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3303.0 - Causes of Death, Australia, 2006 Quality Declaration 
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 14/03/2008   
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TECHNICAL NOTE 2 CORONER CERTIFIED DEATHS


INTRODUCTION

1 In order to complete a death registration, the death must be certified by either a doctor using the Medical Certificate of Cause of Death, or by a coroner. For information regarding the types of deaths certified by a Coroner, please refer to Explanatory Note 35.


2 Further information on coronial certified deaths and ABS processing can be obtained in Information Paper: External Causes of Death, Data Quality and Information Paper: Overview of ABS Causes of Death Collection (cat. no. 3317.0.55.002).


3 All causes of death can be grouped to describe the type of death whether it be from a disease or condition, or is from an injury or whether the cause is unknown. These are generally described as:

  • Natural Causes - are deaths due to a diseases (for example diabetes, cancer, heart, disease etc)
  • External Causes- are deaths due to causes external to the body (for example suicide, transport accidents, falls, poisoning etc).
  • Unknown Causes - are deaths where it is unable to be determined whether the cause was natural or external

4 It is the role of the coroner to investigate the circumstances surrounding all reportable deaths and to establish wherever possible the circumstances surrounding the death, and the cause(s) of death. When coronial investigations are complete, causes of death information is passed to the Registrar of Births, Deaths and Marriages, as well as to the National Coronial Information System (NCIS). The ABS accesses information on the NCIS in order to code coroner certified deaths. Where a case remains open on the NCIS at the time that the ABS ceases processing, all available information is used by the ABS to code the cause of death.


5 The following diagram describes registered deaths in 2006 with regard to the type of certifier, the "type" of death and whether information was available on the NCIS at the end of the ABS 2006 Causes of Death processing period.

Diagram: Introduction



Type of Certifier

6 ABS Causes of death processing is finalised at a point in time. This may mean that not all deaths registered in the reference year which were referred to the coroner, have been investigated, the case closed and relevant information loaded to the NCIS. The coronial process can take several years if an inquest is being held or complex investigations are being undertaken. However, any general increase in the length of coronial investigations (or in the workload of coroners) or, the timeliness of input of coronial findings to the NCIS, has the potential to affect data quality in terms of specificity given that the need for timely information limits the amount of time available to wait for the findings of the longer cases. The fact that a case is still open limits the amount of information available to the ABS in order to be able to code causes of death, and may result in a less specific code being allocated consistent with ICD-10 coding rules.


7 For deaths registered in 2006, 12.7% were certified by a Coroner. There are variations between jurisdictions, from 11.3% in New South Wales to 32.2% in the Northern Territory.

DEATHS, By Type of Certifier - 2006

Doctor
Coroner
Total
no.
%
no.
%
no.
%

NSW
40 510
88.7
5 160
11.3
45 670
100.0
Vic.
28 813
86.5
4 513
13.5
33 326
100.0
Qld
21 729
88.2
2 915
11.8
24 644
100.0
SA
10 070
84.3
1 876
15.7
11 946
100.0
WA
10 139
85.0
1 523
15.0
11 662
100.0
Tas.
3 454
88.3
460
11.7
3 914
100.0
NT
624
67.8
297
32.2
921
100.0
ACT
1 347
81.4
309
18.6
1 656
100.0
Aust.
116 686
87.3
17 053
12.7
133 739
100.0


OPEN AND CLOSED CASES ON NCIS

8 Of those deaths which were certified by a Coroner, 73% had a status of "closed" on NCIS and had full information available to the ABS in order to undertake cause of death coding. The proportion of cases which have a status of "open" on the NCIS varies significantly between jurisdictions. At an Australian level 17% of cases had a status of open at the cessation of ABS processing , with a low of 10% in Victoria to a high of 65% in Queensland. The ABS contacted all Coronial Registrars seeking information on any finalised coronial investigations which were not as yet finalised on the NCIS. Both New South Wales and Queensland provided information which indicates that of the cases with a status of "open" on NCIS for those jurisdiction, approximately 80% have been finalised by the Coroner but had not yet been loaded to the NCIS. No other jurisdiction indicated any significant backlog. Taking into account any apparent administrative backlog in loading data to the NCIS, it appears that approximately 10 - 20% of coronial cases are still under investigation 1 year after the end of the reference period.


9 Open cases accounted for 3.4% of all deaths registered in 2006. The cases with a status of "open" on the NCIS, were investigated with regard to whether the cases were of an unknown cause, natural cause or external cause. Nearly a third (29%) of external causes and two thirds of unknown causes (65%) remained open on the NCIS at the close of processing. A small proportion of natural cause deaths (1.4%) also remained open.

Open Coroner's cases, by type of cause - 2006

NSW
Vic.
QLD
SA
WA
Tas.
NT
ACT
Aust.

External Cause
691
313
748
121
220
36
26
11
2 166
Natural Cause
775
127
703
86
42
12
10
22
1 777
Unknown Cause
153
12
450
8
61
5
8
7
704
Total
1 619
452
1 901
215
323
53
44
40
4 647


10 704 open cases (15%) had insufficient information recorded on NCIS in order to be able to determine any cause of death. These records have been coded to R99 Other ill-defined and unspecified causes of mortality.


11 1777 open cases (38%) had enough information to determine that the cause of death was a natural cause i.e. would be coded to Chapters I to XVII. Of these cases, 459 (26%) were cases relating to chronic heart disease and 228 (13%) related to acute myocardial infarction (heart attack). Overall 1173 (66%) of open cases which were identified as natural causes related to Chapter IX Circulatory Diseases. The remaining 604 (38%) cases were related to a range of other Chapters.


12 Nearly half of all open cases (47%) 2,166 related to external causes. Of the 7,840 deaths attributed to external causes in 2006, 29% were open cases on the NCIS.


Issues for open cases on NCIS

13 Further analysis has been completed of open cases on NCIS to consider mechanism of injury for those cases that were coded to external causes.

Open cases on NCIS at end of ABS Processing which relate to external causes - 2006

NSW
Vic.
QLD
SA
WA
Tas.
NT
ACT
Aust.

Hanging
83
24
136
16
34
8
3
-
304
Falls
37
25
53
11
19
3
-
1
149
Poisoning
128
56
67
24
41
7
1
3
327
Drowning
37
6
43
2
5
-
-
-
93
Transport accidents
92
114
267
21
81
10
9
3
597
Firearms
25
8
35
1
8
1
1
2
81
Sharp objects
20
27
25
5
5
3
6
2
93
Other external causes
62
43
64
23
15
3
4
-
214
Unspecified external cause
207
10
58
18
12
1
2
-
308
Total
691
313
748
121
220
36
26
11
2 166

- nil or rounded to zero (including null cells)


14 Cases related to Transport Accidents accounted for 27% of all open external cause cases, with Poisonings and Hangings accounting for 15% and 14% respectively at a national level. Unspecified causes accounted for 14% of cases. The types of cases still open on NCIS at the cessation of ABS processing vary in proportion across the states and territories, with no discernible pattern.


15 The specificity with which open cases are able to be allocated an ICD-10 code will be directly related to the amount and type of information available on the NCIS. The amount of information available for open cases varies considerably from no information to detailed police, autopsy and toxicology reports. There may also be interim findings of intent. If no information is available about the death on NCIS. The diagram below represents the decision flow for treatment of open cases on NCIS when assigning ICD-10 codes.

Diagram: Issues for open cases on NCIS


16 The causes of death statistics are not currently revised once a coronial enquiry is finalised, even if additional information subsequently becomes available. At the cessation of ABS causes of death processing, ICD-10 coding occurs using whatever information is available on the NCIS.


17 The results of this study are currently being considered by the ABS with regard to possible introduction of a "revisions" process for causes of death commencing with regard to the 2007 reference year. Initial consultation with major users has commenced. An information paper will be released prior to the publication of 2007 Causes of Death which will inform users of the ABS proposed strategy, processes and data implications for a revisions process.



Issues for Closed Cases on NCIS

Intent

18 The manner or "intent" of an injury which leads to death, is determined by whether the injury was inflicted purposefully or not (in some cases, intent cannot be determined) and, when it is inflicted purposefully (intentional), whether the injury was self-inflicted (suicide) or inflicted upon another person (assault).


19 The determination of "intent" for each death (whether intentional self harm, accidental, homicide, undetermined intent) is essential for determining the appropriate ICD-10 code to use for a death.. However, coroners' practices to determine the intent of a death may vary across the states and territories. In general, coroners may be reluctant to determine suicidal intent (particularly in children and young people). In some cases, no statement of intent will be made by a coroner. The reasons may include legislative or regulatory barriers, sympathy with the feelings of the family, or sensitivity to the cultural practices and religious beliefs of the family. For some mechanisms of death where it may be very difficult to determine suicidal intent (e.g. single vehicle accidents, drownings), the burden of proof required for the coroner to establish that the death was suicide may make a finding of suicide less likely. There also may be a reluctance by Coroners to make a final determination of Assault until legal proceedings have been finalised


20 The NCIS records intent on both open and closed cases. Where a case is closed, the ABS codes the cause of death details using the final determination of intent. Where a case remains open on the NCIS at the time that the ABS ceases processing, the "intent at notification" which is recorded on NCIS is utilised by the ABS to code the cause of death.


21 The table below indicates ICD-10 codes that will be allocated according to the intent notification which appears on the NCIS.

Concordance of NCIS intent codes and ICD10 Codes

ICD-10
NCIS "Intent" Responses

Transport Accidents (V01-V99)
Unintentional
Other external causes of accidental injury '(W00-W99)
Unintentional
Sequelae of transport and other accidents (Y85-Y86)
Unintentional
Sequelae of other external causes and supplementary factors (Y89-Y98)
Unintentional
Intentional self-harm (X60-X84, Y87)
Intentional self-harm
Assault ( X85-Y09,Y87)
Assault
Legal intervention (Y35)
Legal intervention
Operations of war (Y36)
Operations of war, civil conflict and acts of terrorism
Complications of medical or surgical care (Y40-Y84, Y88)
Complications of medical or surgical care
Undetermined intent (Y10-Y34, Y87)
Undetermined intent
Transport Accidents (V01-V99)
Still enquiring
Other external causes of accidental injury (W00-W59)
Still enquiring
Sequelae of transport and other accidents (Y85-Y86)
Still enquiring
Sequelae of other external causes and supplementary factors (Y89-Y98)
Still enquiring Sequelae of other external causes and supplementary factors
Undetermined intent ( Y10-Y34), Y87
Unlikely to be known


22 A coronial case may be closed and all information be uploaded to the NCIS, however not have any record of "intent" on the closed case. At the time of the cessation of ABS processing of 2006 causes of death data, 273 deaths which were registered in 2006, had a status of "closed" on NCIS, however there was no intent specified. This represents 3.6% of all external causes. The majority (60%) of these type of records were in Victoria with a mechanism of injury of "falls".

Registered Deaths which had a status of "closed" on NCIS, by mechanism - by State or Territory - 2006

NSW
Vic
QLD
SA
WA
TAS
NT
ACT
AUST

Hanging
1
2
1
-
2
-
-
-
6
Falls
2
161
2
2
1
1
-
-
169
Poisoning
19
38
13
2
3
-
-
-
75
Other external Cause
3
8
5
4
3
-
-
-
23
Total
25
209
21
8
9
1
-
-
273

- nil or rounded to zero (including null cells)


23 These 273 records have been coded to the following codes:

ICD10 codes assigned, by cause of death

ICD10 Codes

Hanging W76
Falls W00-W19
Poisoning X40 - X49
Other external Cause V01 - V99, W20 - W75, W77- W99, X00 - X39, X50- X59,X85 - X99, Y00-Y09, Y35- Y98


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