Interpreting associated causes of death
Circumstances relating to deaths from external causes are complex. Individual factors should not be considered in isolation.
- Associated causes of death were identified for 90.0% of suicides.
- Mood disorders (including depression) were identified for 40.6% of suicides.
- Problems with spousal relationship circumstances were the most common psychosocial risk factor, identified among 25.9% of suicides.
The national mortality dataset provides important information on underlying causes of death in Australia. It also provides in-depth details on associated causes of death. The term 'associated causes' is used when referring to conditions other than the underlying cause of death when using the International Classification of Diseases (ICD). Associated causes can include diseases that are part of the chain of events leading to death, risk factors and co-morbid conditions.
For deaths that are referred to the coroner, the ABS codes causes of death from information contained on the National Coronial Information System (NCIS), including police, autopsy, toxicology and coroners reports. These reports provide a breadth of information relating to these deaths, much of which is highly important from a public health perspective. The coding of underlying and associated causes for coroner-referred deaths aims to capture all relevant details from these reports that sit within the framework of International Classification of Diseases (ICD).
In 2017, the ABS undertook a pilot study to extend the range of information captured using the ICD. The main focus of this study was to incorporate codes relating to psychosocial risk factors in the coding of coroner-referred deaths. This work has since been extended through a collaboration between the ABS, the Australian Institute of Health and Welfare and the Department of Health as part of the Suicide and Self-Harm Monitoring Project. Data is now available for both 2018 and 2019. Engagement on the concepts underpinning this work is ongoing, resulting in small refinements to processes over time.
This report focusses on associated causes for coroner-referred deaths, particularly those due to suicide and accidental drug overdose. When examining these data, it is important to note that not one factor causes a person to die by suicide or other external cause of death. Risk factors should therefore not be considered in isolation. Instead they provide an insight into the complex interaction between biological, psychological and psychosocial factors which have contributed to these deaths. Demographic information such as age, sex and socioeconomic factors also provide additional context which can help guide public health responses to diseases and injuries.
It is important to note that the capture of information on associated causes of death (including psychosocial risk factors) is reliant on the documentation available for any given death. This in turn can be affected by the length of the coronial process for some types of death, the type of information available across different jurisdictions and administrative processes affecting report availability. As such, the information presented in this report reflects information contained within reports available on NCIS at the time of coding and does not necessarily reflect all causes associated with all deaths that have occurred.
Further data on associated causes of death can be found in the suicide datacube in downloads section of this publication.
Associated causes for accidents, assaults and suicides
Deaths from external causes are grouped by intent, which includes accidents, assaults and suicides. Intent may also determine how a death is investigated and can therefore influence the type of information that can be captured and coded. High proportions of accidental drug overdoses and suicides have one or more associated causes. A much lower proportion of transport accidents have associated causes, as many risk factors for these deaths are environmental rather than health related and are therefore outside of the scope of ICD coding.
The table below outlines the number of deaths by intent for coroner-certified deaths in 2019 with at least one contributing associated cause identified.
|Number of deaths with one or more associated causes||Proportion|
|Transport accidents (d)||678||45.5|
|Accidental drug overdose (e)||1,190||96.4|
|Other Intent (h)||231||78.3|
(a) Causes of death data for 2019 are preliminary and subject to a revisions process. See the Data quality section of the methodology in this publication.
(b) For a complete list of psychosocial risk factors, refer to explanatory note Annex listing: Psychosocial codes (exclusions and inclusions) in Psychosocial risk factors as they relate to coroner-referred deaths in Australia (cat. No. 1351.0.55.062).
(c) Accidents include ICD-10 codes V01-X59, Y85-Y86, Y89.9.
(d) Transport accidents ICD-10 codes V01-V99, Y85.
(e) Accidental drug overdose ICD-10 codes X40-X44.
(f) Suicide includes ICD-10 codes X60-X84, Y87.0.
(g) Assault includes ICD-10 codes X85-Y09, Y87.1.
(h) Other intent includes ICD-10 codes Y10-Y34, Y35-Y36, Y87.2, Y890-Y891.
(i) Data presented for suicide is all certifier types.
(j) Care needs to be taken when interpreting data derived from Victorian coroner-referred deaths including suicide. See Technical note: Victorian additional registrations and time series adjustments for detailed information on this issue.