3319.0.55.001 - Multiple Cause of Death Analysis, 1997-2001  
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 22/07/2003   
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How the Death Certificate is completed

Death Certificates in Australia comprise two separate forms; a medical certificate which indicates the cause(s) of death, and a questionnaire providing personal information about the deceased. The medical certificate is completed either by a doctor who was in attendance at the time of death or who can certify as to the cause of death, or by the coroner when the death was unexpected or unexplained. The personal information questionnaire is completed by the next of kin. This normally takes place at the funeral parlour with the help of the funeral director. Both forms are collected by the Registrar of Births and Deaths in each state and territory.

What is on the medical certificate of cause of death

There are two parts to the standard medical certificate of cause of death.

Part I is the area "above the line". This is where the disease or condition directly leading to death is stated followed by any conditions which have given rise to this disease or condition (these are called antecedent causes). Any conditions listed above the line should form what is termed the "morbid train of events" that have led to death. That is, they will form a sequence starting at the disease or condition which directly led to death. This condition may then have been "due to (or as a consequence of)" an antecedent cause which was in turn, "due to (or as a consequence of)" another antecedent cause et cetera. The Underlying Cause is the cause which is listed last. That is, it is the cause that is deemed to have started the morbid train of events.

Part II is the area "below the line".
This area is to be used to list other significant conditions which have contributed to the death but which are not deemed to be part of the morbid train of events leading to the death.

Example of a completed medical certificate of cause of death
Graphic: Example of a completed medical certificate
Cause of death certification Australia: A booklet for the guidance of medical practitioners in completing medical certificates of cause of death (Australian Bureau of Statistics, 1999).

ABS coding of causes of death

The ABS coding process classifies the text describing causes of death into codes for statistical purposes. The data are processed using software developed by the National Center for Health Statistics (of the United States of America).The information is then made available in two forms- entity-axis-data and record-axis-data.

Entity-axis-data contain codes for all causes of death in the order and position that they appeared on the death certificate.
Record-axis-data contain codes for all causes of death, in alphanumeric order, following processing in accordance with ICD coding rules and rules associated with the automated processing system.

Record-axis-data have multiple and underlying causes assigned and have had duplicate and superfluous codes removed, and are thus generally more appropriate for output purposes. In addition, some specific combinations of causes are 'linked', that is they are replaced by a single code. For example, if 'pulmonary oedema' (J81) appears on the death certificate along with 'heart failure unspecified' (I50.9), these two causes are replaced by 'left ventricular failure' (I50.1). Record-axis-data are generally used for ABS publications and have been used for all analysis in this paper. Standard ABS unit record files contain both record-axis-data and entity-axis-data.

While record-axis-data are generally used for multiple cause of death analysis, the Australian Institute of Health and Welfare recommends that entity-axis-data also be "considered for its relevance to multiple cause analysis, to ensure that any relevant codes that become incorporated into linkages are taken into account." (AIHW, 2002.)

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