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SECTION 1 UNDERLYING CAUSE OF DEATH
All deaths registered in 2002 have been coded using the tenth revision of the International Classification of Diseases and Related Health Problems (ICD-10). Data from 1997 onwards are available coded to ICD-10 and data from years 1979 to 1996 are coded to the ninth revision of the International Classification of Diseases (ICD-9) which is generally comparable at the broad Chapter level to deaths coded to ICD-10. Further explanation on the comparability between ICD-9 and ICD-10 as detailed in this publication is provided in Appendix 5.
TRENDS IN LEADING CAUSES
While the 133,707 deaths registered in 2002 were 4% greater than the 128,544 deaths registered in 2001, the standardised death rate of 667 deaths per 100,000 population recorded in 2002 was 0.8% higher than the standardised death rate in 2001 and 20% lower than the 1992 rate. The standardised death rate for males in 2002 was 824 per 100,000, the same as in 2001 and 22% lower than in 1992; for females the standardised death rate in 2002 was 545 per 100,000, 1.7% higher than in 2001 and 18% lower than in 1992. These trends are consistent with continuing improvements in life expectancy in Australia.
Malignant neoplasms were the leading underlying cause of 37,622 deaths in 2002 which shows an increase of 2.4% on the 2001 total of 36,750. Malignant neoplasms were the underlying cause in 28% of all deaths in Australia in 2002, a slight decrease on the 29% of all causes in 2001. Ischaemic heart diseases were the underlying cause of 26,063 deaths in 2002, a slight decrease on the 26,234 deaths in 2001. These numbers represented 19% and 20% of all deaths in 2002 and 2001 respectively. Notwithstanding that the proportion of deaths due to Malignant neoplasms decreased between 2001 and 2002, the disparity between the proportions of deaths due to Malignant neoplasms and Ischaemic heart disease continues to widen when compared with 1992, when both of these underlying causes each represented 26% of all deaths.
The standardised death rate from Malignant neoplasms was 188 deaths per 100,000 population in 2002 compared to 209 in 1992 representing a decrease of 10%. This decrease was not evenly distributed between males and females. The standardised death rate for males from Malignant neoplasms decreased 13% from 278 to 241 per 100,000 between 1992 and 2002. The corresponding decrease for females was 7.4%, with rates of 162 in 1992 and 150 in 2002. During this period, for males, there were decreases in all types of Malignant neoplasms whereas for females there were decreases in all types except for lung cancer where there was an increase in the standardised death rate of 16%.
External causes relate to deaths from accidents, poisonings and violence. In 2002 External causes were responsible for 7,820 deaths or 5.8% of all deaths registered, with a standardised death rate of 40 per 100,000 of population. The 11% decrease in the standardised death rate from all external causes since 1992 is only about half the 20% decrease in the standardised death rate for all causes, and is largely due to a decrease in the rate for Transport accidents which decreased 28% from 14 per 100,000 in 1992 to 10 per 100,000 in 2002. The standardised death rate in 2002 from Intentional self-harm (suicide) for all ages was 19 per 100,000 males and 5 per 100,000 females, which were both decreases from the respective rates recorded in 2001. There were 2,320 deaths attributed to suicide registered in 2002, 134 (5.5%) fewer than the 2001 figure. There were fewer suicides in the 15-24 and 25-34 age groups, 22 and 48 respectively, compared to the numbers reported in 2001.
DEATHS OF ABORIGINAL AND TORRES STRAIT ISLANDER PERSONS
While data on deaths of Aboriginal and Torres Strait Islander Australians are considered to be affected to some degree from 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. Ischaemic heart diseases caused 16% of all Indigenous deaths compared to 20% of the non-Indigenous deaths while Malignant neoplasms were the cause of 15% and 29% of Indigenous and non-Indigenous deaths respectively. Diabetes mellitus accounted for 8% of Indigenous deaths compared to 2% of non-Indigenous deaths. External causes accounted for 16% of Indigenous deaths compared to 6% of non-Indigenous deaths with Intentional self-harm contributing 5% of all Indigenous deaths compared to 2% for the non-Indigenous.
YEARS OF POTENTIAL LIFE LOST (YPLL)
A measure of premature mortality is years of potential life lost for deaths occurring between the ages of 1 year and 78 years inclusive. (Refer to the Technical Note on page 74 for further detail). In 2002, the estimates of YPLL were 645,493 years for males and 357,271 years for females for all causes of death.
The contribution of Malignant neoplasms to the total estimated YPLL varies between males and females. For males aged 1-78 years, the proportion of years of potential life lost from Malignant neoplasms was 29% but for similarly aged females it was 44%, however Malignant neoplasms were reported as the underlying cause in 37% of all male deaths and 43% for all female deaths in this age group.
This difference in YPLL's between the sexes is further illustrated in a comparison of prostate cancer for males and breast cancer in females. In males aged 1-78 years, prostate cancer was reported as the underlying cause in 3.4% of all deaths but contributed only 1.7% to the total YPLL, whereas for females in the same age group, breast cancer was reported as the underlying cause in 8% of all deaths representing 10% of YPLL for females.
In 2002 deaths due to External causes contributed an estimated 178,398 years of potential life lost for males and 57,530 years of potential life lost for females. Although deaths as a result of External causes were 11% and 6.5% of all deaths of those aged 1-78 years for males and females, they represented 28% and 16% for males and females respectively of the total number of years of potential life lost.
Multiple causes of death include all causes and conditions reported on the death certificate (i.e. both underlying and associated causes; see Glossary for further details). Deaths due to External causes are those which occur as a result of accidents, poisonings and/or violence. They are classified according to the event, such as an Accidental fall, leading to the fatal injury. Multiple cause data for External causes include the nature of injury or poisoning, as well as any other causes reported on the death certificate.
NUMBER OF MULTIPLE CAUSES
For the 133,707 deaths registered in 2002, there were 384,362 causes reported (including 16,196 injuries) giving a mean of 2.9 causes per death. In 2002, 21% of all deaths were reported with a single underlying cause only, whereas 53% 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.
LEADING MULTIPLE CAUSES
In 2002, Malignant neoplasms, Ischaemic heart diseases and Cerebrovascular diseases, the leading underlying causes of death responsible for 57% of all deaths, were also the leading multiple causes of death reported either as the underlying or associated cause in 76% of all deaths. The fourth ranked multiple cause was Influenza and pneumonia, which was reported in 14% of all deaths and ranked as the seventh leading underlying cause responsible for 2.3% of deaths. The following table lists the ten leading multiple causes of death (underlying and associated causes) appearing on death certificates for deaths registered in 2002, and their corresponding ranking in terms of underlying causes.
LEADING MULTIPLE CAUSES OF DEATH
(b) Not coded as an underlying cause in accordance with ICD conventions.
RELATIONSHIP OF CAUSES
The following matrix illustrates relationships between the various causes of death in 2002. For example, Malignant neoplasms, the leading underlying cause of 37,622 deaths, was reported alone in 39% of cases and has a relatively low incidence of being reported with other leading causes. In contrast, of the 1,925 deaths assigned to Renal failure as the underlying cause, it was reported alone in only 7.0% of cases but is often reported with Ischaemic heart diseases and Heart failure.
LEADING MULTIPLE CAUSES WITH ASSOCIATED CAUSES
The multiple cause data for External causes includes the External cause (ICD codes V01-Y98), the nature of injury (ICD codes S00-T98) and natural causes (ICD codes A00-R99). In 2002 there were 7,820 deaths due to External causes. For these deaths there were a total of 27,006 multiple causes coded yielding an average of 3.5 causes coded per External cause of death. Deaths as a result of Accidental falls averaged 4.3 multiple causes, reflecting the number of injuries sustained.
In 2002, Transport accidents and Intentional self-harm accounted for 57% of all injuries reported for deaths due to External causes. Transport accidents were the largest source accounting for 31% of the total number of injuries, with 51% of those injuries being to either the head or thorax. Intentional self-harm accounted for 25% of total injuries recorded in 2002 due to external causes, and of these injuries, Asphyxiation was the most common (34%).
SECTION 3 PERINATAL DEATHS
Perinatal deaths comprise stillbirths (fetal deaths) and deaths of infants within the first 28 days of life (neonatal deaths). In Causes of Death Australia publications from 1997, these deaths have included infants and fetuses weighing at least 400 grams or having a gestational age of 20 weeks. To assist the reader and enable comparisons, table 3.1 is based on the World Health Organisation recommended definition which 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 this definition are available from the ABS. All other tables and this summary are based on the 400 g/20 weeks definition.
TRENDS IN PERINATAL DEATHS
In 2002, there were 2,019 perinatal deaths registered in Australia, representing a decrease from the 2,092 deaths registered in 2001. The perinatal death rate also slightly decreased from 8.4 in 2001 to 8.0 deaths per 1,000 total relevant births in 2002 (see Glossary, death rates for further information). In 2002, there were 1,240 fetal deaths and 779 neonatal deaths. Fetal deaths decreased by 3.9% on the number registered in 2001 while neonatal deaths decreased by 2.9%.
In 2002, the sex ratio of male perinatal deaths for every 100 female perinatal deaths was 122, representing a slight decrease on the ratio of 127 recorded in 2001.
AGE OF MOTHER
The majority of births in 2002 were among women aged 20 to 39 years, with 4.6% of births registered to mothers aged less than 20 years and 3.1% to those aged 40 years and over. While actual numbers are relatively small, perinatal deaths registered to mothers aged less than 20 years (7.1% of total perinatal deaths) and aged 40 years and over (4.9%) are proportionally higher than the percentage contributions of these two age groups to births.
In the last ten years, the overall perinatal death rate has decreased by 25%. The extent of this decrease, however, has not been uniform across all age groups. In particular, the perinatal death rate of 12.7 per 1,000 births for the 40 years and over age group is 29% lower than the 1992 rate of 18 per 1,000 births.
CONDITION IN FETUS/INFANT
In 2002, 29% of perinatal deaths were not assigned a specific cause of death in the fetus/infant. Medical certifiers are often unwilling or 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 45% of all fetal deaths registered in 2002 reported no specific cause, the corresponding figure for neonatal deaths was only 2.3%.
The major specific grouping of causes under which perinatal deaths were reported in 2002 included Congenital malformations, deformations and chromosomal abnormalities (18% of the total). Respiratory and cardiovascular disorders, specific to the perinatal period, accounted for 17% of perinatal deaths, while Disorders related to length of gestation and fetal growth contributed a further 14%. The relative importance of particular causes varies between fetal and neonatal deaths.
The major specified conditions reported in fetal deaths registered in 2002 were Intrauterine hypoxia (15%), Congenital malformations, deformations and chromosomal abnormalities (14%) and Disorders related to length of gestation and fetal growth (10%).
Congenital malformations, deformations and chromosomal abnormalities accounted for 23% of neonatal deaths registered in 2002, while Respiratory and cardiovascular disorders, specific to the perinatal period (20%), and Disorders related to length of gestation and fetal growth (20%), were the other major contributors.
CONDITION IN MOTHER
Perinatal deaths differ from general deaths because a condition may be reported in the fetus/infant, the mother, or in both. A maternal condition was reported in 1,351 (67%) of the 2,019 perinatal deaths recorded in 2002. Complications of placenta, cord and membranes was the most frequently reported maternal cause, accounting for 553 or 27% of all perinatal deaths.
In 2002, Maternal complications of pregnancy occurred in 410 perinatal deaths, a decrease of 9.3% on last year. Multiple pregnancy is the most common maternal complication of pregnancy and was reported in 133 perinatal deaths, and representing a decrease of 13% on the number recorded in 2001 and 31% lower than the peak that occurred in 1995.
Multiple births (twins or more) account for 3.3% of babies born annually. The perinatal death rate for multiple births in 2002 was 30.3 per 1,000 live births, just over four times the corresponding rate of 7.2 recorded for single births.
The fetal death rate for multiple births in 2002 was 12.2 per 1,000 live births, almost equalling the rate for 2000 (12.0) which was a ten year low.
For 2002 the neonatal death rate for multiple births was 18.3 per 1,000 live births. While this represents a 34% decrease on the rate of 24.5 recorded in 1992, it is still considerably higher than the 2002 rate for single births of 2.6.
SECTION 4 YEAR OF OCCURRENCE
Information contained in the preceding sections of this publication refer to deaths registered by the state and territory Registrars-General during the calendar year 2002. In this section, deaths statistics are based on a year of occurrence, i.e. the year in which the death actually occurred, irrespective of the year in which it was registered.
Some countries publish deaths statistics on a year of registration basis, some on a year of occurrence basis, and some on both bases. Although in practice some deaths are registered many years after their date of occurrence, it is common international practice when publishing on a year of occurrence basis to include deaths registered within the particular occurrence year and the year immediately following. Analysis of deaths in Australia has shown that the number of deaths registered after the second year are not statistically significant (less than 0.1%). Accordingly, this practice has been adopted for the presentation of year of occurrence data in this publication, to facilitate international comparisons.
Since the 2001 edition of Causes of Death, Australia, the ABS has released the current year's data on a year of registration basis, and summary data on a year of occurrence basis for the preceding year. Data on a year of occurrence basis are considered to be more accurate than data on a year of registration basis as it allows for seasonal analysis, and data are not distorted by the effects of late registrations or changes in time taken to process registrations. However, in those countries where registration systems are complete and timely, there is not an appreciable difference between year of registration tabulations and those on a year of occurrence basis, and the two can be used interchangeably. This is certainly the case in Australia where about 95% of deaths occurring in a particular year are registered in that year.
However, variations in this proportion can occur in certain sub-sets of the population and for particular causes of death. For instance, although 95% of the total 128,862 deaths that occurred in 2001 were registered in 2001, only 88% of the 2,030 Indigenous deaths and 93% of deaths due to External causes that occurred in 2001 were registered in that year.
COMPARISON OF LEADING UNDERLYING CAUSES IN 2001
The following table shows there are negligible percentage differences between leading underlying causes of death presented on year of occurrence basis and year of registration basis in 2001. The cause with the biggest difference is Accidents, which are subject to coronial enquiry which can cause delays in the registration process.
LEADING UNDERLYING CAUSES OF DEATH
(b) A positive percentage difference indicates that more deaths were reported on a year of occurrence basis.
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