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3303.0 - Causes of Death, Australia, 2001  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 10/12/2002   
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SUMMARY OF FINDINGS


SECTION 1 UNDERLYING CAUSE OF DEATH


INTRODUCTION

All deaths registered in 2001 have been coded using the tenth revision of the International Classification of Diseases (ICD-10). Data from 1997 onwards are available coded to ICD-10 and data from years 1979 to 1996 are coded to 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

There were 128,544 deaths registered in 2001, consisting of 66,835 male and 61,709 female deaths, which was a slight increase of 0.2% on the corresponding figure for 2000 (128,291 deaths). While there has been a 7.9% increase in the number of deaths between 1991 and 2001, in the same period there has been a corresponding decrease in the standardised death rate of 21%, from 689.3 in 1991 to 542.2 in 2001, which is consistent with continuing improvements in life expectancy in Australia.

The leading underlying causes of death in 2001 are generally consistent with 2000 data with respect to standardised death rates and relative proportions. However, there have been some changes in these relative proportions since 1991. In 2001, Malignant neoplasms and Ischaemic heart diseases, with contributions of 29% and 20% respectively, were responsible for 49% of all deaths, while in 1991 these two causes contributed equally (26%) and were responsible for 52% of all deaths.

LEADING CAUSES OF DEATH
MALES
FEMALES
PERSONS
PROPORTION
OF TOTAL DEATHS
CAUSE OF DEATH
no.
no.
no.
%

All Causes
66,835
61,709
128,544
100.0
Malignant neoplasm (cancer) (C00-C97)
20,753
15,997
36,750
28.5
Ischaemic heart diseases (I20-I25)
13,906
12,328
26,234
20.4
Cerebrovascular diseases (stroke) (I60-I69)
4,852
7,294
12,146
9.4
Chronic lower respiratory disease (including asthma, emphysema and bronchitis) (J40-J47)
3,419
2,497
5,916
4.6
Accidents (V01-X59)
3,155
1,685
4,840
3.8
Diabetes mellitus (E10-E14)
1,639
1,439
3,078
2.4
Influenza and pneumonia (J10-J18)
1,184
1,518
2,702
2.1
Diseases of arteries, arterioles and capillaries (including atherosclerosis and aortic aneurysm) (I70-I79)
1,381
1,244
2,625
2.0
Heart failure (I50)
982
1,630
2,612
2.0
Intentional self harm (X60-X84)
1,935
519
2,454
1.9
All other causes
13,629
15,558
29,187
22.7


All leading causes of death showed a decrease in standardised death rates between 1991 and 2001 except for Diabetes mellitus and Influenza and pneumonia where the standardised death rates remained relatively unchanged at 13.0 and 10.4 per 100,000 respectively in 2001.

Graph - Standardised Death Rates, Selected underlying causes



In 2001, the 7,038 deaths caused by Malignant neoplasms of the trachea, bronchus and lung (lung cancer) were responsible for 19% of all deaths caused by Malignant neoplasms.

For males, there was a 1.2% increase in the number of deaths in the twelve months, but a decrease of 2.1% in the standardised death rate in the same period. This continues a downward trend which has seen the standardised male death rate decrease 22% from 59.6 in 1991 to 46.5 per 100,000 in 2001. In contrast, for females, there were only marginal increases in both the numbers of deaths and standardised death rate between 2000 and 2001. The death rate has increased 8.7% since 1991.

Graph - Standardised death rates, malignant neoplasm of trachea, bronchus and lung



EXTERNAL CAUSES

External causes relate to deaths from accidents, poisonings and violence and were responsible for 7,876 deaths or 6.1% of all deaths registered in 2001. Since 1991 there has been a 14% decrease in the standardised death rate for deaths from External causes, mainly due to a 29% decrease in the death rate for Transport accidents.

The standardised death rate in 2001 from Intentional self-harm (suicide) for all ages was 20.1 for males and 5.1 for females which was a 2.6% increase for males and no change for females from the 2000 rates. There were 2,454 deaths attributed to suicide registered in 2001, 91 (3.9%) higher than the 2000 figure. Most of this increase occurred in the 45-54 age group, with 20 males and 39 females more than the previous year. However, the number of deaths registered in 2001 from Intentional self-harm is 10% lower than the record 2,723 deaths registered in 1997.


DRUG-INDUCED DEATHS

Drug-induced deaths (excluding alcohol, tobacco and volatile solvents) comprises any death where the underlying cause was attributed to an acute episode of poisoning or toxicity due to drugs and any acute condition caused by drug use where the deceased person was identified as drug dependent. More information on these definitions is given in the ABS Information Paper Drug-Induced Deaths-A Guide to ABS Causes of Death Data (cat. no. 4809.0). In 2001, the total number of drug-induced deaths was 1,038 which represents a 34% decrease on the number reported in 2000.

DRUG-INDUCED DEATHS
Cause of Death and ICD Code
1997
1998
1999
2000
2001

Total Drug-Induced Deaths
1,323
1,645
1,739
1,569
1,038
Accidental (F11-F16, F19, F55, X40-X44)(a)
916
1,243
1,403
1,274
710
Intentional self-harm (X60-X64)
309
310
278
273
285
Assault (X85)
4
6
2
1
4
Undetermined (Y10-Y14)
94
86
56
21
39

(a) Includes two components: Mental and behavioural disorders due to drug use (F11-F16, F19, F55) and Accidental poisoning by drugs (X40-X44).


DEATHS OF ABORIGINAL AND TORRES STRAIT ISLANDER PERSONS

While deaths of Aboriginal and Torres Strait Islander Australians are considered to be underenumerated (see Appendix 6), the comparison of causes of Indigenous deaths with non-Indigenous deaths highlights some major differences. The two leading causes of deaths for Indigenous and non-Indigenous are the same with Ischaemic heart diseases causing 18% and Malignant neoplasms 16% of all recorded Indigenous deaths, compared to 21% and 29% respectively for the non-Indigenous population. External causes account for 17% of Indigenous deaths compared to 6% of non-Indigenous deaths. Diabetes mellitus accounts for 7% of Indigenous deaths compared to 2% of non-Indigenous deaths.


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 and 75 years inclusive. (Refer to the Technical Note on page 77 for further detail).

In 2001, an estimate of YPLL was 528,594 years for males and 273,945 years for females for all causes of death. Malignant neoplasms as the underlying cause was reported in 37% of deaths for males aged 1-75 years. This represented 27% of the years of potential life lost. For females, Malignant neoplasms were reported in 45% of deaths of females aged 1-75 years and represented 41% of years of potential life lost. An estimated 182,642 and 53,706 years of potential years of life lost for males and females respectively occurred in 2001 due to all External causes. Deaths as a result of External causes were 14% and 8% of all deaths aged 1-75 years for males and females, which represented 35% and 20% for males and females respectively of the total number of years of potential life lost.

Graph - Percentage of years of potential life lost, selected underlying causes



SECTION 2 MULTIPLE CAUSES OF DEATH

INTRODUCTION

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 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.


LEADING MULTIPLE CAUSES

In 2001, Malignant neoplasms, Ischaemic heart diseases and Cerebrovascular diseases, the leading underlying causes of death which are responsible for 58% of all deaths, were also the leading multiple causes of death and were reported either as the underlying or associated cause in 77% of all deaths. The fourth ranked multiple cause was Influenza and pneumonia which was reported in 14% of all deaths and was ranked as the seventh leading underlying cause and responsible for 2.1% 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 2001, and their corresponding ranking in terms of underlying causes.

LEADING MULTIPLE CAUSES OF DEATH
MULTIPLE CAUSES (a)......................
UNDERLYING CAUSE
CAUSE OF DEATH AND ICD CODE
no.
%
rank
%
rank

Malignant neoplasms (C00-C97)
41,269
32.1
1
28.6
1
Ischaemic heart diseases (I20-I25)
37,761
29.4
2
20.4
2
Cerebrovascular diseases (I60-I69)
20,202
15.7
3
9.4
3
Influenza and pneumonia (J10-J18)
17,382
13.5
4
2.1
7
Heart failure (I50)
17,023
13.2
5
2.0
9
Chronic lower respiratory diseases (J40-J47)
13,508
10.5
6
4.6
4
Renal failure (N17-N19)
12,384
9.6
7
1.3
12
Injury, poisoning and certain other consequences of external causes (S00-T98)(b)
11,361
8.8
8
..
..
Diabetes mellitus (E10-E14)
10,325
8.0
9
2.4
6
Accidents (V01-X59)
7,248
5.6
10
3.8
5
Deaths from all causes
128,544
100.0
. .
100.0
. .

(a) Number of deaths and percentages may add to more than totals because a death certificate can report more than one leading multiple cause.
(b) Not coded as an underlying cause in accordance with ICD conventions.


NUMBER OF MULTIPLE CAUSES

For the 128,544 deaths registered in 2001, there were 364,473 causes reported (including 15,827 injuries) giving a mean 2.8 causes per death. In 21% of all deaths, only one cause was reported. The average number of causes reported per death varies with age, sex and underlying cause of death. Deaths as a result of External causes recorded 3.4 causes (including injuries) per death in 2001, with deaths as a result of Accidental falls averaging 4.3 causes, reflecting the number of injuries sustained.


RELATIONSHIP OF CAUSES

The following matrix illustrates relationships between the various causes of death in 2001. For example, malignant neoplasms, the leading underlying and multiple cause, was reported alone in 39% of cases and has a relatively low incidence of being reported with other leading causes. In contrast, of the 1,704 deaths caused by Renal failure, it was reported alone on only 8.3% of deaths but is often reported with Ischaemic heart diseases and Heart failure.

LEADING MULTIPLE CAUSES WITH ASSOCIATED CAUSES
Reported with selected associated causes...............................................................
Leading multiple
causes reported as
the underlying cause
Total no.
of deaths
Reported alone %
Malignant neoplasms C00-C97
%
Ischaemic heart
diseases I20-I25
%
Cerebro-
vascular diseases
I60-I69
%
Influenza
and pneumonia J10-J18
%
Heart failure
I50
%
Chronic lower respiratory disease J40-J477
%
Renal failure N17-N19
%

Malignant neoplasms
(C00-C97)
36,750
38.8
. .
7.1
3.6
8.3
3.6
5.6
5.5
Ischaemic heart diseases (I20-I25)
26,234
13.4
5.8
. .
9.2
5.5
23.6
9.8
9.7
Cerebrovascular diseases (I60-I69)
12,146
26.2
4.4
10.2
. .
16.1
5.5
3.5
3.8
Influenza and pneumonia
(J10-J18)
2,702
35.0
2.1
13.4
3.8
. .
5.6
2.6
8.9
Heart failure (I50)
2,612
12.9
5.9
0.5
8.1
28.9
. .
10.5
19.2
Chronic lower respiratory
diseases (J40-J47)
5,916
7.9
6.7
17.1
4.9
31.4
18.1
. .
6.9
Renal failure (N17-N19)
1,704
8.3
4.8
26.5
8.1
12.4
29.0
5.8
. .



SECTION 3 PERINATAL DEATHS


INTRODUCTION

Perinatal deaths comprise stillbirths (fetal deaths) and deaths of infants within the first 28 days of life (neonatal deaths). In Causes of Death 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 2001, there were 2,092 perinatal deaths registered in Australia, which represented a marginal increase over the 2,076 deaths registered in 2000. The perinatal death rate also slightly increased from 8.3 to 8.4 deaths per 1,000 total relevant births (see Glossary, death rates for further information). In 2001, there were 1,290 fetal deaths and 802 neonatal deaths. Fetal deaths decreased by 1% on the number registered in 2000 while neonatal deaths increased by 4%.

Between 1991 and 2001 the perinatal death rate declined from 10.6 to 8.4 deaths per 1,000 births. During this period the fetal rate declined by 19% (6.4 to 5.2 per 1,000 births) whilst the neonatal rate fell by 23% (4.3 to 3.3 per 1,000 births).

Graph - Trends in perinatal deaths



SEX RATIO

In 2001, the sex ratio of male fetal deaths for every 100 female fetal deaths was 114, while the sex ratio in neonatal deaths was 152 which is the highest reported in the time period 1991-2001.

Graph - Trends in sex ratios



AGE OF MOTHER

In 2001, 53% of total perinatal deaths were to mothers aged 25-29 and 30-34 years. While these age groups recorded the highest numbers of perinatal deaths, the death rates of 7.4 and 7.0 per 1,000 births respectively, were the lowest of all age groups. The highest rate is in mothers under 20 years (15.7), while for mothers aged 40 and over, the rate is 11.6.

In the last ten years, the overall perinatal death rate has decreased by 21%. The extent of this decrease, however, has not been uniform across all age groups. In particular, the perinatal death rate of 11.6 per 1,000 births for the 40 years and over age group is 44% lower than the 1991 rate of 20.8 per 1,000 births.

Graph - Perinatal death, rates, age of mother



CONDITION IN FETUS/INFANT

In 2001, 43% of fetal deaths were not allocated to a specific cause of death. Medical certifiers are often unwilling or unable to provide an accurate cause of death without the assistance of an autopsy. The major specified conditions reported in fetal deaths registered in 2001 were intrauterine hypoxia (19% of total), congenital malformations, deformations and chromosomal abnormalities (13%) and disorders related to length of gestation and fetal growth (10%). Congenital malformations, deformations and chromosomal abnormalities accounted for 26% of total neonatal deaths registered in 2001, while respiratory and cardiovascular disorders, specific to the perinatal period (21%) and disorders related to length of gestation and fetal growth (20%) were the other major contributors.


CONDITION IN MOTHER

The underlying cause for perinatal deaths can be attributed to a condition relating to the fetus/infant, the mother or both. A maternal condition was reported in 1,431 (68%) of the 2,092 perinatal deaths recorded in 2001. Complications of placenta, cord and membranes was the most frequently reported maternal cause, accounting for 647 deaths or 31% of all perinatal deaths.

In 2001, maternal complications of pregnancy occurred in 452 perinatal deaths, an increase of 9.4% on last year. Multiple pregnancy is the most common maternal complication of pregnancy and was reported in 153 perinatal deaths which represents an increase of 28% on the number recorded in 2000, but is 21% lower than the peak that occurred in 1995.


SECTION 4 YEAR OF OCCURRENCE


INTRODUCTION

Information contained in the preceding sections in this publication refers to deaths registered by the state and territory Registrars-General during the calendar year 2001. 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 Australian has shown that the number of deaths registered after the second year are of little significance (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.

Commencing with this year's edition of Causes of Death, Australia, the ABS will not only release the most recent data on a year of registration basis, but also 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 128,784 deaths that occurred in 2000 were registered 2000, only 88% of the 2,111 Indigenous deaths and 93% of deaths due to External causes that occurred in 2000 were registered in that year.


COMPARISON OF LEADING UNDERLYING CAUSES IN 2000

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 2000. The two causes with the biggest differences are Accidents and Intentional self-harm. These deaths are subject to coronial enquiry which can cause delays in the registration process.

LEADING UNDERLYING CAUSES OF DEATH
Year of Registration
2000
Year of occurrence
2000
Difference
Cause of death and ICD code
no.
no.
% (a)

All Causes
128,291
128,784
0.38
Malignant neoplasm (cancer) (C00-C97)
35,628
35,825
0.55
Ischaemic heart diseases (I20-I25)
26,521
26,606
0.32
Cerebrovascular diseases (stroke) (I60-I69)
12,300
12,346
0.37
Chronic lower respiratory disease (including asthma, emphysema and bronchitis) (J40-J47)
5,962
5,998
0.60
Accidents (V01-X59)
5,138
5,191
1.03
Diabetes mellitus (E10-E14)
3,006
3,009
0.10
Influenza and pneumonia (J10-J18)
2,937
2,939
0.07
Diseases of arteries, arterioles and capillaries (including atherosclerosis and aortic aneurysm) (I70-I79)
2,617
2,612
-0.19
Heart failure (I50)
2,644
2,633
-0.42
Intentional self harm (X60-X84)
2,363
2,388
-1.06
All other causes
29,175
29,237
0.21

(a) A positive percentage difference indicates that more deaths were reported on a year of occurrence basis.

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