3317.0.55.001 - Information Paper: External Causes of Death, Data Quality, 2005  
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 11/04/2007  First Issue
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1. There are three components of a death registration and all components must be completed in order for the Registrar of Births, Deaths and Marriages (RBDM) to consider a registration finalised:

  1. Death Notification Form - completed by a funeral director, based on information supplied by relatives/friends of the deceased. This form is submitted to the RBDM.
  2. Medical Certificate of Cause of Death - this is either completed by a doctor who attended the patient prior to death or, if the death is suspicious or due to an unnatural cause (approximately 14% of all deaths), a coroner will be responsible for investigating and determining the cause of death. Coroners pass this information on to the National Coronial Information System (NCIS) and to the RBDM.
  3. Certificate of Burial or Cremation - completed by the funeral director. This form is submitted to the RBDM.

2. Three main programs make up the MMDS software suite: SuperMICAR, MICAR200, and ACME/TRANSAX.

  • SuperMICAR is a text searching application designed to automatically encode medical causes of death data into numeric entity reference numbers (ERN). The software takes "cause" text and splits it into separate causes ignoring noise words, such as "massive", "terminal", and "life threatening". For example, if "myocardial infarction due to hypertension" is recorded on one line of the certificate, it will be separated into two causes, ie. the hypertension and the myocardial infarction. Each cause is then analysed, and a unique numeric code (ERN) for each accepted cause of death term is assigned.
    SuperMICAR contains a thesaurus, dictionary and word list. The dictionary holds valid descriptions for each ERN, while the thesaurus contains synonyms for words which cannot be matched in the dictionary. For example, the word "narrowing" may be recorded instead of the medical term stricture. Finally, the word list contains words which are to be ignored and words which separate causes. For example, the words "left" and "right" are important in some cases for coding but superfluous in others. Alternatively, in the above case of myocardial infarction due to hypertension, the "due to" are words which are used to separate causes. The ERNs represent a much more detailed classification than the various versions of the International Classification of Diseases. The design of this system enables a smoother transition between versions of the ICD.
  • MICAR200 performs editing and validation functions by accessing mortality coding rules, which are held in look-up files, together with a dictionary. These rules are applied to the ERNs assigned during the SuperMICAR process, to produce ICD multiple cause codes.
  • ACME/TRANSAX applies World Health Organisation (WHO) rules to the ICD codes determined by MICAR200. ACME uses a number of look-up tables to allocate underlying cause codes appropriately. ACME makes implicit linkages between multiple causes in assigning ICD codes for underlying cause. TRANSAX identifies the relationship between conditions mentioned on the death certificate, and then assigns an ICD code for any significant combinations. For example, if diabetes mellitus is recorded in Part I of the certificate, and coma is mentioned in Part II, ACME will initially assign a code of E14.9, Diabetes without mention of complication for Part I. However taking all of the information on the certificate into account, the correct code to assign would be E14.0, Diabetes with coma. TRANSAX performs this “translation” of the "axis" from entity coding to coding of a particular person, taking into account all causes recorded on the certificate.

3. When more than one condition is entered on the death certificate, the underlying cause is selected using the coding rules of the ICD. Since its adoption in 1948, statistics based on the underlying cause concept have served the purpose of summarising international cause-specific mortality statistics into a single index which has been used to assess trends in causes of death.

The leading causes of death have changed over time from infectious and parasitic diseases to chronic and degenerative diseases. As the population ages the focus on chronic diseases and understanding their co-morbidities becomes increasingly important. Selecting only a single underlying cause leads to the loss of other valuable information that is often important in understanding disease processes.

ICD-10 code

Transport accidents
Pedestrian injured in transport accident
Pedal cyclist injured in transport accident
Motorcycle rider injured in transport accident
Occupant of three-wheeled motor vehicle injured in transport accident
Car occupant injured in transport accident
Occupant of pick-up truck or van injured in transport accident
Occupant of heavy transport vehicle injured in transport accident
Bus occupant injured in transport accident
Other land transport accidents
Water transport accidents
Air and space transport accidents
Other and unspecified transport accidents
Other external causes of accidental injury
Exposure to inanimate mechanical forces
Exposure to animate mechanical forces
Accidental drowning and submersion
Other accidental threats to breathing
Exposure to electric current, radiation and extreme ambient air temperature and pressure
Exposure to smoke, fire and flames
Contact with heat and hot substances
Contact with venomous animals and plants
Exposure to forces of nature
Accidental poisoning by and exposure to noxious substances
Overexertion, travel and privation
Accidental exposure to other and unspecified factors
Intentional self-harm
Event of undetermined intent
Legal intervention and operations of war
Complications of medical and surgical care
Drugs, medicaments and biological substances causing adverse effects in therapeutic use
Misadventures to patients during surgical and medical care
Medical devices associated with adverse incidents in diagnostic and therapeutic use
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
Sequelae of external causes of morbidity and mortality
Supplementary factors related to causes of morbidity and mortality classified elsewhere

Source: International Classification of Diseases, ICD-10

5. The WHO-FIC Education Committee, in partnership with the International Federation of Health Records Organisations (IFHRO), has developed a certification program for coding using ICD-10. This is an opportunity to increase knowledge and proficiency, leading to higher quality national and international data, and to provide recognition of coders’ skills. Certification will assess a coders ability to read and comprehend death certificates and to recognise and select the proper ICD-10 code for the underlying cause of death, based on international conventions for use of the ICD. Coders will undertake an exam which includes successfully coding a number of death certificates, describe the rules they have used, and explain their selection. The certificates would feature a variety of situations, such as external causes and maternal mortality. The ABS will be participating in this international certification program.

6. A range of actions were taken to reduce the number of incomplete records used as the basis for the causes of death statistics for 2004 and 2005, including extending processing time. The extra effort, while costly in terms of time and resources, allowed a very substantial improvement to be made to the quality of the final external causes data for these registration years. For 2004, the data were compiled before and after the additional processing time, allowing comparison as illustrated below.

Graph: Change from Preliminary to Final ABS 2004 data

7. Australian Transport Safety Bureau (ATSB) statistics are based on reports of road crashes from police and other organisations responsible for road safety within each State and Territory. Specifically, the data are obtained from the following sources:
  • Roads and Traffic Authority, New South Wales.
  • Vicroads.
  • Queensland Transport.
  • Department for Transport, Energy and Infrastructure, South Australia.
  • Western Australia Police.
  • Department of Infrastructure, Energy and Resources, Tasmania.
  • Department of Planning and Infrastructure, Northern Territory.
  • Territory and Municipal Services, Australian Capital Territory.

Road death statistics include any deaths occurring within 30 days of a crash stemming from injuries received in the crash. The statistics are compiled according to the date of the crash, and are subject to revision as further information is obtained.