TECHNICAL NOTE 2 CAUSES OF DEATH REVISIONS PROCESS
OVERVIEW
1 There have been two process improvements implemented by the ABS in recent years which have improved the quality of data, with the biggest improvements seen in the external cause chapter and for coroner certified deaths. These processes were both implemented for the 2008 reference year. The first was a revisions process outlined in Explanatory Notes 52-54 and the second was in relation to the use of additional information from the Medical Certificate of Cause of death and from information stored within reports on the NCIS, see Explanatory Notes 55-56 for further information. The following technical note outlines the impact of these two processes.
2 Previous publications of Causes of Death, Australia indicated that all coroner certified deaths registered from the 2007 reference year onwards are now subject to a revisions process. Data are deemed preliminary when published for the first time, revised when published the following year and final when published two years after initial publication. In order to improve the quality of historical data, the 2006 reference year data has also been revised (see Technical Notes, Causes of Death Revisions, 2006 in the Causes of Death, Australia, 2010 release). Therefore in the current release, 2006 to 2012 data are final, 2013 data are revised, and 2014 data are preliminary. The 2013 and 2014 data will be subject to further revisions. Data for the 2006 reference year has not been included for analysis in this technical note because the revisions process was different to that of the 2007-2012 reference years.
IMPACT OF REVISIONS
3 Table 1 illustrates preliminary, revised and final data for the 2012 reference year, for deaths certified by a coroner, by selected causes. Data are presented by the number of deaths allocated to codes which have no specificity of cause (R99), mechanism (X59, X84 and Y09) or intent (Y10-Y34) (whether the injury was inflicted purposefully or not). As indicated in Table 1, the number of deaths coded to these ill-defined causes decreases as they progress through the revisions process and are assigned more specific codes.
TABLE 1: SELECTED CAUSES OF DEATH, DEATHS CERTIFIED BY A CORONER - Preliminary, Revised and Final Data, Australia, 2012 |
|
 | 2012 reference year | Change (prelim to final) |
| P | R | F | | |
| Cause of death and ICD-10 code | no | no | no | no | % |
|
| R99 | 1 053 | 894 | 878 | -175 | -16.6% |
| X59, X84, Y09 | 764 | 750 | 728 | -36 | -4.7% |
| Y10-Y34 | 301 | 262 | 246 | -55 | -18.3% |
|
|
4 Table 2 provides further information on the impact of the revisions process for the 2012 reference year at the ICD-10 chapter level. As expected, the chapter to record the greatest change in the 2012 reference year is Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), which decreased by 168 deaths from preliminary to final coding. The cause of death codes in this chapter are considered to be 'ill-defined', such that deaths are coded to this chapter in the absence of information which would enable a more specific code to be applied. As the status of coroner cases moves from open to closed, and more information becomes available to the ABS for the coding of these deaths, R00-R99 deaths are able to be coded to more specific causes. The bulk of the 168 deaths from this chapter were re-coded to Diseases of the circulatory system (I00-I99) and to External causes of morbidity and mortality (V01-Y98) through the revisions process. These chapters increased by 92 deaths (0.2%) and 63 deaths (0.7%) respectively from preliminary to final coding for the 2012 reference year.
TABLE 2 - CAUSES OF DEATH REVISIONS , (PRELIMINARY, REVISED, FINAL) - by ICD-10 chapter - 2012 reference year |
|
| 2012 reference year | Change (prelim to final) |
| P | R | F | | |
| Cause of death and ICD-10 code | no | no | no | no | % |
|
| Certain infectious and parasitic diseases (A00-B99) | 2 394 | 2 394 | 2 394 | 0 | 0.0 |
| Neoplasms (C00-D48) | 43 505 | 43 505 | 43 506 | 1 | 0.0 |
| Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism D50-D89 | 439 | 439 | 439 | 0 | 0.0 |
| Endocrine, nutritional and metabolic diseases (E00-E90) | 6 047 | 6 050 | 6 050 | 3 | 0.0 |
| Mental and behavioural disorders (F00-F99) | 8 120 | 8 116 | 8 113 | -7 | -0.1 |
| Diseases of the nervous system (G00-G99) | 6 884 | 6 895 | 6 896 | 12 | 0.2 |
| Diseases of the circulatory system (I00-I99) | 43 946 | 44 042 | 44 038 | 92 | 0.2 |
| Diseases of the respiratory system (J00-J99) | 13 258 | 13 264 | 13 260 | 2 | 0.0 |
| Diseases of the digestive system (K00-K93) | 5 256 | 5 262 | 5 255 | -1 | 0.0 |
| Diseases of the skin and subcutaneous tissue (L00-L99) | 399 | 398 | 398 | -1 | -0.3 |
| Diseases of the musculoskeletal system and connective tissue (MOO-M99) | 1 161 | 1 160 | 1 160 | -1 | -0.1 |
| Diseases of the genitourinary system (N00-N99) | 3 816 | 3 818 | 3 817 | 1 | 0.0 |
| Certain conditions originating in the perinatal period (P00-P96) | 510 | 511 | 512 | 2 | 0.4 |
| Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) | 548 | 550 | 550 | 2 | 0.4 |
| Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) | 1 505 | 1 353 | 1 337 | -168 | -11.2 |
| External causes of morbidity and mortality (V01-Y98) | 9 275 | 9 306 | 9 338 | 63 | 0.7 |
| Total(a) | 147 098 | 147 098 | 147 098 | 0 | 0.0 |
|
| (a) Includes deaths coded to H00-H59, H60-H95, and O00-O99. |
5 Table 3 shows a comparison of change, from preliminary to final, for 2008 to 2012. As above, the largest change is seen in the number of deaths attributed to Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99). Over time there has been a gradual decline in the size of the percentage decrease in the change between preliminary and final data for this chapter, which indicates that more specific codes have been allocated in preliminary coding.
TABLE 3 - CAUSES OF DEATH REVISIONS, by selected ICD-10 chapter - changes from preliminary to final data: by percentage - 2008 to 2012 |
|
| 2008 | 2009 | 2010 | 2011 | 2012 |
| Cause of death and ICD-10 code | % | % | % | % | % |
|
| Certain infectious and parasitic diseases (A00-B99) | 1.8 | 0.3 | 0.2 | 0.0 | 0.0 |
| Neoplasms (C00-D48) | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 |
| Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism D50-D89 | 0.2 | 0.2 | 0.5 | 0.2 | 0.0 |
| Endocrine, nutritional and metabolic diseases (E00-E90) | -0.2 | 0.3 | 0.2 | 0.0 | 0.0 |
| Mental and behavioural disorders (F00-F99) | -0.5 | -0.1 | 0.1 | 0.1 | -0.1 |
| Diseases of the nervous system (G00-G99) | 0.4 | 0.1 | 0.1 | 0.0 | 0.2 |
| Diseases of the circulatory system (I00-I99) | 0.4 | 0.2 | 0.0 | 0.0 | 0.2 |
| Diseases of the respiratory system (J00-J99) | 0.1 | 0.0 | 0.1 | -0.1 | 0.0 |
| Diseases of the digestive system (K00-K93) | 0.6 | 0.1 | -0.2 | 0.2 | -0.3 |
| Diseases of the skin and subcutaneous tissue (L00-L99) | -0.5 | 0.8 | -0.3 | 0.5 | 0.5 |
| Diseases of the musculoskeletal system and connective tissue (MOO-M99) | -0.7 | 0.0 | 0.1 | 0.2 | -0.1 |
| Diseases of the genitourinary system (N00-N99) | 0.4 | 0.1 | 0.0 | -0.1 | 0.0 |
| Certain conditions originating in the perinatal period (P00-P96) | 0.2 | -0.3 | 0.0 | -0.3 | 0.4 |
| Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) | 0.8 | 0.9 | 0.8 | 0.7 | 0.4 |
| Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) | -31.4 | -29.9 | -16.5 | -11.7 | -11.2 |
| External causes of morbidity and mortality (V01-Y98) | 1.1 | 2.1 | 1.2 | 0.9 | 0.7 |
|
6 While the revisions process has a minimal impact at the overall chapter level (with the exception of Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)), significant data improvements become more apparent when considering movements within individual chapters. Table 4 provides information on the impact of revisions on 2012 data at the sub-chapter level, mainly for the External causes of morbidity and mortality (V01-Y98) chapter. The following causes of death see notable reductions:
- Other ill-defined and unspecified causes of mortality (R99) (-175 deaths); and
- Event of undetermined intent (Y10-Y34) (-55 deaths)
Increases include:
- Intentional self-harm (X60-X84) (45 deaths)
- Car occupant injured in transport accident (V40-V49) (31 deaths)
- Falls (W00-W19) (20 deaths)
TABLE 4: CAUSES OF DEATH REVISIONS (PRELIMINARY, REVISED, FINAL), by ICD-10 selected causes - 2012
|
| 2012 | Change (preliminary to final) |
| Preliminary | Revised | Final | | |
| Cause of death and ICD-10 code | no. | no. | no. | no | % |
|
| Sudden infant death syndrome (R95) | 50 | 58 | 58 | 8 | 16.0 |
| Other ill-defined and unspecified causes of mortality (R99) | 1 053 | 894 | 878 | -175 | -16.6 |
| Pedestrian injured in transport accident (V01-V09) | 257 | 260 | 257 | 0 | 0.0 |
| Pedal cyclist injured in transport accident (V10-V19) | 36 | 37 | 37 | 1 | 2.8 |
| Motorcycle rider injured in transport accident (V20-V29) | 213 | 214 | 215 | 2 | 0.9 |
| Car occupant injured in transport accident (V40-V49) | 757 | 772 | 788 | 31 | 4.1 |
| Occupant of pick-up truck or van injured in transport accident (V50-V59) | 6 | 6 | 10 | 4 | 66.7 |
| Occupant of heavy transport vehicle injured in transport accident (V60-V69) | 31 | 32 | 31 | 0 | 0.0 |
| Other land transport accidents (V80-V89) | 81 | 73 | 63 | -18 | -22.2 |
| Water transport accidents (V90-V94) | 57 | 57 | 56 | -1 | -1.8 |
| Air and space transport accidents (V95-V97) | 38 | 38 | 40 | 2 | 5.3 |
| Falls (W00-W19) | 1 997 | 1 999 | 2 017 | 20 | 1.0 |
| Exposure to inanimate mechanical forces (W20-W49) | 78 | 79 | 83 | 5 | 6.4 |
| Accidental drowning and submersion (W65-W74) | 188 | 191 | 194 | 6 | 3.2 |
| Other accidental threats to breathing (W75-W84) | 229 | 231 | 232 | 3 | 1.3 |
| Exposure to smoke, fire and flames (X00-X09) | 56 | 58 | 60 | 4 | 7.1 |
| Exposure to forces of nature (X30-X39) | 34 | 34 | 33 | -1 | -2.9 |
| Accidental poisoning by and exposure to noxious substances (X40-X49) | 936 | 940 | 941 | 5 | 0.5 |
| Accidental exposure to other and unspecified factors (X58-X59) | 727 | 715 | 705 | -22 | -3.0 |
| Intentional self-harm (X60-X84)(a) | 2 535 | 2 574 | 2 580 | 45 | 1.8 |
| Assault (X85-Y09) | 273 | 287 | 285 | 12 | 4.4 |
| Event of undetermined intent (Y10-Y34) | 301 | 262 | 246 | -55 | -18.3 |
| Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59) | 90 | 91 | 91 | 1 | 1.1 |
| Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure (Y83-Y84) | 155 | 155 | 168 | 13 | 8.4 |
| Sequelae of external causes of morbidity and mortality (Y85-Y89) | 132 | 133 | 133 | 1 | 0.8 |
(a) Care needs to be taken in interpreting figures relating to intentional self-harm. See Explanatory Notes 85-92.
7 Table 5 shows the percentage change between preliminary and final data for 2008, 2009, 2010, 2011 and 2012 data at the sub-chapter level. Some notable changes due to the revisions process are described below.
- As expected, ill-defined codes, such as Other ill-defined and unspecified causes of mortality (R99) and Event of undetermined intent (Y10-Y34) have seen large percentage decreases from preliminary to final data for most reference years.
- Deaths due to Other land transport accidents (V80-V89) saw a decrease from 81 to 63 (22.2%) in preliminary to final 2012 data.
- Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure (Y83-Y84) increased by 8.4% from 155 to 168.
TABLE 5 - Cause of Death Revisions, by ICD-10 selected causes - Percentage change between preliminary and final data - 2008 to 2012 |
|
| Cause of death and ICD-10 code | 2008 | 2009 | 2010 | 2011 | 2012 |
|
| Sudden infant death syndrome (R95) | 30.5 | 21.8 | 17.3 | 33.3 | 16.0 |
| Other ill-defined and unspecified causes of mortality (R99) | -46.5 | -51.3 | -30.0 | -20.6 | -16.6 |
| Pedestrian injured in transport accident (V01-V09) | 24.6 | 25.3 | 7.5 | 5.4 | 0.0 |
| Pedal cyclist injured in transport accident (V10-V19) | 16.7 | 5.7 | 0.0 | 6.7 | 2.8 |
| Motorcycle rider injured in transport accident (V20-V29) | 19.5 | 14.7 | 6.8 | 2.8 | 0.9 |
| Car occupant injured in transport accident (V40-V49) | 11.7 | 14.8 | 19.0 | 18.4 | 4.1 |
| Occupant of pick-up truck or van injured in transport accident (V50-V59) | 102.9 | 36.2 | -65.2 | -92.7 | 66.7 |
| Occupant of heavy transport vehicle injured in transport accident (V60-V69) | 26.8 | 10.0 | 14.3 | 36.0 | 0.0 |
| Other land transport accidents (V80-V89) | 3.7 | -34.6 | -28.7 | -39.4 | -22.2 |
| Water transport accidents (V90-V94) | 15.6 | 37.1 | 11.6 | 6.1 | -1.8 |
| Air and space transport accidents (V95-V97) | 9.1 | 22.2 | 8.3 | 12.8 | 5.3 |
| Falls (W00-W19) | 8.4 | 5.8 | 2.6 | 1.5 | 1.0 |
| Exposure to inanimate mechanical forces (W20-W49) | 17.6 | 0.0 | 0.0 | -8.7 | 6.4 |
| Accidental drowning and submersion (W65-W74) | 15.7 | 9.9 | 0.5 | -1.2 | 3.2 |
| Other accidental threats to breathing (W75-W84) | 7.7 | 5.5 | 0.5 | 5.8 | 1.3 |
| Exposure to smoke, fire and flames (X00-X09) | 16.7 | 4.1 | 22.4 | 2.5 | 7.1 |
| Exposure to forces of nature (X30-X39) | 3.4 | 4.9 | 4.5 | 13.2 | -2.9 |
| Accidental poisoning by and exposure to noxious substances (X40-X49) | 40.8 | 25.7 | 17.2 | 2.1 | 0.5 |
| Accidental exposure to other and unspecified factors (X58-X59) | -12.3 | -1.1 | -1.3 | -1.5 | -3.0 |
| Intentional self-harm (X60-X84)(a) | 6.8 | 9.6 | 5.0 | 5.3 | 1.8 |
| Assault (X85-Y09) | 23.6 | 29.5 | 18.9 | 29.3 | 4.4 |
| Event of undetermined intent (Y10-Y34) | -57.7 | -60.7 | -55.0 | -41.5 | -18.3 |
| Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59) | 6.3 | -1.7 | -2.7 | -6.0 | 1.1 |
Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication,
without mention of misadventure at the time of the procedure (Y83-Y84) | -3.2 | 6.4 | 3.4 | 1.7 | 8.4 |
| Sequelae of external causes of morbidity and mortality (Y85-Y89) | -1.9 | -3.8 | 2.5 | 3.4 | 0.8 |
|
| (a) Care needs to be taken in interpreting figures relating to intentional self-harm. See Explanatory Notes 85-92. |
|
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