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UNDERSTANDING DIABETES MORTALITY IN AUSTRALIA
Diabetes is more likely to be reported as an associated cause of death as opposed to an underlying cause of death. In these instances, the doctor certifying the death recognises that diabetes has contributed to the train of events leading to the person's death, but that it did not initiate that train of events. Many of these deaths could be termed diabetes-related, as a complication of the diabetes, such as heart or kidney disease, is assigned as the underlying cause of death but diabetes is present on the death certificate.
Not all deaths with diabetes as an associated cause are diabetes-related. A definition of those underlying causes that are most likely to signal a diabetes-related death was developed by the United Kingdom Prospective Diabetes Study, and was subsequently modified by the Australian National Diabetes Data Working Group. This definition is provided at the end of the article, and includes all of those deaths for which diabetes is the underlying cause and a selection of other underlying causes for which diabetes is an associated cause.
Using this definition, there were 8,355 diabetes-related deaths in 2015. The standardised death rate for diabetes-related deaths was 28.7 deaths per 100,000 people compared to 16.1 for deaths where diabetes was the underlying cause. Again males have a consistently higher death rate than females, and there has been a marginal decrease in the death rate over time.
Footnote(s): (a) Standardised death rates. Deaths per 100,000 of estimated mid-year population. See Glossary for further information. (b) ‘Diabetes-related deaths’ is based on the definition of ‘deaths related to diabetes’ used in the United Kingdom Prospective Diabetes Study (UKPDS 1998). The UKPDS definition has been modified by diabetes specialists on the National Diabetes Data Working Group (NDDWG) to include ischaemic heart disease, sequelae of stroke and heart failure, and other commonly recognised complications of diabetes. See Table 2.3 for specified ICD-10 codes pertaining to diabetes-related deaths. (c) Causes of death data for 2015 are preliminary and subject to a revisions process. See Explanatory Notes 52-55 and A More Timely Annual Collection: Changes to ABS Processes (Technical Note) in this publication.
DIABETES ON DEATH CERTIFICATES
There is a considerable difference between the number of deaths in a given year with diabetes as the underlying cause (4,662 in 2015), compared with the number of deaths that might be considered diabetes-related (8,355 in 2015). However, there were actually a total of 16,420 deaths in 2015 (10.3% of all deaths) where diabetes was mentioned on a death certificate. Many of these mentions were in Part II of the death certificate. Part II is used by doctors to report other significant diseases, conditions, or injuries that contributed to death but which did not result in the underlying cause of death given in Part I. The use of Part II for recording diabetes mostly precludes it from being chosen as the underlying cause of death, but the fact it is mentioned is significant and is likely to be of interest to researchers and policy makers working on related matters.
DIABETES IN THE ABORIGINAL AND TORRES STRAIT ISLANDER POPULATION
Aboriginal and Torres Strait Islander deaths include those recorded in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory. Data for Victoria, Tasmania and the Australian Capital Territory have been excluded in line with national reporting guidelines (for information on issues with Aboriginal and Torres Strait Islander identification, see Explanatory Notes 56-66).
Diabetes (E10-E14) was the second leading underlying cause of death of Aboriginal and Torres Strait Islander Australians in 2015, accounting for 194 deaths, or 6.7% of all Aboriginal and Torres Strait Islander deaths. The standardised death rate for diabetes was 4.7 times higher for Aboriginal and Torres Strait Islander Australians compared to non-Indigenous Australians in 2015 (76.9 and 16.3 deaths per 100,000 people, respectively). However, the rate is also the lowest recorded for Aboriginal and Torres Strait Islander people in the past 5 years.
Footnote(s): (a) Standardised death rate. Deaths per 100,000 of estimated mid-year population. See Glossary for further information. (b) Data are reported by jurisdiction of usual residence for NSW, Qld, WA, SA and the NT only. Data for Victoria, Tasmania and the Australian Capital Territory have been excluded in line with national reporting guidelines. For information on issues with Aboriginal and Torres Strait Islander identification, see Explanatory Notes 56-66. (c) Causes of death data for 2015 are preliminary and subject to a revisions process. See Explanatory Notes 52-55 and A More Timely Annual Collection: Changes to ABS Processes (Technical Note) in this publication.
Source(s): Standardised death rates for Diabetes (E10-E14), by Indigenous status, 2015
DEFINITION OF DIABETES-RELATED DEATHS
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