3303.0 - Causes of Death, Australia, 2015 Quality Declaration 
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TECHNICAL NOTE 2 CAUSES OF DEATH REVISIONS, 2013 FINAL DATA
This note was released on 4 April, 2017.


OVERVIEW

1 Deaths that are referred to a coroner can take time to be fully investigated. To account for this, the ABS has implemented a revisions process for those deaths where coronial investigations remained open at the time an initial cause of death was assigned. Data are deemed preliminary when first published, revised when published the following year and final when published after a second year. This technical note focuses specifically on final data for 2013.

2 The revisions process has been applied to all reference periods from 2006 onwards. Revisions are one of two measures implemented to enable timely data to be released on coroner-certified deaths (see Explanatory Notes 52-66 for further information). The second measure, referred to as 'open coding', ensures that all available documentation is taken into account when assigning a cause of death to coronial cases that are yet to be finalised. The combination of these two measures, along with ongoing enhancements in the timeliness and completeness of documentation on the National Coronial Information System (NCIS), have resulted in significant improvements to the quality of preliminary cause of death data.

3 There are three main improvements to the causes of death data which are gained through the revisions process. Firstly, for deaths from natural causes a more specified condition may be identified. For example, a death may be coded to a condition such as cardiac arrest at preliminary coding, but with the later addition of an autopsy report, an underlying ischaemic heart condition could be identified. Secondly, for deaths from external causes (accidents, assaults and suicides) more information might be provided on mechanism. For example, a death coded to an unspecified accident with a fracture of hip, may later be found to have been caused by a fall down steps. Lastly, external causes may also have the intent of death updated through revisions. For example, a drug overdose where the intent of death was not determined at preliminary coding, may be updated to an intentional drug overdose when a coronial finding has been made.


IMPACT OF REVISIONS


4 The expected outcome of the revisions process is to improve data quality. Enhancements to data quality could include improved understanding of either mechanism or intent. It may also mean that an underlying cause is identified where that has not previously been possible. Table 1 focuses on changes in the number of coroner referred deaths which were assigned less specified codes, including Ill defined and unspecified causes (R99), those with an unspecified mechanism (X59, X84 and Y09) and those with an unspecified intent (Y10-Y34). Table 1 highlights that 30.2% of deaths with an unspecified mechanism were re-assigned through the revisions process, along with 41.6% of those with an unspecified intent.



TABLE 1: SELECTED CAUSES OF DEATH, DEATHS CERTIFIED BY A CORONER - Preliminary, Revised and Final Data, Australia, 2013

2013 reference year
Change (prelim to final)
P
R
F
Cause of death and ICD-10 code
no
no
no
no
%

R99
933
887
846
-87
-9.3%
X59, X84, Y09
268
259
187
-81
-30.2%
Y10-Y34
296
230
173
-123
-41.6%


5 Table 2 provides the counts of deaths by ICD-10 chapter for the 2013 reference period across the three years of the revisions process. Revisions are most likely to result in decreases in the number of deaths assigned to the Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) chapter with corresponding increases in other chapters.

6 Those deaths originally coded to the Symptoms and signs chapter (R00-R99) which are subsequently reassigned through the revisions process, are often reassigned to natural causes of death. This is usually the result of an autopsy revealing the cause of death. Less than half of those reassigned are found to be deaths from External causes (V01-Y98), and in 2013 only 8 of these were found to be suicide deaths.

TABLE 2 - CAUSES OF DEATH REVISIONS, (PRELIMINARY, REVISED, FINAL) - by ICD-10 chapter - 2013 reference year

2013 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)
2 676
2 681
2 682
6
0.2
Neoplasms (C00-D48)
44 674
44 673
44 676
2
0.0
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism D50-D89
500
501
502
2
0.4
Endocrine, nutritional and metabolic diseases (E00-E90)
6 101
6 105
6 108
7
0.1
Mental and behavioural disorders (F00-F99)
8 200
8 198
8 191
-9
-0.1
Diseases of the nervous system (G00-G99)
7 513
7 520
7 528
15
0.2
Diseases of the circulatory system (I00-I99)
43 603
43 607
43 615
12
0.0
Diseases of the respiratory system (J00-J99)
12 465
12 470
12 475
10
0.1
Diseases of the digestive system (K00-K93)
5 423
5 418
5 422
-1
0.0
Diseases of the skin and subcutaneous tissue (L00-L99)
435
435
435
0
0.0
Diseases of the musculoskeletal system and connective tissue (MOO-M99)
1 181
1 183
1 185
4
0.3
Diseases of the genitourinary system (N00-N99)
3 110
3 108
3 108
-2
-0.1
Certain conditions originating in the perinatal period (P00-P96)
562
559
559
-3
-0.5
Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
620
621
622
2
0.3
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
1 460
1 417
1 380
-80
-5.5
External causes of morbidity and mortality (V01-Y98)
9 136
9 163
9 171
35
0.4
Total(a)
147 678
147 678
147 678
0
0.0

(a) Includes deaths coded to H00-H59, H60-H95, and O00-O99.



7 Table 3 highlights how chapter-level data for the past five years (2009 to 2013) has changed proportionately through the revisions process. In each year, the largest decrease is observed in the Symptoms and signs chapter (R00-R99). However, over time there has been a notable decline in the proportionate decreases, ranging from 29.9% for the 2009 reference period to 5.5% for the 2013 reference period. This illustrates improvements in the quality of preliminary data over time.

TABLE 3 - CAUSES OF DEATH REVISIONS, by selected ICD-10 chapter - changes from preliminary to final data: by percentage - 2009 to 2013

2009
2010
2011
2012
2013
Cause of death and ICD-10 code
%
%
%
%
%

Certain infectious and parasitic diseases (A00-B99)
0.3
0.2
0.0
0.0
0.2
Neoplasms (C00-D48)
0.0
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
0.2
0.5
0.2
0.0
0.4
Endocrine, nutritional and metabolic diseases (E00-E90)
0.3
0.2
0.0
0.0
0.1
Mental and behavioural disorders (F00-F99)
-0.1
0.1
0.1
-0.1
-0.1
Diseases of the nervous system (G00-G99)
0.1
0.1
0.0
0.2
0.2
Diseases of the circulatory system (I00-I99)
0.2
0.0
0.0
0.2
0.0
Diseases of the respiratory system (J00-J99)
0.0
0.1
-0.1
0.0
0.1
Diseases of the digestive system (K00-K93)
0.1
-0.2
0.2
0.0
0.0
Diseases of the skin and subcutaneous tissue (L00-L99)
0.8
-0.3
0.5
-0.3
0.0
Diseases of the musculoskeletal system and connective tissue (MOO-M99)
0.0
0.1
0.2
-0.1
0.3
Diseases of the genitourinary system (N00-N99)
0.1
0.0
-0.1
0.0
-0.1
Certain conditions originating in the perinatal period (P00-P96)
-0.3
0.0
-0.3
0.4
-0.5
Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
0.9
0.8
0.7
0.4
0.3
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
-29.9
-16.5
-11.7
-11.2
-5.5
External causes of morbidity and mortality (V01-Y98)
2.1
1.2
0.9
0.7
0.4


8 While the revisions process has a minimal impact at the chapter level (with the exception of Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)), data improvements become more apparent when considering movements within individual chapters. Table 4 provides information changes at the sub-chapter level for the 2013 reference period, with a focus on the External causes of morbidity and mortality (V01-Y98) chapter. Notable decreases include:
  • Event of undetermined intent (Y10-Y34) (-123 deaths);
  • Other ill-defined and unspecified causes of mortality (R99) (-87 deaths); and
  • Accidental exposure to other and unspecified factors (X58-X59) (-63 deaths).

Notable increases include:
  • Intentional self-harm (X60-X84) (88 deaths);
  • Falls (W00-W19) (71 deaths);
  • Car occupant injured in transport accident (V40-V49) (37 deaths); and
  • Assault (X85-Y09) (32 deaths).

TABLE 4: CAUSES OF DEATH REVISIONS (PRELIMINARY, REVISED, FINAL), by ICD-10 selected causes - 2013

2013
Change (preliminary to final)
Preliminary
Revised
Final
Cause of death and ICD-10 code
no.
no.
no.
no
%

Sudden infant death syndrome (R95)
54
57
61
7
13.0
Other ill-defined and unspecified causes of mortality (R99)
958
912
871
-87
-9.1
Pedestrian injured in transport accident (V01-V09)
197
204
207
10
5.1
Pedal cyclist injured in transport accident (V10-V19)
53
54
54
1
1.9
Motorcycle rider injured in transport accident (V20-V29)
222
223
223
1
0.5
Car occupant injured in transport accident (V40-V49)
689
699
726
37
5.4
Occupant of pick-up truck or van injured in transport accident (V50-V59)
4
4
5
1
25.0
Occupant of heavy transport vehicle injured in transport accident (V60-V69)
20
21
21
1
5.0
Other land transport accidents (V80-V89)
131
124
108
-23
-17.6
Water transport accidents (V90-V94)
59
59
58
-1
-1.7
Air and space transport accidents (V95-V97)
49
49
50
1
2.0
Falls (W00-W19)
1 920
1 921
1 991
71
3.7
Exposure to inanimate mechanical forces (W20-W49)
88
88
93
5
5.7
Accidental drowning and submersion (W65-W74)
210
212
214
4
1.9
Other accidental threats to breathing (W75-W84)
169
175
170
1
0.6
Exposure to smoke, fire and flames (X00-X09)
56
56
58
2
3.6
Exposure to forces of nature (X30-X39)
34
35
35
1
2.9
Accidental poisoning by and exposure to noxious substances (X40-X49)
1 058
1 062
1 059
1
0.1
Accidental exposure to other and unspecified factors (X58-X59)
743
740
680
-63
-8.5
Intentional self-harm (X60-X84)(a)
2 520
2 568
2 608
88
3.5
Assault (X85-Y09)
216
227
248
32
14.8
Event of undetermined intent (Y10-Y34)
296
230
173
-123
41.6
Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59)
37
40
39
2
5.4
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
187
170
-11
-6.1
Sequelae of external causes of morbidity and mortality (Y85-Y89)
125
125
120
-5
-4.0


(a) Care should be taken in interpreting figures relating to intentional self-harm. See Explanatory Notes 85-93.