3303.0 - Causes of Death, Australia, 2016

ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 27/09/2017

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Understanding diabetes mortality in Australia

Diabetes in Australia

Diabetes is a chronic metabolic condition where glucose levels are too high within the bloodstream. It is a manageable condition, but despite this it can lead to many complications which cause or contribute to a person's death. In 2016, Diabetes mellitus (E10-E14) was the underlying cause of 4,770 deaths, making it the seventh leading cause of death overall. The standardised death rate from diabetes was 16.2 deaths per 100,000 people, and there have been consistently higher rates of death among males compared to females. The death rate has decreased marginally over the past 10 years from 16.7 to 16.2 deaths per 100,000 people.

Prior to 2016, diabetes was consistently the sixth leading cause of death in Australia. However, a change to the grouping for colorectal cancers has altered the rankings for leading causes of death in Australia, meaning that diabetes has moved to the seventh leading cause and colorectal cancer to the sixth leading cause of death. Backcasted figures using the new leading cause tabulation for colorectal cancer, ranks diabetes as the seventh leading cause of death in a ten year time series. Please see Australia's Leading Causes of Death article and Explanatory Note 37 for further information on this change.

Graph Image for Standardised death rates for Diabetes (E10-E14) in Australia, per 100,000, 2007-2016 (a)(b)(c)(d)

Footnote(s): (a) Standardised death rate. Deaths per 100,000 of estimated mid-year population. See Glossary for further information. (b) All causes of death data from 2006 onward are subject to a revisions process - once data for a reference year are 'final', they are no longer revised. Affected data in this table are: 2007-2013 (final), 2014 (revised), 2015-2016 (preliminary). See Explanatory Notes 55-58. See also Causes of Death Revisions, 2012 and 2013 (Technical Note) in Causes of Death, Australia, 2014 (cat. no. 3303.0). (c) The age-standardised death rates for 2012-2015 presented in this table have been recalculated using 2016-census-based population estimates. As a result, these rates may differ from those previously published. (d) Deaths registered on Norfolk Island from 1 July 2016 are included in this publication for the first time, see Explanatory Notes 12-15.

Source(s): Standardised death rates for Diabetes (E10-E14) in Australia, per 100,000, 2007-2016 (a)(b)(c)(d)-Standardised death rates for Diabetes Mellitus (E10-E14) in Australia, per 100,000, 2007-2016

For those deaths where diabetes is the underlying cause, it is common for multiple chronic conditions to also appear on the death certificate. In 2016 there were an average of 5.1 conditions listed on death certificates where diabetes was the underlying cause, compared with 3.3 conditions listed on all death certificates. Conditions commonly associated with diabetes include heart and kidney diseases. Conditions commonly associated with deaths from diabetes are shown in the graph below.

Graph Image for Deaths due to Diabetes and associated leading causes, 2016 (a)(b)(c)(d)(e)

Footnote(s): a) This graph presents deaths for which Diabetes (E10-E14) is the underlying cause of death. The underlying cause of death refers to the disease or injury which initiated the train of morbid events leading directly to death. (b) Associated causes of death are all causes listed on the death certificate other than the underlying cause of death. (c) The associated causes listed are based on the WHO tabulation of leading causes. See Explanatory Notes 35-37 for further information. Groupings of deaths coded to Chapter XVIII: Symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99) are not included in analysis, due to the unspecific nature of these causes. (d) Causes of death data for 2016 are preliminary and subject to a revisions process. See Explanatory Notes 55-58. (e) Deaths registered on Norfolk Island from 1 July 2016 are included in this publication for the first time, see Explanatory Notes 12-15.

Source(s): Deaths due to Diabetes and associated leading causes, 2016 (a)(b)(c)(d)(e)-Deaths due to diabetes and its leading associated causes, 2016

Diabetes-related deaths

Diabetes is more likely to be reported as an associated cause of death as opposed to an underlying cause of death. In these instances, the doctor certifying the death recognises that diabetes has contributed to the train of events leading to the person's death, but that it did not initiate that train of events.

The relationship between diabetes and certain other conditions such as heart disease, stroke, kidney diseases and other vascular diseases is complex. These conditions often occur concurrently and diabetes can cause or exacerbate these conditions in different circumstances. Where one of these conditions is the underlying cause of death and diabetes is an associated cause, these deaths can be termed diabetes-related. A full list of conditions used to determine the number of diabetes-related deaths is provided at the end of this article.

Using this definition, there were 8,327 diabetes-related deaths in 2016. The standardised death rate for diabetes-related deaths was 28.1 deaths per 100,000 people compared to 16.2 for deaths where diabetes was the underlying cause. Again males have a consistently higher death rate than females, and there has been a marginal decrease in the death rate over time.

There were many more deaths from other underlying causes where diabetes was also mentioned on the death certificate. In 2016, there were a total of 16,451 deaths (10.4% of all deaths) where diabetes was mentioned on the death certificate and therefore considered a contributory factor in the death.

Aboriginal and Torres Strait Islander population

While Diabetes (E10-E14) is the seventh leading cause of death among the entire population, it was the second leading cause of death of Aboriginal and Torres Strait Islander Australians. In 2016, diabetes accounted for 228 (7.8%) of all Aboriginal and Torres Strait Islander deaths. The standardised death rate for diabetes was 5.0 times higher for Aboriginal and Torres Strait Islander Australians compared to non-Indigenous Australians in 2016 (81.2 and 16.4 deaths per 100,000 people, respectively).

Counts of Aboriginal and Torres Strait Islander deaths include those recorded in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory. Data for Victoria, Tasmania and the Australian Capital Territory have been excluded in line with national reporting guidelines (for information on issues with Aboriginal and Torres Strait Islander identification, see Explanatory Notes 59-70).

Graph Image for Age-standardised death rates for Diabetes (E10-E14), Indigenous Status, per 100,000, 2012-2016 (a)(b)(c)(d)(e)

Footnote(s): (a) Standardised death rate. Deaths per 100,000 of estimated mid-year population. See Glossary for further information. (b) Data are reported by jurisdiction of usual residence for NSW, Qld, WA, SA and the NT only. Data for Victoria, Tasmania and the Australian Capital Territory have been excluded in line with national reporting guidelines. For information on issues with Aboriginal and Torres Strait Islander identification, see Explanatory Notes 59-70 (c) Causes of death data for 2016 are preliminary and subject to a revisions process, see Explanatory Notes 55-58 (d) The age-standardised death rates for 2012-2015 presented in this table have been recalculated using 2016-census-based population estimates. As a result, these rates may differ from those previously published. (e) Deaths registered on Norfolk Island from 1 July 2016 are included in this publication for the first time, see Explanatory Notes 12-15.

Source(s): Age-standardised death rates for Diabetes (E10-E14), Indigenous Status, per 100,000, 2012-2016 (a)(b)(c)(d)(e)-Age-Standardised death rates for Diabetes (E10-E14) by Indigenous Status, per 100,000, 2012-2016

Using the same construct for counting the number of diabetes-related deaths, there were 335 diabetes-related deaths among Aboriginal and Torres Strait Islander people in 2016, with a standardised death rate of 114.4 deaths per 100,000 people. There were 557 deaths of Aboriginal and Torres Strait Islander people in 2016 where diabetes was mentioned on the death certificate. Diabetes was a factor in 19.1% of Aboriginal and Torres Strait Islander deaths.

Diabetes-related deaths, specified ICD-10 codes(a)(b)

Diabetes-Related Deaths	ICD-10 Codes

Diabetes is listed as the underlying cause of death	E10, E11, E13, E14, O24
Diabetes is listed as an associated cause of death, where the underlying cause of death was one of:
Myocardial infarction (heart attack)	I21–I22
Ischaemic heart disease	I20,I24,I25
Stroke or sequelae of stroke	I60–I64, I69.0–I69.4
Heart failure	I50
Sudden death (cardiac arrest)	I46
Peripheral vascular disease	I70–I74
Kidney disease	N00–N28
Hyperglycaemia	R73
Hypoglycaemia	E16.1–E16.2


(a) Source National indicators for monitoring diabetes, AIHW 2007
(b) ‘Diabetes-related deaths’ is based on the definition of ‘deaths related to diabetes’ used in the United Kingdom Prospective Diabetes Study (UKPDS 1998). The UKPDS definition has been modified by diabetes specialists on the National Diabetes Data Working Group (NDDWG) to include ischaemic heart disease, sequelae of stroke and heart failure, and other commonly recognised complications of diabetes.