3303.0 - Causes of Death, Australia, 2013 Quality Declaration 
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TECHNICAL NOTE 3 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 cause of death and from information stored within reports on the NCIS, see Explanatory Notes 55-57 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 2011 data are final, 2012 data are revised, and 2013 data are preliminary. The 2012 and 2013 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 2007-2011 reference years.


IMPACT OF REVISIONS

3 Table 1 illustrates preliminary, revised and final data for the 2011 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, 2011

2011 reference year
Change (prelim to final)
P
R
F
Cause of death and ICD-10 code
no
no
no
no
%

R99
703
567
550
-153
-21.8%
X59, X84, Y09
82
48
44
-38
-46.3%
Y10-Y34
470
328
275
-195
-41.5%


4 Table 2 provides further information on the impact of the revisions process for the 2011 reference year at the ICD-10 chapter level. As expected, the chapter to record the greatest change in the 2011 reference year is Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), which decreased by 134 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 134 deaths from this chapter were re-coded to External causes of morbidity and mortality (V01-Y98) through the revisions process. This chapter increased by 86 deaths (0.9%) from preliminary to final coding for the 2011 reference year.

TABLE 2 - CAUSES OF DEATH REVISIONS , (PRELIMINARY, REVISED, FINAL) - by ICD-10 chapter - 2011 reference year

2011 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)
2 400
2 400
2 400
0
0.0
Neoplasms (C00-D48)
43 721
43 731
43 732
11
0.0
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism D50-D89
467
468
468
1
0.2
Endocrine, nutritional and metabolic diseases (E00-E90)
6 077
6 080
6 080
3
0.0
Mental and behavioural disorders (F00-F99)
7 631
7 644
7 641
10
0.1
Diseases of the nervous system (G00-G99)
6 741
6 744
6 744
3
0.0
Diseases of the circulatory system (I00-I99)
45 622
45 634
45 637
15
0.0
Diseases of the respiratory system (J00-J99)
12 529
12 517
12 518
-11
-0.1
Diseases of the digestive system (K00-K93)
5 199
5 208
5 210
11
0.2
Diseases of the skin and subcutaneous tissue (L00-L99)
441
443
443
2
0.5
Diseases of the musculoskeletal system and connective tissue (MOO-M99)
1 170
1 172
1 172
2
0.2
Diseases of the genitourinary system (N00-N99)
3 478
3 477
3 476
-2
-0.1
Certain conditions originating in the perinatal period (P00-P96)
614
612
612
-2
-0.3
Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
546
550
550
4
0.7
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
1 143
1 025
1 009
-134
-11.7
External causes of morbidity and mortality (V01-Y98)
9 123
9 196
9 209
86
0.9
Total(a)
146 932
146 932
146 932
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 2007 to 2011. 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 - 2007, 2008, 2009, 2010 and 2011

2007
2008
2009
2010
2011
Cause of death and ICD-10 code
%
%
%
%
%

Certain infectious and parasitic diseases (A00-B99)
-0.1
1.8
0.3
0.2
0.0
Neoplasms (C00-D48)
0.1
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
0.8
0.2
0.2
0.5
0.2
Endocrine, nutritional and metabolic diseases (E00-E90)
0.5
-0.2
0.3
0.2
0.0
Mental and behavioural disorders (F00-F99)
-0.4
-0.5
-0.1
0.1
0.1
Diseases of the nervous system (G00-G99)
0.3
0.4
0.1
0.1
0.0
Diseases of the circulatory system (I00-I99)
0.7
0.4
0.2
0.0
0.0
Diseases of the respiratory system (J00-J99)
0.4
0.1
0.0
0.1
-0.1
Diseases of the digestive system (K00-K93)
0.9
0.6
0.1
-0.2
0.2
Diseases of the skin and subcutaneous tissue (L00-L99)
0.6
-0.5
0.8
-0.3
0.5
Diseases of the musculoskeletal system and connective tissue (MOO-M99)
1.3
-0.7
0.0
0.1
0.2
Diseases of the genitourinary system (N00-N99)
0.2
0.4
0.1
0.0
-0.1
Certain conditions originating in the perinatal period (P00-P96)
1.6
0.2
-0.3
0.0
-0.3
Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
3.7
0.8
0.9
0.8
0.7
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
-46.4
-31.4
-29.9
-16.5
-11.7
External causes of morbidity and mortality (V01-Y98)
4.3
1.1
2.1
1.2
0.9


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 2011 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:
  • Event of undetermined intent (Y10-Y34) (-195 deaths);
  • Other ill-defined and unspecified causes of mortality (R99) (-153 deaths);
  • Other land transport accidents (V80-V89) (-63 deaths); and
  • Occupant of pick-up truck or van injured in transport accident (V50-V59) (-51 deaths) (see discussion below).

Notable increases include:
  • Car occupant injured in transport accident (V40-V49) (123 deaths);
  • Intentional self-harm (X60-X84) (120 deaths);
  • Assault (X85-Y09) (55 deaths);
  • Falls (W00-W19) (27 deaths); and
  • Accidental poisoning by and exposure to noxious substances (X40-X49) (21 deaths)

The revisions process not only enables an improvement in the specificity of causes of death codes that can be applied to deaths, but also enables coding improvements to be applied to open cases. For example, Tables 4 and 5, below, show a decrease in the number of deaths due to Occupant of pick-up truck or van injured in transport accident (V50-V59) in the 2011 reference year. This cause decreased by 92.7% when comparing preliminary (55 deaths) and final (4 deaths) data for the 2011 reference year. This decrease is due to an improvement in quality assurance measures, which resulted in the more accurate coding of these transport accident deaths involving a utility vehicle to Car occupant injured in transport accident (V40-V49).

TABLE 4: CAUSES OF DEATH REVISIONS (PRELIMINARY, REVISED, FINAL), by ICD-10 selected causes - 2011

2011
Change (preliminary to final)
Preliminary
Revised
Final
Cause of death and ICD-10 code
no.
no.
no.
no
%

Sudden infant death syndrome (R95)
63
82
84
21
33.3
Other ill-defined and unspecified causes of mortality (R99)
742
606
589
-153
-20.6
Pedestrian injured in transport accident (V01-V09)
224
235
236
12
5.4
Pedal cyclist injured in transport accident (V10-V19)
30
32
32
2
6.7
Motorcycle rider injured in transport accident (V20-V29)
213
216
219
6
2.8
Car occupant injured in transport accident (V40-V49)
670
781
793
123
18.4
Occupant of pick-up truck or van injured in transport accident (V50-V59)
55
4
4
-51
-92.7
Occupant of heavy transport vehicle injured in transport accident (V60-V69)
25
33
34
9
36.0
Other land transport accidents (V80-V89)
160
105
97
-63
-39.4
Water transport accidents (V90-V94)
99
105
105
6
6.1
Air and space transport accidents (V95-V97)
39
44
44
5
12.8
Falls (W00-W19)
1 845
1 867
1 872
27
1.5
Exposure to inanimate mechanical forces (W20-W49)
92
85
84
-8
-8.7
Accidental drowning and submersion (W65-W74)
169
166
167
-2
-1.2
Other accidental threats to breathing (W75-W84)
226
234
239
13
5.8
Exposure to smoke, fire and flames (X00-X09)
81
81
83
2
2.5
Exposure to forces of nature (X30-X39)
68
77
77
9
13.2
Accidental poisoning by and exposure to noxious substances (X40-X49)
987
990
1 008
21
2.1
Accidental exposure to other and unspecified factors (X58-X59)
730
721
719
-11
-1.5
Intentional self-harm (X60-X84)(a)
2 272
2 379
2 392
120
5.3
Assault (X85-Y09)
188
229
243
55
29.3
Event of undetermined intent (Y10-Y34)
470
328
275
-195
-41.5
Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59)
84
79
79
-5
-6.0
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)
181
183
184
3
1.7
Sequelae of external causes of morbidity and mortality (Y85-Y89)
147
152
152
5
3.4


(a) Care needs to be taken in interpreting figures relating to suicide. See Explanatory Notes 87-93.


7 Table 5 shows the percentage change between preliminary and final data for 2007, 2008, 2009, 2010 and 2011 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 Exposure to forces of nature (X30-X39) increased by 13.2% (68 to 77) from preliminary to final 2011 data, whilst deaths due to Accidental exposure to other and unspecified factors (X58-X59) dropped from 730 to 719 (11%).
  • Deaths due to Other land transport accidents (V80-V89) saw a decrease from 160 to 97 (39.4%) in preliminary to final 2011 data.
  • Deaths due to Occupant of pick-up truck or van injured in transport accident (V50-V59) decreased from 55 to 4 (92.7%), whilst deaths due to Car occupant injured in transport accident (V40-V49) increased by 18.4%, from 670 to 793. This was a combination of both the revisions process, as well as an improvement in quality assurance measures and coding accuracy during the revisions period (see Technical Note, Causes of Death Revisions 2010 and 2011, Causes of Death, Australia, 2012).
    TABLE 5 - Cause of Death Revisions, by ICD-10 selected causes - Percentage change between preliminary and final data - 2007, 2008, 2009, 2010 and 2011

    Cause of death and ICD-10 code
    2007
    2008
    2009
    2010
    2011

    Sudden infant death syndrome (R95)
    15.5
    30.5
    21.8
    17.3
    33.3
    Other ill-defined and unspecified causes of mortality (R99)
    -68.1
    -46.5
    -51.3
    -30.0
    -20.6
    Pedestrian injured in transport accident (V01-V09)
    26.9
    24.6
    25.3
    7.5
    5.4
    Pedal cyclist injured in transport accident (V10-V19)
    32.4
    16.7
    5.7
    0.0
    6.7
    Motorcycle rider injured in transport accident (V20-V29)
    25.0
    19.5
    14.7
    6.8
    2.8
    Car occupant injured in transport accident (V40-V49)
    20.8
    11.7
    14.8
    19.0
    18.4
    Occupant of pick-up truck or van injured in transport accident (V50-V59)
    39.6
    102.9
    36.2
    -65.2
    -92.7
    Occupant of heavy transport vehicle injured in transport accident (V60-V69)
    56.3
    26.8
    10.0
    14.3
    36.0
    Other land transport accidents (V80-V89)
    84.5
    3.7
    -34.6
    -28.7
    -39.4
    Water transport accidents (V90-V94)
    16.1
    15.6
    37.1
    11.6
    6.1
    Air and space transport accidents (V95-V97)
    47.2
    9.1
    22.2
    8.3
    12.8
    Falls (W00-W19)
    12.4
    8.4
    5.8
    2.6
    1.5
    Exposure to inanimate mechanical forces (W20-W49)
    30.5
    17.6
    0.0
    0.0
    -8.7
    Accidental drowning and submersion (W65-W74)
    4.4
    15.7
    9.9
    0.5
    -1.2
    Other accidental threats to breathing (W75-W84)
    4.1
    7.7
    5.5
    0.5
    5.8
    Exposure to smoke, fire and flames (X00-X09)
    24.1
    16.7
    4.1
    22.4
    2.5
    Exposure to forces of nature (X30-X39)
    5.8
    3.4
    4.9
    4.5
    13.2
    Accidental poisoning by and exposure to noxious substances (X40-X49)
    32.7
    40.8
    25.7
    17.2
    2.1
    Accidental exposure to other and unspecified factors (X58-X59)
    -18.2
    -12.3
    -1.1
    -1.3
    -1.5
    Intentional self-harm (X60-X84)(a)
    18.5
    6.8
    9.6
    5.0
    5.3
    Assault (X85-Y09)
    33.3
    23.6
    29.5
    18.9
    29.3
    Event of undetermined intent (Y10-Y34)
    -66.7
    -57.7
    -60.7
    -55.0
    -41.5
    Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59)
    1.7
    6.3
    -1.7
    -2.7
    -6.0
    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)
    -2.1
    -3.2
    6.4
    3.4
    1.7
    Sequelae of external causes of morbidity and mortality (Y85-Y89)
    2.1
    -1.9
    -3.8
    2.5
    3.4

    (a) Care needs to be taken in interpreting figures relating to suicide. See Explanatory Notes 87-93.