths are not subject to the revisions process.

External causes of death

Deaths due to causes external to the body (for example suicide, transport accidents, falls, poisoning etc.). These relate to ICD-10 codes V01-Y98.

External territories

Australian external territories include Australian Antarctic Territory, Coral Sea Islands Territory, Territory of Ashmore and Cartier Islands, and Territory of Heard and McDonald Islands.

Fetal death

A fetal death is a death prior to the complete expulsion or extraction from its mother as a product of conception of at least 20 completed weeks of gestation or with a birth weight of at least 400 grams (or at least 22 weeks' gestation or 500 grams' birthweight when using the World Health Organization definition of a fetal death). The death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

ICD

International Statistical Classification of Diseases and Related Health Problems. The purpose of the ICD is to permit the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. The ICD, which is endorsed by the World Health Organization, is primarily designed for the classification of diseases and injuries with a formal diagnosis. The ICD-10 is the current classification system, which is structured using an alphanumeric coding scheme. Each disease or health problem listed on the death certificate is assigned a 3-character identification code. Cause of death statistics can be produced for aggregates of these, for example, chapter level (letter), 2-character code (first two characters of the assigned code), and 3-character code (first three characters of the assigned code). See 'Health classifications' in the Explanatory Notes for further information on the ICD.

Mortality

See Death.

Natural cause of death

Deaths due to diseases (for example diabetes, cancer, heart disease etc.) that are not external or unknown.

Perinatal death

A death that is either a fetal death (i.e. a death prior to the complete expulsion or extraction from its mother as a product of conception of 20 completed weeks of gestation or with a birth weight of at least 400 grams (or 22 weeks' gestation or 500 grams' birth weight according to the World Health Organization scope)), or a neonatal death (i.e. death of a live born baby within 28 completed days of birth).

Reference year

The year that presented data refers to. See 'Scope and coverage' in the Explanatory Notes for further information on reference year.

Registration year

Data presented on a year of registration basis relate to the date the death was registered with the relevant state or territory Registrar of Births, Deaths and Marriages. In most cases the year of registration and year of occurrence for a particular death will be the same, but in some cases there may be a delay between occurrence and registration of death.

Registry of Births, Deaths and Marriages

Each state and territory has a Registry of Births, Deaths and Marriages. It is a legal requirement that all deaths are recorded by the relevant Registry for the state or territory in which the death occurred.

Reportable deaths

Deaths which are reported to a coroner. See 'Cause of death - certifier type' in the Explanatory Notes for further information on what constitutes a reportable death.

State or territory of registration

State or territory of registration refers to the state or territory in which the death was registered. It is the state or territory in which the death occurred, but is not necessarily the deceased's state or territory of usual residence.

Stillbirth

See Fetal death.

Underlying cause of death

The disease or injury that initiated the train of morbid events leading directly to death. Accidental and violent deaths are classified according to the external cause, that is, to the circumstances of the accident or violence which produced the fatal injury rather than to the nature of the injury.

Unknown cause of death

Deaths for which it is not possible to determine between a natural and an external cause.

Year of occurrence

Data presented on a year of occurrence basis relate to the date the death occurred rather than when it was registered with the relevant state or territory Registrar of Births, Deaths and Marriages. See ' Scope and coverage' in the Explanatory Notes for more information.

Data downloads

Causes of death, Australia - doctor certified deaths, summary table, 2019