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. 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. For information regarding the types of deaths certified by a Coroner, please refer to Explanatory Note 2.

2 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 commenced using the NCIS to code coroner certified deaths for the 2003 reference year. Since 2006, the ABS has relied totally on information available on the National Coronial Information System ( NCIS) to code deaths certified by a Coroner. Prior to 2006, the ABS had sought additional information on coroner certified deaths where information was not available on NCIS by undertaking personal visits to Coroner offices to extract information from paper records. From 2006 onwards, where a case remains open on the NCIS at the time the ABS ceases processing, only information available on NCIS is used by the ABS to code the cause of death. Where insufficient information is available to code a cause of death (e.g. a coroner certified death was yet to be finalised by the Coroner), less specific ICD codes are assigned as required by the ICD coding rules.

3 Up to and including deaths registered in 2006, ABS Causes of death processing was finalised at a point in time. This meant that not all deaths registered in the reference year which were referred to the coroner, had 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

4 All coroner certified deaths registered after 1 January 2007 will be subject to a revision process. This is a change from previous years where all ABS processing of causes of death data for a particular reference period was finalised approximately 13 months after the end of the reference period. The revision process will enable the use of additional information relating to coroner certified deaths as it becomes available over time, resulting in increased specificity of the assigned ICD-10 codes.

5 Causes of death data for 2007 coroner certified deaths will be updated as more information becomes available to the ABS. Revised data for 2007 will be published both on a year registration basis and a year of occurrence basis in the 2008 Causes of death publication, due to be released in March 2010 and again in the publication relating to the 2009 collection due for release in 2011. Revisions will only impact on coroner certified deaths, as further information becomes available to the ABS about the causes of these deaths.

6 All information in this paper which refers to the cessation of ABS processing of 2007 data, should be considered with regard to paragraphs 3 and 4 of this technical note i.e. all open coroner cases on NCIS will be revised when the case is finalised, therefore the information in this paper only refers to the point in time (30 January 2009) when initial 2007 processing was finalised.

7 Further information on coroner certified deaths and ABS processing can be obtained in Information Paper: ABS Causes of Death Collection: Concepts, Sources and Methods (cat. no. 3317.0.55.002).

8 Further information on ABS processes for coding suicide deaths can be obtained in Technical Note: ABS Coding of Suicide Deaths


Deaths by Type of Certifier

9 For deaths registered in 2007, 12% were certified by a Coroner. There are variations between jurisdictions, ranging from 11% of deaths certified by a coroner in New South Wales, to 32% of deaths certified by a coroner in the Northern Territory. The proportion of deaths certified by a Coroner in 2007 is comparable to previous years.

T1.1 Deaths by Cerifier Type - state/territory of registration, 2006-2007(a)
	2006					2007
	Doctor		Coroner		Total	Doctor		Coroner		Total
	no.	%	no.	%	no.	no.	%	no.	%	no.
NSW	40 510	88.7	5 160	11.3	45 670	41 352	89.2	5 015	10.8	46 367
Vic.	28 813	86.5	4 513	13.5	33 326	29 752	87.7	4 171	12.3	33 923
Qld	21 729	88.2	2 915	11.8	24 644	23 040	88.6	2 975	11.4	26 015
SA	10 068	84.3	1 878	15.7	11 946	10 521	84.9	1 867	15.1	12 388
WA	10 139	86.9	1 523	13.1	11 662	10 570	85.9	1 734	14.1	12 304
Tas.	3 454	88.2	460	11.8	3 914	3 654	89.1	447	10.9	4 101
NT	624	67.8	297	32.2	921	662	67.9	313	32.1	975
ACT	1 347	81.3	309	18.7	1 656	1 452	81.5	329	18.5	1 781
Australia	116 684	87.2	17 055	12.8	133 739	121 003	87.8	16 851	12.2	137 854
(a) Causes of death data for 2007 is subject to revision. See Explanatory Notes 3-4 for further information.

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

11 The following diagram describes registered deaths in 2007 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 2007 Causes of Death processing period.

OPEN AND CLOSED CASES ON NCIS

12 Of those deaths which were certified by a Coroner, 70% 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 30% of cases had a status of open at the time this publication was compiled, with a low of 11% in the ACT to a high of 72% in Queensland.

T1.2 Available Case Status for ABS Use on National Coronial Information System
	2006 cases as at 30 January 2007					2007 cases as at 30 January 2008(a)
	Closed		Open		Total	Closed		Open		Total
	no.	%	no.	%		no.	%	no.	%
NSW	3 541	68.6	1 619	31.4	5 160	3 595	71.7	1 420	28.3	5 015
Vic.	4 061	90.0	452	10.0	4 513	3 388	81.2	783	18.8	4 171
Qld	1 014	34.8	1 901	65.2	2 915	825	27.7	2 150	72.3	2 975
SA	1 661	88.6	215	11.5	1 876	1 593	85.3	274	14.7	1 867
WA	1 200	78.8	323	21.2	1 523	1 416	81.7	318	18.3	1 734
Tas.	407	88.5	53	11.5	460	384	85.9	63	14.1	447
NT	253	85.2	44	14.8	297	228	72.8	85	27.2	313
ACT	269	87.1	40	12.9	309	294	89.4	35	10.6	329
Australia	12 406	72.7	4 647	27.3	17 053	11 723	69.6	5 128	30.4	16 851
(a) Causes of death data for 2007 is subject to revision. See Explanatory Notes 3-4 for further information.

13 Open cases accounted for 3.5% of all deaths registered in 2007. 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 unknown causes (54%) and 28% of all external causes remained open on the NCIS at the close of processing. A small proportion of all natural cause deaths (1.5%) also remained open.

T1.3 Cases on NCIS with status of Open, by type of cause - 2007(a)(b)
	External Cause		Natural Cause		Unknown Cause		Total
State or territory	no.	%	no.	%	no.	%	no.
NSW	515	36.3	677	47.7	228	16.1	1 420
Vic.	450	57.5	310	39.6	23	2.9	783
Qld	790	36.7	675	31.4	685	31.9	2 150
SA	130	47.4	106	38.7	38	13.9	274
WA	202	63.5	76	23.9	40	12.6	318
Tas.	35	55.6	24	38.1	4	6.3	63
NT	62	72.9	18	21.2	5	5.9	85
ACT	10	28.6	21	60.0	4	11.4	35
Australia	2 194	42.8	1 907	37.2	1 027	20.0	5 128
(a) Causes of death data for 2007 is subject to revision. See Explanatory Notes 3-4 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. It is important to note that cells with a zero value have not been affected by confidentialisation.

14 In 2007, 1,027 open cases (20% of all open cases) 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.

15 A further 1,907 open cases (37%) 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, 1233 (65%) related to Chapter IX Circulatory Diseases. The remaining 674 (35%) cases were related to a range of other chapters.

T1.4 Deaths, Open Cases on NCIS which relate to Natural Causes - 2007(a)(b)
ICD10 Chapters	No.
Infectious diseases (A00-B99)	25
Cancer (C00-D48)	119
Blood and immunity disorders (D50-D89)	7
Endocrine, nutritional and metabolic diseases (E00-E90)	48
Mental and behavioural disorders (F00-F99)	53
Diseases of the nervous system (G00-G99)	63
Diseases of the Eye and Ear (H00-H95)	2
Diseases of the heart and blood vessels (I00-I99)	1 233
Diseases of the respiratory system (J00-J99)	141
Diseases of the digestive system (K00-K93)	125
Diseases of the skin and subcutaneous tissue (L00-L99)	-
Diseases of the muscles, bones and tendons (M00-M99)	13
Diseases of the kidney and urinary system (N00-N99)	22
Pregnancy and Childbirth (O00- O99)	3
Conditions originating in the perinatal period (P00-P96)	27
Congenital and chromosomal abnormalities (Q00-Q99)	26
TOTAL	1 907
- nil or rounded to zero (including null cells)
(a) 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. It is important to note that cells with a zero value have not been affected by confidentialisation.
(b) Causes of death data for 2007 is subject to revision. See Explanatory Notes 3-4 for further information.

16 Nearly half of all open cases (2,194, 43%) related to external causes. Of the 7,893 deaths attributed to external causes in 2007, 28% were open cases on the NCIS.

17 Further analysis has been completed of open cases on NCIS to consider mechanism of injury for those cases that were coded to external causes, as shown in T1.5.

T1.5 Deaths, Open Cases on NCIS which relate to External causes by mechanism - 2007(a)(b)
	Hanging	Falls	Poisoning	Drowning	Trasnport Accidents	Firearms	Sharp Objects	Other	Unspecified	Total
NSW	84	27	92	41	54	22	3	129	63	515
VIC	57	40	74	11	66	14	15	168	5	450
QLD	175	19	88	31	142	47	22	237	29	790
SA	18	10	26	4	29	9	5	22	7	130
WA	23	8	29	7	94	3	5	28	5	202
TAS	1	3	8	-	9	2	1	10	1	35
NT	7	4	4	1	29	3	3	10	1	62
ACT	-	1	1	1	1	-	1	3	2	10
Australia	365	112	322	96	424	100	55	607	113	2 194
- nil or rounded to zero (including null cells)
(a) Causes of death data for 2007 is subject to revision. See Explanatory Notes 3-4 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. It is important to note that cells with a zero value have not been affected by confidentialisation.

18 Cases related to Transport Accidents accounted for 19% of all open external cause cases, with Poisonings and Hangings accounting for 15% and 17% respectively at a national level. Unspecified external causes accounted for 5% 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.

19 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 T1.6.

Table T1.6 Deaths, Open Cases on NCIS which relate to External causes, by intent - 2007(a)(b)
	Accident	Suicide	Assault	Undetermined	Other	Total
NSW	195	55	8	252	5	515
VIC	126	85	24	203	12	450
QLD	226	161	19	377	7	790
SA	61	39	13	15	2	130
WA	136	29	15	20	2	202
TAS	23	5	3	3	1	35
NT	42	10	6	4	-	62
ACT	7	-	2	1	-	10
Australia	816	384	90	875	29	2 194
- nil or rounded to zero (including null cells)
(a) Causes of death data for 2007 is subject to revision. See Explanatory Notes 3-4 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. It is important to note that cells with a zero value have not been affected by confidentialisation.

20 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.

21 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).

22 The determination of "intent" for each death (whether intentional self harm, accidental, homicide or 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.

23 The coding process for open coroners cases has been altered with respect to 2007 data. Up to and including 2006 data, if there was no information in the "intent" status field on the NCIS, ABS coders would follow a strict interpretation of the ICD-10 coding rules and use the default intent of "accidental". A change to the 2007 version of ICD-10 regarding coding rules for "undetermined intent" have resulted in coders being able to allocate deaths to "undetermined intent" in the absence of a legal ruling.

24 All deaths registered after 1 January 2007 which have an NCIS status of "open" , will be recoded by the ABS once the case status has changed to "closed". Revised data will be published both on a year of registration basis and a year of occurrence basis in the 2008 Causes of death publication, due for release in March 2010, and again in the publication relating to the 2009 collection, due for release in 2011.