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3303.0 - Causes of Death, Australia, 2008 Quality Declaration 
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 31/03/2010   
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TECHNICAL NOTE 1 2008 COD COLLECTION - PROCESS IMPROVEMENTS


INTRODUCTION

1 This Technical Note contains information on two processing improvements which have been introduced to the causes of death collection for the release of 2008 preliminary data. These improvements relate to the way the ABS codes coroner certified deaths and have had the effect of significantly improving the quality of cause of death codes assigned to coroner certified cases.

2 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. 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. Generally most deaths due to external causes will be referred to a coroner for investigation; these include those deaths which are possible instances of Intentional self-harm [Suicide].

3 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 Coroners Information System (NCIS). The ABS uses the NCIS as the only source of data to code coroner certified deaths. Where a case remains open on the NCIS at the time the ABS ceases processing and insufficient information is available to code a cause of death, less specific ICD codes are assigned as required by the ICD coding rules.

4 The specificity with which open cases are able to be allocated an ICD-10 code is 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'.

5 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 by another person (assault).

6 In order to classify a death as Suicide the ICD-10 interpretation used by the ABS requires that specific documentation from a medical or legal authority be available regarding both the self-inflicted nature and suicidal intent of the incident. If this information is not available then the death must be classified as accidental. ABS uses instructions for coders to ensure consistency in the coding of suicide deaths.

7 The first of the new processes to be introduced for 2008 data relates to the way that the ABS utilises information on the Medical Certificate of Cause of Death. For both open and closed coroners cases, more time was taken to investigate part 2 of the certificate when a non-specific underlying cause was shown in part 1. Part 2 of the certificate details conditions that may have contributed to the death but were not part of the sequence of events that led to death.

8 The second new process relates to the use of additional information available on NCIS. Increased resources and time were spent investigating coroners reports to identify specific causes of death. This involved making increased use of police reports, toxicology reports, autopsy reports and coroners findings for both open and closed cases to minimise the use of non-specific causes and intents.

9 The introduction of these processes have resulted in improved data quality in relation to assigning unspecified cause codes to coroner certified deaths. There has been a decrease of 381 (33%) in the number of coroner certified deaths attributed to Other ill-defined and unspecified causes of mortality (R99) from 1,160 in 2007 (preliminary) to 779 in 2008 (preliminary).

10 As less specific codes are generally associated with open rather than closed coroner certified cases, the new processes have had the effect of significantly improving the quality of cause of death codes assigned to open cases. Additionally, a large number of coroner cases are due to external causes, therefore the new processes have also had the effect of improving these data, including Suicide data.

11 Prior to 2008, these processes were not routinely undertaken for coroner certified cases. The impact of these new processes on the 2008 data are discussed further in this Technical Note.

12 The timeline below presents the processing cycle for the 2008 data thus far. It shows the different processing dates for doctor certified and coroner certified deaths.

Diagram: INTRODUCTION

13 The 2008 data provided in this publication has not yet been subjected to the revisions process, which will further improve the quality of the data. Therefore, the information on 2008 causes of death is considered preliminary - i.e. refers to the point in time (31 January 2010) when initial 2008 processing was finalised. The 2008 data will go through the revisions process twice, and will be released in the Causes of Death publications in 2011 (2008 revised) and 2012 (2008 final). Information on the revisions process and how it is applied to causes of death data can be found in Technical Note 2: Causes of Death - Revisions Process.


DEATHS BY TYPE OF CERTIFIER

14 For deaths registered in 2008, 13% were certified by a coroner. There are variations between jurisdictions in relation to deaths certified by a coroner, ranging from 10-11% of deaths certified by a coroner in New South Wales, Queensland and Tasmania to 32% of deaths certified by a coroner in the Northern Territory. The proportion of deaths certified by a coroner in 2008 is comparable to previous years.

Table 1: Deaths by type of Certifier and state/territory of registration - 2007 and 2008(a)(b)(c)

Doctor (2007)
Coroner (2007)
Total (2007)
Doctor (2008)
Coroner (2008)
Total (2008)
no.
%
no.
%
no.
no.
%
no.
%
no.

NSW
41 352
89
5 015
11
46 367
42 983
89
5 342
11
48 325
Vic.
29 752
88
4 171
12
33 923
30 097
85
5 417
15
35 514
Qld
23 040
89
2 975
11
26 015
24 415
89
3 139
11
27 554
SA
10 521
85
1 867
15
12 388
10 810
86
1 832
14
12 642
WA
10 570
86
1 734
14
12 304
10 936
86
1 813
14
12 749
Tas.
3 654
89
447
11
4 101
3 751
90
439
10
4 190
NT
662
68
313
32
975
703
68
338
32
1 041
ACT
1 452
82
329
19
1 781
1 583
82
348
18
1 931
Australia
121 003
88
16 851
12
137 854
125 278
87
18 668
13
143 946

(a) 2008 data have been subject to process improvements which have increased the quality of these data. See Technical Note 1: 2008 COD Collection - Process Improvements for further information.
(b) 2007 data are revised and subject to a further revisions process. See Technical Note 3: 2007 Revisions for further information.
(c) Causes of death data for 2008 are preliminary and subject to a revisions process. See Technical Note 2: Causes of Death - Revisions Process.


15 All causes of death can be grouped to describe the type of death, whether it be from a disease or condition, or from an injury or whether the cause is unknown. These are generally described as:
  • Natural Causes - deaths due to diseases (for example diabetes, cancer, heart disease etc) (A00-Q99, R00-R98)
  • External Causes- deaths due to causes external to the body (for example Suicide, transport accidents, falls, poisoning etc) (V01-Y98)
  • Unknown Causes - deaths where it is unable to be determined whether the cause was natural or external (R99)

16 The following diagram describes registered deaths in 2008 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 2008 Causes of Death processing period.

Diagram: DEATHS BY TYPE OF CERTIFIER


OPEN AND CLOSED CASES ON NCIS

17 There were 18,668 deaths (or 13% of all deaths) certified by a coroner in 2008. Of those, 11,335 (61%) had a status of closed on NCIS and ABS had full information available in order to undertake cause of death coding. There were 6,949 (37%) cases with a status of open on NCIS in 2008 which may not have had information available at the time of processing. However, all open cases were subject to the new processing improvements and use was made of any additional information found in part 2 of the Medical Certificate of Cause of Death, or in any available police reports, toxicology reports, autopsy reports or coroners findings.

18 On a jurisdictional level, the proportion of cases which have a status of open on the NCIS varies significantly. This means that the impact of the new process improvements has varied across states and territories. The largest impact was to Queensland coroner certified cases, where 66% of cases were open at the cessation of ABS processing compared with the Australia-wide average of 37%.

Table 2: Coroner certified deaths, by Case status, State and territory of registration - 2008(a)(b)(c)

2008 Cases as at January 2010
Closed
Open
Other(d)
Total
no.
%
no.
%
no.

NSW
3 098
58
2 145
40
99
5 342
Vic.
3 650
67
1 694
31
73
5 417
Qld
899
29
2 067
66
173
3 139
SA
1 536
84
290
16
6
1 832
WA
1 290
71
503
28
20
1 813
Tas.
356
81
77
18
6
439
NT
227
67
104
31
7
338
ACT
279
80
69
20
-
348
Australia
11 335
61
6 949
37
384
18 668

- nil or rounded to zero (including null cells)
(a) 2008 data have been subject to process improvements which have increased the quality of these data. See Technical Note 1: 2008 COD Collection - Process Improvements for further information.
(b) Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. Cells with a zero value have not been affected by confidentialisation.
(c) Causes of death data for 2008 are preliminary and subject to a revisions process. See Technical Note 2: Causes of Death - Revisions Process.
(d) Includes coroner case status of 'blank', 'not stated' and 'not applicable'.


19 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. Over half of all deaths in 2008 due to unknown causes (53%), and 38% of all deaths due to external causes, were coroner certified deaths which remained open on the NCIS at the close of processing. A small proportion of all deaths due to natural causes (2.4%) were also coroner certified deaths which remained open.

20 In 2008, 467 open cases (6.7% of all open cases) had insufficient information recorded on NCIS to enable any cause of death to be determined. These records have been coded to Other ill-defined and unspecified causes of mortality (R99). This compared to 977 open cases (19% of all open cases) coded to Other ill-defined and unspecified causes of mortality (R99) for preliminary 2007 cause of death data. The table below indicates the impact of 2008 processing improvements on the number of open coroner cases assigned to external or natural causes rather than 'unknown'.

Table 3 Open coroner cases by type of cause, 2007 Preliminary and 2008 Preliminary(a)(b)(c)(d) - State and territory of registration(e)

NSW
Vic
QLD
SA
WA
TAS
NT
ACT
AUST

Preliminary 2007

External Cause(f)
515
450
790
130
202
35
62
10
2 194
% of total
36.3
57.5
36.7
47.4
63.5
55.6
72.9
28.6
42.8
Natural Cause(g)
699
319
690
107
76
27
18
21
1 957
% of total
49.2
40.7
32.1
39.1
23.9
42.9
21.2
60.0
38.2
Unknown Cause(h)
206
14
670
37
40
3
5
2
977
% of total
14.5
1.8
31.2
13.5
12.6
1.6
5.9
11.4
19.1
Total
1 420
783
2 150
274
318
63
85
35
5 128

Preliminary 2008

External Cause
892
840
904
159
373
46
70
29
3 313
% of total
41.6
49.6
43.7
54.8
74.2
59.7
67.3
42.0
47.7
Natural Cause
1 137
825
876
121
114
30
29
37
3 169
% of total
53.0
48.7
42.4
41.7
22.7
39.0
27.9
53.6
45.6
Unknown Cause
116
29
287
10
16
1
5
1
467
% of total
5.4
1.7
13.9
3.4
3.2
1.3
4.8
1.4
6.7
Total
2 145
1 694
2 067
290
503
77
104
69
6 949

(a) 2008 data have been subject to process improvements which have increased the quality of these data. See Technical Note 1: 2008 COD Collection - Process Improvements for further information.
(b) Causes of death data for 2008 are preliminary and subject to a revisions process. See Technical Note 2: Causes of Death - Revisions Process.
(c) 2007 data presented here are preliminary and have not been subjected to the revisions process. See Technical Note 3: 2007 Revisions for further information.
(d) For 2007 preliminary data, some data have moved between originally published cause categories due to a more specific allocation to 'Natural' and 'Unknown' cause categories during the processing of 2008 data.
(e) Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. Cells with a zero value have not been affected by confidentialisation.
(f) External Causes- deaths due to causes external to the body (for example suicide, transport accidents, falls, poisoning etc). External causes are certified by coroners. (V01-V99)
(g) Natural Causes - deaths due to diseases (for example diabetes, cancer, heart disease etc). Natural causes are predominantly certified by doctors. (A00-Q99, R00-R98)
(h) Unknown Causes - deaths where it is unable to be determined whether the cause was natural or external. Predominantly these deaths are certified by coroners. (R99)



IMPACT ON EXTERNAL CAUSE BY INTENT DATA

21 Further analysis has also been completed of open cases on NCIS to consider the intent of the injury for those cases that were coded to external causes, as shown in the table below. This analysis highlights the improvements in data quality due to the changes in processing coroner certified cases which were introduced in 2008.

22 For 2008, there were 3,313 open coroner cases assigned an external cause of death. Of these cases, 38% (1,267) were coded to accidental intent, 26% (856) were coded to an intent of Suicide, 4% (126) were coded to assault and 31% (1,064) were found to have either an undetermined or other intent. This contrasted with the intent of external cause deaths in 2007 preliminary data, where 37% (816) of open cases due to external causes were coded to accidental intent, 18% (384) were coded to an intent of Suicide, 4% (90) were coded to assault and 41% (904) were found to have either an undetermined or other intent. The increase of open case external cause deaths coded to an intent of Suicide, and the corresponding decrease in those deaths assigned an undetermined or other intent, reflects the improved processes outlined above.

Table 4: Open coroner cases, External causes by intent - State and territory of registration - 2007-2008(a)(b)(c)(d)(e)

Accidental (V01-X59, Y85, Y86)
Intentional self harm (X60-X84, Y87.0)(f)
Assault (X85-Y09, Y87.1)
Undetermined intent (Y10-Y34, Y87.2)
Other
Total

2007

NSW
195
55
8
252
5
515
%
37.9
10.7
1.6
48.9
0.9
100
VIC
130
85
24
205
6
450
%
28.9
18.9
5.3
45.6
1.3
100
QLD
227
161
19
377
6
790
%
28.7
20.4
2.4
47.7
0.8
100
SA
61
39
13
16
3
130
%
46.9
30.0
10.0
12.3
2.3
100
WA
136
29
16
20
3
202
%
67.3
14.4
7.9
9.9
1.5
100
TAS
23
5
2
4
2
35
%
65.7
14.3
5.7
11.4
5.7
100
NT
42
10
6
2
-
62
%
67.7
16.1
9.7
3.2
-
100
ACT
7
-
3
4
-
10
%
70.0
-
30.0
40.0
-
100
AUS
821
384
91
878
20
2 194
%
37.4
17.5
4.1
40.0
0.9
100

2008

NSW
218
173
19
478
4
892
%
24.4
19.4
2.1
53.6
0.5
100
VIC
320
187
24
297
12
840
%
38.1
22.2
2.9
35.4
1.4
100
QLD
365
335
21
178
5
904
%
40.4
37.1
2.3
19.7
0.5
100
SA
74
34
18
27
6
159
%
46.5
21.4
11.3
17.0
3.8
100
WA
203
87
32
48
3
373
%
54.4
23.3
8.6
12.9
0.8
100
TAS
19
21
3
3
-
46
%
41.3
45.7
6.5
6.5
-
100
NT
49
14
6
2
-
70
%
70.0
20.0
8.6
2.9
-
100
ACT
19
5
3
-
2
29
%
65.5
17.2
10.3
-
6.9
100
AUS
1 267
856
126
1 033
31
3 313
%
38.2
25.8
3.8
31.2
0.9
100

- nil or rounded to zero (including null cells)
(a) 2008 data have been subject to process improvements which have increased the quality of these data. See Technical Note 1: 2008 COD Collection - Process Improvements for further information.
(b) Causes of death data for 2008 are preliminary and subject to a revisions process. See Technical Note 2: Causes of Death - Revisions Process.
(c) 2007 data presented here are preliminary and have not been subjected to the revisions process. See Technical Note 3: 2007 Revisions for further information.
(d) For 2007 preliminary data, some data have moved between originally published intent categories due to a more specific code allocation in the processing of 2008 data.
(e) Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. Cells with a zero value have not been affected by confidentialisation.
(f) Care needs to be taken in interpreting figures relating to Suicide due to limitations of data, see Explanatory Notes 72-75.



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