Causes of Death, Australia methodology

Latest release
Reference period
2021

Data collection

Australian causes of death statistics

This publication contains statistics on causes of death for Australia, together with selected statistics on perinatal deaths.

Statistics on perinatal deaths for the 2007-2009 reference years were published separately in Perinatal Deaths, Australia, 2009 (cat. no. 3304.0).

Information in Causes of Death, Australia is not comparable with deaths data published in the monthly Provisional Mortality Statistics reports which provides preliminary counts of deaths by date of occurrence in 2021.

In order to complete a death registration, the death must be certified by either a doctor using the Medical Certificate of Cause of Death, or by a coroner. In 2021, 87.7% of deaths were certified by a doctor. The remaining 12.3% were certified by a coroner. There are variations between jurisdictions in relation to the proportion of deaths certified by a coroner, ranging from 6.9% of deaths certified by a coroner and registered in Queensland, to 25.4% of deaths certified by a coroner and registered in the Northern Territory.

In order to complete a perinatal death registration, the death must be certified by either a doctor, using the Medical Certificate of Cause of Perinatal Death, or by a coroner. In 2021, 97.6% of perinatal deaths were certified by a doctor, with the remaining 2.4% certified by a coroner.

It is the role of the coroner to investigate the circumstances surrounding all reportable deaths and to establish, wherever possible, the circumstances surrounding the death, and the cause(s) of death. Although there is variation across jurisdictions in what constitutes a death that is reportable to a coroner, they are generally reported in circumstances such as:

• where the person died unexpectedly and the cause of death is unknown
• where the person died in a violent or unnatural manner
• where the person died during, or as a result of an anaesthetic
• where the person was 'held in care' or in custody immediately before they died
• where the identity of the person who has died is unknown.

The registration of deaths is the responsibility of the eight individual state and territory Registries of Births, Deaths and Marriages. As part of the registration process, information about the cause of death is supplied by the medical practitioner certifying the death or by a coroner. Other information about the deceased is supplied by a relative or other person acquainted with the deceased, or by an official of the institution where the death occurred. The information is provided to the Australian Bureau of Statistics (ABS) by individual registries for coding and compilation into aggregate statistics. In addition, the ABS supplements this data with information from the National Coronial Information System (NCIS). As a voluntary collaboration between the Australian States and Territories and New Zealand, the NCIS is independent of the coronial system and does not form any part of the coronial investigation process. The NCIS enables access to some documents from the coronial investigation but it is not intended to be a full replica of the coronial brief.

The diagram below outlines the Australian Causes of Death Statistics System. Each death is certified by either a doctor or coroner and the resultant information is provided to the Australian Bureau of Statistics (ABS) through the Registrar of Births, Deaths and Marriages in each state or territory. Information is also provided via the National Coronial Information System for those deaths certified by a coroner. The ABS processes, codes and validates this information, which is then provided in statistical outputs.

Australian causes of death statistics system

The flow chart begins with a death event. A death event has two options, a funeral director or reportable cause of death. Funeral director registers the death with the registrar of births deaths and marriages.

A reportable death has two options, yes or no. No, a Not reportable death, will be certified by a doctor then registered with the registrar of births deaths and marriages. Yes, a reportable death, goes to a coroner investigation. Coroner investigation contains three fields, police investigation, autopsy, and other (e.g. toxicology).

Coroner investigation goes to certification by coroner. There are two options from certification by coroner, registrar of births deaths and marriages and National Coronial Information System.

The next section of the flow chart is called ABS processing. The flow chart continues from registrar of births deaths and marriages and National Coronial Information System to Australian Bureau of Statistics amalgamation and record checks.

This flows to cause of death coding and validation process. This then flows to validation and finalisation of deaths file.

The flow chart ends at the next section called statistics available to users at the statistical outputs option.

Scope of causes of death statistics

Ideally, for compiling annual time series, the number of deaths should be recorded and reported as those which occurred within a given reference period, such as a calendar year. However, there can be lags in the registration of deaths with the state or territory registries and so not all deaths are registered in the year that they occur. There may also be further delays to the ABS receiving notification of the death from the registries due to processing or data transfer lags. Therefore, every death record will have:

• a date on which the death occurred (the date of occurrence)
• a date on which the death is registered with the state and territory registry (date of registration)
• a date on which the registered death is lodged with the ABS and deemed in scope.

With exception to the statistics published by Year of Occurrence (Data Cube 14), all deaths referred to in this publication relate to the number of deaths registered, not those which actually occurred, in the years shown.

The scope for each reference year of the death registrations includes:

• deaths registered in the reference year and received by the ABS in the reference year
• deaths registered in the reference year and received by the ABS in the first quarter of the subsequent year
• deaths registered in the years prior to the reference year but not received by ABS until the reference year or the first quarter of the subsequent year, provided that these records have not been included in any statistics from earlier periods.

From 2007 onwards, data for a particular reference year includes all deaths registered in Australia for the reference year that are received by the ABS by the end of the March quarter of the subsequent year. Death records received by the ABS during the March quarter of 2022 which were initially registered in 2021 (but for which registration was not fully completed until 2022) were assigned to the 2021 reference year. Any registrations relating to 2021 which were received by the ABS from April 2022 will be assigned to the 2022 reference year. Approximately 5% to 8% of deaths occurring in one year are not registered until the following year or later.

Prior to 2007, the scope for the reference year of the Death Registrations collection included:

• deaths registered in the reference year and received by the ABS in the reference year
• deaths registered in the reference year and received by the ABS in the first quarter of the subsequent year
• deaths registered during the two years prior to the reference year but not received by the ABS until the reference year.

The ABS Causes of Death collection includes all deaths that occurred and were registered in Australia, including deaths of persons whose usual residence was overseas. Deaths of Australian residents that occurred outside Australia may be registered by individual registries, but are not included in ABS deaths or causes of death statistics.

The current scope of the statistics includes:

• all deaths being registered for the first time
• deaths in Australia of temporary visitors to Australia
• deaths occurring within Australian Territorial waters
• deaths occurring in Australian Antarctic Territories or other external territories (including Norfolk Island)
• deaths occurring in transit (i.e. on ships or planes) if registered in the Australian state or territory of 'next port of call'
• deaths of Australian Nationals overseas who were employed at Australian legations and consular offices (i.e. deaths of Australian diplomats while overseas) where able to be identified
• deaths that occurred in earlier reference periods that have not been previously registered (late registrations).

The scope of the statistics excludes:

• repatriation of human remains where the death occurred overseas
• deaths of foreign diplomatic staff in Australia (where these are able to be identified)
• stillbirths/fetal deaths (these are included in perinatal death statistics (see Perinatal deaths, below)). In 2007-2009 these were published separately in Perinatal Deaths, Australia (cat. no. 3304.0) but are now included in this publication.

Deaths registered on Norfolk Island from 1 July 2016 are included in this publication. This is due to the introduction of the Norfolk Island Legislation Amendment Act 2015. Norfolk Island deaths are included in statistics for "Other Territories" as well as totals for all of Australia. Deaths registered on Norfolk Island prior to 1 July 2016 were not in scope for death statistics. Prior to 1 July 2016, deaths of people that occurred in Australia with a usual residence of Norfolk Island were included in Australian totals, but assigned a usual residence of 'overseas'. With the inclusion of Norfolk Island as a territory of Australia in the Australian Statistical Geography Standard (ASGS) 2016, those deaths which occurred in Australia between January and June 2016 with a usual residence of Norfolk Island were allocated to the Norfolk Island SA2 code instead of the 'overseas' category.

Acknowledgements

This publication draws extensively on information provided freely by the state and territory Registries of Births, Deaths and Marriages, and the Victorian Department of Justice who manage the National Coronial Information System (NCIS). Their continued cooperation is very much appreciated: without it, the wide range of vitals statistics published by the ABS would not be available. Information received by the ABS is treated in strict confidence as required by the Census and Statistics Act 1905.

Data quality

From the Causes of Death Australia, 2015 publication, data has been released approximately six months earlier than previous issues (2014 and prior). This was due to a number of improvements in the processing of demographic and cause of death information.

In compiling causes of death statistics, the ABS employs a variety of measures to improve quality, which include:

• providing certifiers with certification booklets for guidance in reporting causes of death on medical certificates, see Information Paper: Cause of Death Certification Australia, 2008
• seeking detailed information from the National Coronial Information System (NCIS)
• editing checks at the individual record and aggregate levels.

Increase in number of death registrations

The number of deaths registered in 2021 (171,469) increased by 10,169 compared to 2020 registrations. All jurisdictions recorded an increase in death registrations in 2021. This follows lower death counts in  2020, after the introduction of public health measures to limit the spread of COVID-19.

Coroner certified deaths data

Deaths that are referred to a coroner can take time to be fully investigated, which subsequently affects the availability of data to the ABS for cause of death coding. Each year, some coroner cases are coded by the ABS before the coronial proceedings are finalised. Coroner cases that have not been closed or had all information made available can impact on data quality as less specific ICD codes often need to be applied.

At the time of coding 2021 data, there was a higher proportion of open coroner cases than at the time of preliminary coding in previous years (67.2% in 2021 versus a 5-year average for 2015-2019 of 56.2%). This is reflected in the 2021 dataset by a higher proportion of deaths due to Other ill-defined and unspecified causes of mortality (R99). Cases coded to R99 made up 9.8% of the coroner certified deaths dataset in 2021, compared with a historical average of 6.3%. Of these cases, 74.6% are open cases that fall within the scope of the ABS causes of death revisions process.

Causes of death data for 2021 would ordinarily be revised in early 2024. In light of the information detailed above, an early revision of 2021 data will be conducted during the upcoming revisions cycle in 2023. This revision will target open cases currently coded to Other ill-defined and unspecified causes of mortality (R99), Exposure to unspecified factor (X59) and Unspecified event, undetermined intent (Y34), with the aim of enhancing the specificity of the codes applied to these cases by capturing additional coronial information made available since initial coding.

Causes of death with a high proportion of coroner certified deaths (e.g., suicide, assault, drug-induced deaths) should be interpreted with caution due to the expectation that these data will change during revisions.

Drug-induced deaths

Drug-induced deaths are those which are directly attributable to drug use. They include deaths due to acute drug toxicity (e.g. overdose) and chronic drug use (e.g. drug-induced cardiac conditions).

On average, 97% of drug-induced deaths are certified by a coroner. There are multiple complex factors which need to be considered when a death is certified as drug-induced. The timing between the death and toxicology testing can influence the levels and types of drugs detected, making it difficult to determine the true level of a drug at the time of death. Individual tolerance levels may also vary considerably depending on multiple factors, including sex, body mass and a person’s previous exposure to a drug. Contextual factors around the death must also be considered such as pre-existing natural disease and reports from informants (e.g., friends and families) regarding the circumstances surrounding death. For these reasons, the certification of a death as being drug-induced can take significant time to complete, making these deaths particularly sensitive to the revisions process.

Drug-induced deaths data is preliminary for 2021 and 2020 - interpretation should take into account that numbers of drug-induced deaths will increase when the ABS revisions process is applied. Revised data for drug-induced deaths in 2021 will be published in early 2023.

Historical considerations

As a result of two reconciliation exercises conducted jointly between the ABS and the Victorian Registry of Births Deaths and Marriages (Victorian RBDM), additional historical death registrations have been added to mortality dataset. This was due to an issue associated with the Registry's previous processing system (replaced in 2019) which resulted in some death registrations not being delivered to the ABS in the year they were registered.

The first exercise (conducted in the first quarter of 2020) resulted in the identification of an additional 2,812 death registrations from 2017 to 2019 that had not previously been provided to the ABS. Of these, 40.4% were registered in 2017, 57.0% in 2018 and the remainder in 2019 (2.6%). The 2,812 Victorian deaths were in scope of the 2019 reference year and therefore included in 2019 counts of total deaths in both the Deaths, Australia, 2019 and Causes of Death, Australia, 2019 datasets.

Of the 2,739 deaths that were registered in 2017 and 2018 and submitted to the ABS for the 2019 reference year 62.9% were certified by a coroner with the remaining 37.1% certified by a doctor. This led to an increase across a number of causes of death, with those more likely to be referred to a coroner (i.e. external causes of death) experiencing larger effects from the delayed delivery of registrations. A time series adjustment was applied to deaths due to suicide, assault and accidental drug overdose to enable a more accurate comparison of mortality over time for these causes. See Technical note: Victorian additional registrations and time series adjustments in Causes of Death, Australia, 2019 for detailed information on this issue.

In order to present a more accurate time series, where historical data is presented for Victoria for the years 2017-2019 in the commentary in this publication, the Victorian additional registrations from this first reconciliation exercise have been presented by year of registration across all causes (not just the three causes of suicide, assault and accidental drug overdose). Numbers presented in the commentary may therefore differ from numbers presented in the data cubes and components may not add up to totals.

A subsequent exercise (conducted in the first quarter of 2022) identified a further 1,864 death registrations from 2013 to 2016 that had not previously been provided to the ABS. Of these, 31.7% were registered in 2013, 24.6% in 2014, 7.7% in 2015 and the remainder in 2016 (36.1%). As these deaths occurred more than five years prior to the 2021 reference year, they are not considered to be representative of mortality in 2021 and are excluded from the 2021 reference year counts. In the Deaths, Australia, 2021 publication these additional registrations have been included in tables that are presented by year of occurrence of death only.

There were 72 deaths of these 1,864 registrations that were due to suicide. These 72 deaths due to suicide have been included according to the year of registration in relevant data tables and commentary. All other registrations are included in year of occurrence outputs only. See Technical note: Victorian additional registrations (2013-2016) for more details on these registrations and how they are reflected in published data.

Additionally, as part of the implementation of the new registration system in Victoria in February 2019, there was a change in the way coroner referred deaths are reported to the ABS. Previously there was a range of factors that would determine the point at which a coroner referred death was reported to the ABS, often leading to significant delays in reporting. From 2019, this changed and interim registrations (open cases) have been submitted to the ABS resulting in more timely delivery of death registration information to the ABS.

Western Australian causes of death data revisions 2016 to 2020

An issue has been identified with cause of death data for Western Australia where some information was not uploading in full to the ABS Mortality processing system. The issue mostly impacts associated cause data for doctor certified deaths in Western Australia from 2016 forward. 2021 data has been updated, and revised data for 2016 to 2020 will be provided in a future update to the 2021 Causes of Death publication.

Updates to deaths due to Other ill-defined and unspecified causes of mortality (R99) in the 2017 reference year

Traditionally coroner referred deaths are in scope for revision twice after initial publication, with the latest revision cycle having included finalising 2018 and the first revision of 2019 reference year data. Throughout the coding year 67 coroner referred deaths in the 2017 reference year with an underlying cause due to Other ill-defined and unspecified causes of mortality (R99) were identified to have an updated cause of death description, which would lead to assigning a more specified underlying cause of death.

See the Data quality section of the methodology and Causes of Death Revisions, 2018 Final Data (Technical Note) and 2019 Revised Data (Technical Note) in Causes of Death, Australia, 2020 for more information surrounding the revisions process.

The table below outlines the causes of death the 67 deaths are now assigned to. The majority of deaths (94%) were recoded to specific natural causes of death (A00-R95), with 29 being coded to the Diseases of the circulatory system (I00-I99). Four deaths were coded to an external cause.

Re-coding of 2017 reference year deaths due to Other ill-defined and unspecified causes of mortality (R99)
Cause of death and ICD-10 codeNumber of deaths re-coded from R99 to this cause of death% of total deaths recoded
Certain infectious and parasitic diseases (A00-B99)23.0
Neoplasms (C00-D48)11.5
Endocrine, nutritional and metabolic diseases (E00-E90)69.0
Mental and behavioural disorders (F00-F99)11.5
Diseases of the nervous system (G00-G99)46.0
Diseases of the circulatory system (I00-I99)2943.3
Ischaemic heart diseases (I20-I25)1928.4
Diseases of the respiratory system (J00-J99)811.9
Diseases of the digestive system (K00-K93)46.0
Certain conditions originating in the perinatal period (P00-P96)23.0
Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)46.0
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)23.0
External causes of morbidity and mortality (V01-Y98)46.0
Accidental poisoning by and exposure to noxious substances (X40-X49)23.0
Intentional self-harm (X60-X84, Y87.0)11.5
Sequelae of external causes of morbidity and mortality (Y85-Y89)11.5
Total67100.0

Live birth counts used in mortality rate denominators

In 2016 and 2017 there were lower than expected registration counts for New South Wales. The ABS worked with the NSW Registry of Births, Deaths and Marriages (NSW RBDM) to investigate these counts, highlighting that changes to identity requirements in 2016 had prevented some registrations from being finalised. The NSW RBDM worked with parents to finalise these registrations, enabling many to be included in 2018 counts. Other initiatives also contributed to the higher count of births in NSW in 2018, including the implementation of an online birth registration system and a campaign aimed at increasing registrations among Aboriginal and Torres Strait Islander parents.

In 2018, the Northern Territory Registry of Births, Deaths and Marriages identified a processing issue that led to delays in completing the registration of some births that occurred in previous years. These births have since been registered, resulting in 355 additional births being included in 2018 data, the majority of which (339) were of Aboriginal and Torres Strait Islander children. Care should be taken when interpreting changes in birth counts, infant death rates and fertility rates for the Northern Territory in recent years.

In 2020, lockdowns due to the COVID-19 pandemic influenced the number of birth registrations in Australia, with fewer births registered in 2020 compared to recent years.

Death registration counts

In November 2010, the Queensland Registrar of Births, Deaths and Marriages advised the ABS of an outstanding deaths registration initiative undertaken by the registry. This initiative resulted in the November 2010 registration of 374 previously unregistered deaths which occurred between 1992 and 2006 (including a few for which a date of death was unknown). Of these, around three-quarters (284) were deaths of Aboriginal and Torres Strait Islander Australians. A data adjustment is made for tables which include Aboriginal and Torres Strait Islander data for Queensland for 2010. For further information refer to Technical Notes, Registration of Outstanding Deaths, Queensland, 2010 in Deaths, Australia, 2010 and Retrospective Deaths by Causes of Death, Queensland, 2010, in Causes of Death, Australia, 2010.

In September quarter 2011 the high number of death registrations in New South Wales was queried with the New South Wales Registry of Births, Deaths and Marriages. Information provided by the Registry indicates that these fluctuations may be the result of changes in processing rates. This may have contributed to the increase in the number of deaths registered in New South Wales in 2011. New South Wales deaths in 2011 (50,182) were 5.8% higher than in 2010 (47,453).

Revisions process

For coroner certified deaths, the specificity of cause of death coding can be affected by the length of time for the coronial process to be finalised and the coroner case closed. To improve the quality of ICD coding, all coroner certified deaths registered after 1 January 2006 are subject to a revisions process.

Up to and including deaths registered in 2005, ABS Causes of Death processing was finalised at a point in time. At this point, not all coroners' cases had been investigated, the case closed and relevant information loaded into the National Coronial Information System (NCIS). The coronial process can take several years if an inquest is being held or complex investigations are being undertaken. In these instances, the cases remain open on the NCIS and relevant reports may be unavailable. Coroners' cases that have not been closed or had all information made available can impact on data quality as less specific ICD codes often need to be applied.

The revisions process to date has focused on cases that remain open on the NCIS database. ABS coders investigate and use additional information from police reports, toxicology reports, autopsy reports and coroners' findings to assign more specific causes of death. The use of this additional information occurs at either 12 or 24 months after initial processing and the specificity of the assigned ICD-10 codes increase over time. As 12 or 24 months pass after initial processing, many coronial cases are closed, with the coroner having dispensed a cause of death and relevant reports have been made available. This allows ABS coders to assign a more specific cause of death.

These published outputs include 2021 and 2020 preliminary data, and 2019 revised data. Data for reference years up to and including 2018 are considered final and no longer subject to the revisions process. Final data for 2019 and revised data for 2020 will be released in early 2023.

Statistical outputs

Data cells with small values have been randomly assigned to protect confidentiality. As a result some totals will not equal the sum of their components. Cells with 0 values have not been affected by confidentialisation.

Where figures have been rounded, discrepancies may occur between totals and sums of the component items.

ABS published outputs are available free of charge from the ABS website. Click on 'Statistics' to gain access to the full range of ABS statistical and reference information. For details on products scheduled for release in the coming week, click on the Future Releases link on the ABS homepage.

Classifications

Socio-demographic classifications

A range of socio-demographic data is available from the ABS Causes of Death collection including age, sex, and Aboriginal and Torres Strait Islander origin. This data has been coded and presented on standard classifications developed by the ABS. Where these are not released in the Causes of Death published outputs, they can be sourced on request from the ABS.

The Aboriginal and Torres Strait Islander origin is captured through the death registration process and coded and presented in this publication based on the ABS Indigenous Status classification, see Indigenous Status Standard, 2014.

Geographic classifications

Since the publication of Causes of Death, Australia, 2011, the ABS has released data based on the Australian Statistical Geography Standard (ASGS). The ASGS is a hierarchical classification system that defines more stable, consistent and meaningful areas than those of the Australian Standard Geographical Classification (ASGC), which was used to define geographical areas for output prior to the release of 2011 reference year data. Under the ASGS, the usual residence of the deceased is coded to the meshblock level. For further information, refer to the Australian Statistical Geography Standard (ASGS) Edition 3, July 2021 - June 2026

Causes of death statistics are presented at the state/territory and national level in this publication. These statistics have been compiled based on the state or territory of usual residence of the deceased, regardless of where in Australia the death occurred and was registered. Deaths of persons usually resident overseas which occur in Australia are included in the state/territory in which their death was registered. Usual residence data at the sub-state level for 2001 to 2020 has been revised to reflect the 2021 version of the ASGS.

The country of birth of the deceased is coded and presented based on the Standard Australian Classification of Countries (SACC). Deaths coded according to the SACC reflect the country of birth of the deceased, as opposed to ancestry. This classification groups neighbouring countries into progressively broader geographic areas on the basis of their similarity in terms of social, cultural, economic and political characteristics. For further information, refer to the Standard Australian Classification of Countries (SACC).

Health classifications: International Classification of Diseases

The International Classification of Diseases (ICD) is the international standard classification for epidemiological purposes and is designed to promote international comparability in the collection, processing, classification, and presentation of causes of death statistics. The classification is used to classify diseases and causes of disease or injury as recorded on many types of medical records as well as death records. The ICD has been revised periodically to incorporate changes in the medical field. Currently the ICD 10th revision is used for Australian causes of death statistics.

The ICD-10 is a variable-axis classification meaning that the classification does not group diseases only based on anatomical sites, but also on the type of disease. Epidemiological data and statistical data is grouped according to:

• epidemic diseases
• constitutional or general diseases
• local diseases arranged by site
• developmental diseases
• injuries.

For example, a systemic disease such as sepsis is grouped with infectious diseases; a disease primarily affecting one body system, such as a myocardial infarction, is grouped with circulatory diseases; and a congenital condition, such as spina bifida, is grouped with congenital conditions.

For further information and access to versions of the ICD refer to WHO International Classification of Diseases (ICD).

Updates to the ICD

The Update and Revision Committee (URC), a WHO advisory group on updates to ICD-10, maintains the cumulative and annual lists of approved updates to the ICD-10 classification. The updates to ICD-10 are of numerous types including the addition and deletion of codes, changes to coding instructions and modification and clarification of terms.

From the 2013 reference year, the ABS implemented a new automated coding system called Iris. The 2013-2021 data coded in the Iris system applied updated versions of the ICD-10 when coding multiple causes of death, and when selecting the underlying cause of death. The 2021 reference year causes of death data presented in this publication was coded using version 5.8.0 of Iris software which applied the WHO ICD-10 updates (2020 version). For coding of 2021 data, the dictionary was updated to reflect new codes added including for vaccine deaths and long COVID-19. More information on Iris and ICD-10 versioning can be found in the table below. For details of further impacts of this change from 2013 data onwards, see the ABS Implementation of the Iris Software: Understanding Coding and Process Improvements Technical Note, in the Causes of Death, Australia, 2013 publication.

Reference yearIris versionICD-10 coding year
2013-20174.4.12013
20185.4.02016
20195.6.02019
20205.8.02020
20215.8.02021

Coding of COVID-19

In response to the COVID-19 pandemic, the World Health Organization (WHO) issued the ICD emergency codes U07.1 COVID-19, virus identified and U07.2 COVID-19, virus not identified. A death directly due to COVID-19 is defined by the WHO as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death.

In 2021, COVID-19 vaccinations were introduced globally. The World Health Organization subsequently issued the ICD-10 emergency code U12.9 (COVID-19 vaccines causing adverse effects in therapeutic use, unspecified) to capture adverse effects of COVID-19 vaccines in therapeutic use. This code allows COVID-19 vaccine-related deaths to be identified separately from deaths involving adverse reactions to other vaccines and biological substances.

In summary, the following new emergency codes have been issued by WHO since 2020 in response to the emergence of COVID-19 to be used when coding causes of death for statistical purposes:

• U07.1 COVID-19 virus identified - This code is used when COVID-19 is confirmed by laboratory testing.
• U07.2 COVID-19 virus not identified - This code is used for suspected or clinical diagnoses of COVID-19 where testing is not completed or inconclusive.
• U08 Personal history of COVID-19 - This code is used when a person has recovered from COVID-19 and no long-term effects have been certified as contributing to an individual’s death and/or COVID-19 is listed on the death certificate but it did not contribute to the death. These deaths are not included in COVID-19 mortality tabulations.
• U09 Post COVID-19 condition -This code is used to link long term conditions including chronic lung conditions that are the result of the virus. These deaths are included in COVID-19 mortality tabulations as associated causes of death.
• U10 Multisystem inflammatory syndrome associated with COVID-19 - This code is used to identify people who have died from COVID-19 where the virus has led to a multi-inflammatory response syndrome.
• U11 Need for immunization against COVID-19 - This code has been assigned to deaths where an incidental mention of a COVID-19 vaccine has been listed on the death certificate. An incidental mention is where the doctor has stated that a person recently received a vaccine but it did not have any contribution to death.
• U12 COVID-19 vaccines causing adverse effects in therapeutic use - This code allows COVID-19 vaccine-related deaths to be identified separately from deaths involving adverse reactions to other vaccines and biological substances.

A further code ‘Z03.8 Examination for observation and other specified reasons’ can be used to record a negative test result in order to capture this information on the death certificate. These deaths are not tabulated as being due to COVID-19.

With the introduction of 2019 ICD-10 updates there was a change to the code for deaths due to poisoning by and exposure to carbon monoxide and other gases and vapours. This change was applied to poisoning across multiple intents including accident (X47), intentional (X67), assault (X88) and undetermined intent (Y17). There are now multiple fourth-digit options for X47, X67, X88 and Y17. Previously, when a death occurred as a result of poisoning by and exposure to carbon monoxide and other gases and vapours, there was no option to further identify carbon monoxide from other gases and vapours as well as to specify the source of the carbon monoxide. ABS mortality coders are now required to choose from multiple fourth-digit options to further specify the death:

• X47.0/X67.0/X88.0/Y17.0 carbon monoxide from combustion engine exhaust
• X47.1/X67.1/X88.1/Y17.2 carbon monoxide from utility gas
• X47.2/X67.2/X88.2/Y17.2 carbon monoxide from other domestic fuels
• X47.3/X67.3/X88.3/Y17.3 carbon monoxide from other sources
• X47.4/X67.4/X88.4/Y17.3 carbon monoxide from unspecified sources
• X47.8/X67.8/X88.8/Y17.8 other specified gases and vapours
• X47.9/X67.9/X88.9/Y17.9 unspecified gases and vapours

Prior to the 2013 reference year, the 2006 version of the ICD-10 was the most recent version used for coding deaths, with the exception of two updates that were applied after the 2006 reference year. The first update was implemented in 2007 and related to the use of mental and behavioural disorders due to psychoactive substance use, acute intoxication (F10.0, F11.0...F19.0) as an underlying cause of death. If the acute intoxication initiated the train of morbid events it is now assigned an external accidental poisoning code (X40-X49) corresponding to the type of drug used. For example, if the death had been due to alcohol intoxication, the underlying cause before the update was F10.0, and after the update the underlying cause is X45, with poisoning code T51.9. The second update implemented from the 2009 reference year was the addition of Influenza due to certain identified virus (J09) to the Influenza and Pneumonia block. This addition was implemented to capture deaths due to Swine flu and Avian flu, which were reaching health epidemic status worldwide.

The cumulative list of ICD-10 updates can be found online.

Mortality coding

Types of deaths

Conditions on the medical certificate of cause of death are coded to the International Classifications of Diseases, 10th revision (see Classifications section of the methodology for more information). All causes of death can be grouped to describe the type of death, whether it be from a disease or condition, or from an injury, or whether the cause is unknown. These are generally described as:

• Natural Causes - deaths due to diseases (for example diabetes, cancer, heart disease etc.) (A00-Q99, R00-R98)
• External Causes - deaths due to causes external to the body (for example intentional self-harm, transport accidents, falls, poisoning etc.) (V01-Y98)
• Unknown Causes - deaths where it is unable to be determined whether the cause was natural or external (R99).

Where an accidental or violent death occurs, the underlying cause is classified according to the circumstances of the fatal injury, rather than the nature of the injury, which is coded separately. For example, a motorcyclist may crash into a tree (V27.4) and sustain multiple fractures to the skull and facial bones (S02.7), which leads to death. The underlying cause of death is the crash itself (V27.4), as it is the circumstance which led to the injuries that ultimately caused the death.

Automated coding

From the 2013 reference year, the ABS implemented a new automated coding system called Iris. The 2013-2021 data coded in the Iris system applied updated versions of the ICD-10 when coding multiple causes of death, and when selecting the underlying cause of death. The 2021 reference year causes of death data presented in this publication was coded using version 5.8.0 of Iris software which applied the WHO ICD-10 updates (2020 version). For coding of 2021 data, the dictionary was updated to reflect new codes added including for vaccine deaths and long COVID-19. More information on Iris and ICD-10 versioning can be found in the table below. For details of further impacts of this change from 2013 data onwards, see the ABS Implementation of the Iris Software: Understanding Coding and Process Improvements Technical note, in the Causes of Death, Australia, 2013 publication and Updates to Iris coding software: Implementing WHO updates and improvements in coding processes Technical note, in the Causes of Death, Australia, 2018 publication.

Reference yearIris versionICD-10 coding year
2013-20174.4.12013
20185.4.02016
20195.6.02019
20205.8.02020
20215.8.02021

Coding of coroner certified deaths

The quality of causes of death coding can be affected by changes in the way information is reported by certifiers, by lags in completion of coroner cases and the processing of the findings. While changes in reporting and lags in coronial processes can affect coding of all causes of death, those coded to Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified and Chapter XX: External causes of morbidity and mortality are more likely to be affected because the code assigned within the chapter may vary depending on the coroner's findings (in accordance with ICD-10 coding rules).

Where a case remains open on the NCIS at the time the ABS ceases processing, and insufficient information is available to code a cause of death (e.g. a coroner certified death was yet to be finalised by the coroner), less specific ICD codes are assigned, as required by the ICD coding rules.

The specificity with which open cases are able to be coded is directly related to the amount and type of information available on the NCIS. The amount of information available for open cases varies considerably from no information to detailed police, autopsy and toxicology reports. There may also be interim findings of 'intent'.

The manner or intent of an injury which leads to death, is determined by whether the injury was inflicted purposefully or not. When it was inflicted purposefully (intentional), a determination should be made as to whether the injury was self-inflicted (suicide) or inflicted by another person (assault). However, intent cannot be determined in all cases.

Coding concepts: Underlying and multiple causes of death

ICD-10 codes are assigned to all conditions on a medical certificate of cause of death and rules applied to select an underlying cause of death. The WHO defines the underlying cause of death as the disease or injury that initiated the train of morbid events leading directly to death. Accidental and violent deaths are classified according to the external cause, that is, to the circumstances of the accident or violence which produced the fatal injury rather than to the nature of the injury. The majority of data presented in the datacubes in this publication is tabulated according to the underlying cause of death.

Multiple causes of death include all causes and conditions reported on the death certificate (i.e. both underlying and associated causes; see the Glossary for further details). As all entries on the death certificate are taken into account, multiple causes of death statistics are valuable in recognising the impact of conditions and diseases which are less likely to be an underlying cause, highlighting relationships between concurrent disease processes, and giving an indication of injuries which occur as a result of specific external events. These features of multiple causes of death data provide a more in depth picture of mortality in Australia.

When analysing data on multiple causes of death, data can be presented in two ways: by counts of deaths or by counts of mentions. When analysis is conducted by counts of death, the figures are describing the number of people who have died with a particular disease or disorder. Multiple Causes of Death data derived from counts of mentions is the total number of incidences of a particular disease or disorder on the death certificate. For example, an individual may have had Breast cancer (C50) and then developed Secondary lung cancer (C78.0). This individual would be counted once if counts were by the number of deaths from cancer, but twice if the counts were by the number of mentions of cancer. Care should be taken to differentiate between counts and mentions when analysing multiple causes of death data.

Changes in patterns of mortality are studied by policy makers and researchers to improve health outcomes for all Australians. However, changes in patterns of mortality can occur for many reasons. Changes can reflect a real increase or decrease in the prevalence of a disease or disorder, or a change in medical treatment. Mortality data changes can also be a result of administrative processes which can potentially impact on the data, for example, International Classification of Disease (ICD) coding classification changes and updates, and differences in how deaths are certified. Analysis of the multiple causes of death data can give a deeper understanding of how the complete dataset may be affected by both real and administrative changes. For example, in 2009, the World Health Organization (WHO) recommended introducing code J09 (Influenza due to certain identified influenza virus) to the ICD-10 in response to the worldwide epidemics of swine flu and avian flu. There were 98 people who died as a direct consequence of contracting these strains of the flu across 2009 and 2010. In addition there were 51 people who had this flu when they died and for whom this would have been a complicating factor. Additional health risk factors may also be identified. When swine or avian flu was the underlying cause of death, multiple causes data shows obesity and respiratory problems as a common associated cause. In this way, multiple causes data provides policy makers and researchers a greater insight beyond the underlying cause of death.

Coding of pneumonia, organism unspecified (J18)

As part of a collection-wide initiative by the ABS to improve specificity of cause of death coding in the 2008 and 2009 reference years, doctor certified deaths due to Pneumonia, organism unspecified (J18) reduced substantially. This was as a result of the ABS manually interrogating conditions located in Part 2 of the Medical Certificate Cause of Death (MCCD), reallocating them to a more specific cause of death code.

In 2010 there was a shift in this pattern. The number of doctor certified deaths assigned to J18 increased by 690 deaths, or 49.5%. The reason for the 2010 data movement was a more consistent use of coding software decision tables throughout both coding and quality assurance processes. These decision tables provide clear rules for when Pneumonia can be selected as an underlying cause of death, in relation to the information listed in Part 2 of the MCCD.

The 2010 increase represented a return to counts observed prior to 2008. In 2007, 2,293 doctor certified deaths were assigned to J18, therefore the 2010 count for this cause of death (2,085) is considered a return to the trend which existed prior to the coding of 2008 and 2009 data. The data from 2011 onwards has been consistent with this trend.

Transport accidents

There were 1,264 deaths attributed to road crashes (V01-V79, V89.2, X82, Y32) in 2021. Of these, 41 were of suicidal intent (X82) and there were a further 17 where the intent could not be determined (Y32). When making comparisons between road deaths from the ABS Causes of Death collection and road deaths from other sources, the scope and coverage rules applying to each collection should be considered. It should be noted that the number of road-traffic-related deaths attributed to transport accidents for 2021 is expected to change as data is subject to the revisions process.

There were 77 transport accidents (V00-V99) that were registered in Victoria in 2017 and 2018 but not supplied to the ABS as an official death registration until 2019. These 77 deaths are included in the 2019 reference year data for Victoria and Australia totals of transport accidents. For more information refer to Technical note: Victorian additional registrations and time series adjustments in Causes of Death, Australia, 2019.

The number of deaths attributable to Accident to watercraft causing drowning and submersion (V90) increased from 26 in 2010 to 75 in 2011. This increase is primarily due to deaths resulting from an incident in December 2010 when a boat collided with cliffs on Christmas Island. These deaths were registered with the Western Australian Registry of Births, Deaths and Marriages in January 2011, resulting in an increase in the number of deaths coded to V90 in Western Australia.

Assaults

The number of deaths recorded as Assault (X85-Y09, Y87.1) i.e. murder, manslaughter and their sequelae, published in the ABS Causes of Death publication, differ from those published by the ABS in Recorded Crime - Victims, Australia. Reasons for the different counts include differences in scope and coverage between the two collections, as well as legal proceedings that are pending finalisation. It is important to note that the number of deaths attributed to assault for 2021 is expected to change as data is subject to the revisions process. See Causes of Death Revisions, 2018 Final Data (Technical Note) and 2019 Revised Data (Technical Note) in Causes of Death, Australia, 2020.

There were 28 deaths due to assault that were registered in Victoria in 2017 (13 deaths) and 2018 (15 deaths) that were not submitted to the ABS until the 2019 reference year. These deaths are included in the total number of all cause deaths for 2019 in line with ABS scope of mortality data. When analysing assaults as an individual cause of death a time series adjustment has been applied and these 28 deaths have been reassigned to their respective registration years in the data cubes of this publication.

COVID-19

The source of all cause of death data for the ABS is collected through the civil registration system either by the Medical Certificate of Cause of Death (MCCD) for doctor certified deaths or the pathology report or coronial findings for coroner referred deaths (accessed via the National Coronial Information System). This enables identification of the underlying cause of death and other associated causes. Civil registration based data is not directly comparable with that released from disease surveillance systems which are designed to release information rapidly on both infections and mortality. Information about mortality sourced from the registration-based system takes longer to receive than information reported through the surveillance system, but it is more comprehensive and can provide important additional insights into deaths from COVID-19.

The civil registration system also captures deaths which may be caused by the COVID-19 vaccine. Deaths due to the vaccine identified by the ABS are certified by a medical practitioner or a coroner. Independent analysis and interpretation of deaths data by authorities such as the Therapeutic Goods Administration (TGA) is not conveyed to the ABS or reflected in coding outputs. Due to the scope of the ABS deaths collection, data received and published by the ABS may differ from data collected through the TGA's independent investigations into COVID-19 vaccine-related deaths.

Mortality tabulations and methodologies

Leading causes of death

Ranking causes of death is a useful method of describing patterns of mortality in a population and allows comparison over time and between populations. However, different methods of grouping causes of death can result in a vastly different list of leading causes for any given population. A ranking of leading causes of death based on broad cause groupings such as 'cancers' or 'heart disease' does not identify the leading causes within these groups, which is needed to inform policy on interventions and health advocacy. Similarly, a ranking based on very narrow cause groupings or including diseases that have a low frequency, can be meaningless in informing policy.

Tabulations of leading causes presented in this publication are based on research presented in the Bulletin of the World Health Organization, Volume 84, Number 4, April 2006, 297-304. The determination of groupings in this list is primarily driven by data from individual countries representing different regions of the world. Other groupings are based on prevention strategies, or to maintain homogeneity within the groups of cause categories. Since the aforementioned bulletin was published, a decision was made by WHO to include deaths associated with the H1N1 influenza strain (commonly known as swine flu) in the ICD-10 classification as Influenza due to certain identified influenza virus (J09). This code has been included with the Influenza and Pneumonia leading cause grouping in the Causes of Death publication since the 2009 reference year.

Since 2015, the ABS includes C26.0 (malignant neoplasm of the intestinal tract, part unspecified) in the WHO leading cause grouping for Malignant neoplasm of colon, sigmoid, rectum and anus (now C18-C21, C26.0). For further details on the reasoning behind the inclusion of C26.0 in this leading cause grouping, see Complexities in the measurement of bowel cancer in Australia, in Causes of Death, Australia, 2015. This change has been applied in this publication to data for all reference years that appear in tables involving leading cause tabulations. This differs to publications prior to 2015, for which C26.0 was not included in this leading cause grouping, and also differs to the suggested WHO tabulation of leading causes for these cancers. Comparisons with data for this leading cause, and associated leading cause rankings, as they appear in previous publications should therefore be made with caution. Time-series data by leading causes has been published in Australia's leading causes of death in this publication.

The ABS now includes Y87.0 (Sequelae of intentional self-harm), Y87.1 (Sequelae of assault) and Y85 (Sequelae transport accidents) in the WHO leading cause grouping for Intentional self-harm (now X60-X84, Y87.0), Assault (now X85-Y09, Y87.1) and Land transport Accidents (V01-V89, Y85). This change has been applied to harmonise data between the WHO leading cause grouping and subject specific data cubes for intentional self-harm, assault and transport accidents which is published as part of the ABS Causes of Death collection. This change applies to publication data for all reference years that appear in tables involving leading cause tabulations. This differs to previous publications, where Y87.0, Y87.1 and Y85 were not included in these leading cause groupings, and also differs to the suggested WHO tabulation of leading causes. Comparisons with data for these leading causes, and associated leading cause rankings, as they appear in previous publications should therefore be made with caution. Time-series data by leading causes has been published in Australia's leading causes of death in this publication.

Deaths coded to Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) are not included in tabulations of leading causes due to the unspecified nature of these causes. Many deaths coded to this chapter are likely to be affected by revisions, and hence recoded to more specific causes of death as they progress through the revisions process. An exception to this is Ill-defined and unknown causes of mortality (R95-R99), which is included in the analysis for deaths of those under the age of one year, as Sudden Infant Death Syndrome (R95) and Sudden Unexpected Death in Infancy (R99) is included in this cause grouping. A further exception is any comparisons between the Aboriginal and Torres Strait Islander and non-Indigenous populations. For these comparisons the Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) grouping is included. This aligns with the WHO recommendation to include this grouping when comparing smaller populations that may have higher numbers of deaths due to this cause grouping. As deaths in this grouping are likely to be affected by revisions, the leading cause rankings may change once the data has been revised.

Years of potential life lost (YPLL)

Years of Potential Life Lost (YPLL) measures the extent of 'premature' mortality, which is assumed to be any death between the ages of 1-78 years inclusive, and aids in assessing the significance of specific diseases or trauma as a cause of premature death. YPLL weights age at death reflective of premature mortality, and causes of death with a higher median age have lower YPLL as lower weighting is given to older ages, and higher weighting is given to younger ages. Examples can be seen in deaths due to Dementia, including Alzheimer's disease and suicide. Dementia affects the very elderly and has a high median age of death of 89.2 years, which translates to a lower number of YPLL (6,888). Suicide has a lower median age at death (44.8) and a high number of YPLL (107,068).

Estimates of YPLL are calculated for deaths of persons aged 1-78 years based on the assumption that deaths occurring at these ages are premature. The inclusion of deaths under one year would bias the YPLL calculation because of the relatively high mortality rate for that age, and 79 years was the median age at death when this series of YPLL was calculated using 2001 as the standard year. As shown below, the calculation uses the current ABS standard population of all persons in the Australian population at 30 June 2001.

YPLL is derived from: $$YPLL=\sum_{x}\left(D_{x}(79-A_{x}\right))$$ where: $$A_{x}$$ = adjusted age at death. As age at death is only available in completed years the midpoint of the reported age is chosen (e.g. age at death 34 years was adjusted to 34.5). $$D_{x}$$ = registered number of deaths at age $${x}$$ due to a particular cause of death. YPLL is directly standardised for age using the following formula: where the age correction factor $$C_{x}$$ is defined for age $${x}$$ as: $$C_{x}=\frac{N_{xs}}{N_{s}}.\frac{1}{N_{x}}.N$$ where: $${N}$$ = estimated number of persons resident in Australia aged 1-78 years at 30 June 2021 $$N_{x}$$ = estimated number of persons resident in Australia aged $${x}$$ years at 30 June 2021 $$N_{xs}$$ = estimated number of persons resident in Australia aged $${x}$$ years at 30 June 2001 (standard population) $$N_{s}$$ = estimated number of persons resident in Australia aged 1-78 years at 30 June 2001 (standard population).

The data cubes contain directly age-standardised death rates and YPLL for males, females and persons. In some cases the summation of the results for males and females will not equate to persons. The reason for this is that different standardisation factors are applied separately for males, females and persons.

Age-standardised death rates (SDRs)

Age-standardised death rates enable the comparison of death rates over time and between populations of different age-structures. Along with adult, infant and child mortality rates, they are used to determine whether the mortality rate of the Aboriginal and Torres Strait Islander population is declining over time, and whether the gap between Aboriginal and Torres Strait Islander and non-Indigenous populations is narrowing. However, there have been inconsistencies in the way different government agencies have calculated age-standardised death rates in the past. The ABS uses the direct method of age-standardisation as it allows for valid comparisons of mortality rates between different study populations and across time. This method was agreed to by the ABS, Australian Institute of Health and Welfare (AIHW) and other stakeholders. For further information see: AIHW (2011) Principles on the use of direct age-standardisation in administrative data collections: for measuring the gap between Indigenous and non-Indigenous Australians. Cat. no. CSI 12. Canberra: AIHW.

The direct method has been used throughout the publication and data cubes for age-standardised death rates. Age-standardised death rates for specific causes of death with fewer than a total of 20 deaths have not been published due to issues of robustness.

For further information, see Appendix: Principles on the use of direct age-standardisation, from Deaths, Australia, 2010.

In this publication, age-standardised and age-specific death rates for all persons for the 2012-2021 reference years have been calculated using preliminary 2021 Census-based population estimates. Rates for Aboriginal and Torres Strait Islander persons for the 2012-2021 reference years have been calculated using 2016 Census-based population estimates (projections and backcasts). Non-Indigenous estimates have been derived by subtracting the 2016 Census based Aboriginal and Torres Strait Island population estimates from the total 2021 Census-based estimated resident population (ERP). Rates calculated from population denominators derived from different Censuses may cause artificially large rate differences. Rate comparisons should not be made with previous publications for Aboriginal and Torres Islander data. See Estimates and Projections, Aboriginal and Torres Strait Islander Australians for more information.

For more details on data used in calculating death rates, refer to the Appendix - data used in calculating death rates

Tabulation of selected causes of death

There are standard ways for listing causes of death and there are formal recommendations concerning lists for tabulation to assist international comparisons. The World Health Organization (WHO) provides a number of standard tabulation lists for presentation of causes of death statistics, that assist international comparability. WHO also recommend that when there is not a need for international comparability then lists should be designed to reflect local requirements. These special lists can be developed, for example, to monitor progress of local health programs.

Firearm deaths tabulation

Causes of death attributable to firearm mortality include ICD-10 codes:

• W32-W34, Accidental discharge of firearms
• X72-X74, Intentional self-harm (suicide) by discharge of firearms
• X93-X95, Assault (homicide) by discharge of firearms
• Y22-Y24, Discharge of firearms, undetermined intent
• Y35.0, Legal intervention involving firearm discharge.

Deaths from injury by firearms exclude deaths due to explosives and other causes indirectly related to firearms.

Drug-induced death tabulation

The data presented for drug-induced deaths in this publication is based upon tabulation created by the United States Centers for Disease Control and Prevention (CDC).

Causes of death attributable to drug-induced mortality include ICD-10 codes:

• D52.1, Drug-induced folate deficiency anaemia
• D59.0, Drug-induced haemolytic anaemia
• D59.2, Drug-induced nonautoimmune haemolytic anaemia
• D61.1, Drug-induced aplastic anaemia
• D64.2, Secondary sideroblastic anaemia due to drugs and toxins
• E06.4, Drug-induced thyroiditis
• E16.0, Drug-induced hypoglycaemia without coma
• E23.1, Drug-induced hypopituitarism
• E24.2, Drug-induced Cushing’s syndrome
• E27.3, Drug-induced adrenocortical insufficiency
• E66.1, Drug-induced obesity
• F11.0-F11.5, Use of opioids causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F11.7-F11.9, Use of opioid causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• F12.0-F12.5, Use of cannabis causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F12.7-F12.9, Use of cannabis causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• F13.0-F13.5, Use of sedative or hypnotics causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F13.7-F13.9, Use of sedative or hypnotics causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• F14.0-F14.5, Use of cocaine causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F14.7-F14.9, Use of cocaine causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• F15.0-F15.5, Use of caffeine causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F15.7-F15.9, Use of caffeine causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• F16.0-F16.5, Use of hallucinogens causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F16.7-F16.9, Use of hallucinogens causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• F18.0-F18.5, Use of volatile solvents causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F18.7-F18.9, Use of volatile solvents causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• F19.0-F19.5, Use of multiple drugs and other psychoactive substances causing intoxication, harmful use (abuse), dependence, withdrawal or psychosis
• F19.7-F19.9, Use of multiple drugs and other psychoactive substances causing late onset psychosis, other mental and behavioural disorders and unspecified behavioural disorders
• G21.1, Other drug-induced secondary Parkinsonism
• G24.0, Drug-induced dystonia
• G25.1, Drug-induced tremor
• G25.4, Drug-induced chorea
• G25.6, Drug-induced tics and other tics of organic origin
• G44.4, Drug-induced headache, not elsewhere classified
• G62.0, Drug-induced polyneuropathy
• G72.0, Drug-induced myopathy
• I95.2, Hypotension due to drugs
• J70.2, Acute drug-induced interstitial lung disorders
• J70.3, Chronic drug-induced interstitial lung disorders
• J70.4, Drug-induced interstitial lung disorder, unspecified
• L10.5, Drug-induced pemphigus
• L27.0, Generalized skin eruption due to drugs and medicaments
• L27.1, Localized skin eruption due to drugs and medicaments
• M10.2, Drug-induced gout
• M32.0, Drug-induced systemic lupus erythematosus
• M80.4, Drug-induced osteoporosis with pathological fracture
• M81.4, Drug-induced osteoporosis
• M83.5, Other drug-induced osteomalacia in adults
• M87.1, Osteonecrosis due to drugs
• R78.1, Finding of opiate drug in blood
• R78.2, Finding of cocaine in blood
• R78.3, Finding of hallucinogen in blood
• R78.4, Finding of other drugs of addictive potential in blood
• R78.5, Finding of psychotropic drug in blood
• X40-X44, Accidental poisoning by and exposure to drugs, medicaments and biological substances
• X60-X64, Intentional self-poisoning (suicide) by and exposure to drugs, medicaments and biological substances
• X85, Assault (homicide) by drugs, medicaments and biological substances
• Y10-Y14, Poisoning by and exposure to drugs, medicaments and biological substances, undetermined intent.

Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Also excluded are newborn deaths associated with mother’s drug use.

Opioid-induced death tabulation

The data presented for opioid-induced deaths in this publication is a modified version of the drug-induced deaths tabulation created by the United States Centers for Disease Control and Prevention (CDC). To capture opioid-induced deaths, the following poisoning codes present at the multiple causes of death level were used in combination with the CDC drug-induced underlying cause of death tabulation.

Causes of death attributable to opioids include ICD-10 codes present at the multiple causes of death level:

• T40.0, Opium
• T40.1, Heroin
• T40.2, Other opioids (e.g. Codeine, Morphine)
• T40.4, Other synthetic narcotics (e.g. Pethidine)
• T40.6, Other and unspecified narcotics.

Alcohol-induced death tabulation¹

Causes of death attributable to alcohol-induced mortality include ICD-10 codes:

• E24.4, Alcohol-induced pseudo-Cushing’s syndrome
• F10, Mental and behavioural disorders due to alcohol use
• G31.2, Degeneration of nervous system due to alcohol
• G62.1, Alcoholic polyneuropathy
• G72.1, Alcoholic myopathy
• I42.6, Alcoholic cardiomyopathy
• K29.2, Alcoholic gastritis
• K70, Alcoholic liver disease
• K85.2 Alcohol-induced acute pancreatitis
• K86.0, Alcohol-induced chronic pancreatitis
• R78.0, Finding of alcohol in blood
• X45, Accidental poisoning by and exposure to alcohol
• X65, Intentional self-poisoning by and exposure to alcohol
• Y15, Poisoning by and exposure to alcohol, undetermined intent.

Alcohol-induced causes exclude accidents, homicides, and other causes indirectly related to alcohol use. This category also excludes newborn deaths associated with maternal alcohol use.

1. Miniño AM, Heron MP, Murphy SL, Kochankek, KD. Deaths: Final Data for 2004. National vital statistics reports; vol 55 no 19. Hyattsville, MD: National Center for Health Statistics. 2007.

Non-communicable disease death tabulation²

Causes of death attributable to Non-Communicable Diseases (NCDs) include ICD-10 codes:

• C00-C97, D45-D46, D47.1, D47.3-D47.5, Cancers
• I00-I99, Cardiovascular diseases
• E10-E14, Diabetes
• J30-J98, Chronic lower respiratory diseases.

2. World Health Organization (WHO). Non-Communicable Diseases Global Monitoring Framework: Indicator Definitions and Specifications. Note: The WHO Cancer tabulation for NCDs includes only C00-C97. To be consistent with ABS Causes of Death reporting additional cancer codes (D45-D46, D47.1, D47.3-D47.5) are recommended for inclusion when analysing cancer related NCDs.

Risk factors (associated causes of death) tabulation

The following tabulation has been applied to deaths due to intentional self-harm (see Risk factors for Intentional Self-Harm (suicide) and table 11.17) and deaths due to acute drug toxicity (see table 13.8).

• A00-A09: Intestinal infectious diseases
• A15-A19: Tuberculosis
• A20, A44, A75-A79, A82-A84, A85.2, A90-A96, A98.0-A98.2, A98.8, B50-B57: Vector-borne diseases and rabies
• A33-A37, A80, B01, B05, B06, B15, B16, B17.0, B18.0, B18.1, B18.9, B19, B26: Vaccine-preventable diseases
• A39, A87, G00-G03: Meningitis
• A40-A41: Septicaemia
• B20-B24: Human immunodeficiency virus [HIV] disease
• C00-C97, D45-D46, D47.1, D47.3-D47.5: Malignant neoplasms
• D00-D48, excl. codes in malignant category: Other neoplasms
• D50-D53, E40-E46: Malnutrition and nutritional anaemias
• D52.1, D59.0, D59.2, D61.1, D64.2, E06.4, E16.0, E23.1, E24.2, E27.3, E66.1, F11.1-F11.9, F12.1-F12.9, F13.1-F13.9, F14.1-F14.9, F15.1-F15.9, F16.1-F16.9, F18.1-F18.9, F19.1-F19.9, G21.1, G24.0, G25.1, G25.4, G25.6, G44.4, G62.0, G72.0, I95.2, J70.2, J70.3, J70.4, L10.5, L27.0, L27.1, M10.2, M32.0, M80.4, M81.4, M83.5, M87.1: Chronic psychoactive substance abuse disorders
• E10-E14: Diabetes mellitus
• E24.4, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K86.0, F10.1-F10.9: Chronic alcohol abuse disorders
• E86-E87: Electrolyte imbalance
• F01, F03, G30: Dementia, including Alzheimer's disease
• F04-F09: Other organic mental disorders
• F1[1-6,8-9].0, R78.1-R78.9: Acute psychoactive substance use and intoxication
• F1[1-6,8-9].0, R78.1-R78.9, T36-T50 excl. deaths with an underlying cause of X40-X45, X60-X65 or Y10-Y15: Acute psychoactive substance use and intoxication where drugs or alcohol were not the mechanism of death
• F10.0, R78.0, T51: Acute alcohol use and intoxication
• F10.0, R78.0, T51 excl. deaths with an underlying cause of X40-X45, X60-X65 or Y10-Y15: Acute alcohol use and intoxication where drugs or alcohol were not the mechanism of death
• F20-F29: Schizophrenia, schizotypal and delusional disorder
• F30-F39: Mood [affective] disorders
• F41.8, Z29.0, Z29.9: Problems related to prophylactic measures for COVID-19
• F45.4, F62.8, G43-G44, H92.0, H57.1, K08.8, K14.6, M25.5, M54, M79.6, N23, N64.4, R07, R10, R51-R52: Pain
• F50-F59: Behavioural syndromes associated with physiological disturbances and physical factors
• F51, G47, Z91.3: Problems with sleep
• F60-F69 excl. F630: Disorders of adult personality and behaviour
• F63.0, Z72.6: Gambling and betting
• F70-F79: Mental retardation
• F80-F89: Disorders of psychological development
• F90-F98: Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
• F99: Unspecified mental disorder
• G20: Parkinson disease
• G40-G41: Epilepsy and Status epilepticus
• I05-I09: Chronic rheumatic heart diseases
• I10-I15: Hypertensive diseases
• I20-I25: Ischaemic heart diseases
• I26-I28: Pulmonary heart disease and diseases of pulmonary circulation
• I34-I38: Nonrheumatic valve disorders
• I42: Cardiomyopathy
• I46: Cardiac arrest
• I47-I49: Cardiac arrhythmias
• I50-I51: Heart failure and complications and ill-defined descriptions of heart disease
• I60-I69: Cerebrovascular diseases
• I70: Atherosclerosis
• I71: Aortic aneurysm and dissection
• J00-J06, J20-J22: Acute respiratory diseases other than influenza and pneumonia
• J09-J18: Influenza and pneumonia
• J40-J47: Chronic lower respiratory diseases
• J80-J84: Other respiratory diseases principally affecting the interstitium
• J96: Respiratory failure
• K35-K46, K56: Appendicitis, hernia and intestinal obstruction
• K71-K77: Other liver diseases
• M00-M99 excl. codes in pain and chronic drug use categories: Other musculoskeletal disorders
• N00-N39 excl. N23: Diseases of the urinary system
• O00-O99: Pregnancy, childbirth and the puerperium
• P00-P96: Certain conditions originating in the perinatal period
• Q00-Q99: Congenital malformations, deformations and chromosomal abnormalities
• R45.8: Suicide ideation
• U07.1, U07.2: COVID-19
• V01-V89, Y85: Land transport accidents
• W00-W19: Accidental falls
• W32-W34: Unintentional firearm discharge
• W65-W74: Accidental drowning and submersion
• W75-W84: Other accidental threats to breathing
• X40-X49: Accidental poisoning
• X60-X84, Y870: Intentional self-harm
• X85-Y09: Assault
• Y10-Y34: Event of undetermined intent
• Z00-Z13: Persons encountering health services for examination and investigation
• Z30-Z39: Persons encountering health services in circumstances related to reproduction
• Z40-Z54: Persons encountering health services for specific procedures and health care
• Z55: Problems related to education and literacy
• Z56: Problems related to employment and unemployment
• Z59.0-Z59.3, Z59.9: Problems related to housing
• Z59.4-Z59.8: Problems related to economic circumstances
• Z60: Problems related to social environment
• Z61-Z62: Problems related to negative life events in childhood and upbringing
• Z63.0, Z63.5: Problems in spousal relationship circumstances
• Z63.1-Z63.3, Z63.6-Z63.9: Problems in relationships with family and friends
• Z63.4, Z81.8: Death of a family member or person in primary support network
• Z64: Problems related to certain psychosocial circumstances
• Z65.0-Z65.4: Problems related to legal circumstances
• Z65.5-Z65.9: Other problems related to psychosocial circumstances
• Z73.0-Z73.2, Z73.4-Z73.5, Z73.8-Z73.9: Other problems related to life-management difficulty
• Z73.3, F40-F48 excl. F41.8, F45.4: Anxiety and stress related disorders
• Z73.6: Limitation of activities due to disability
• Z74: Problems related to care-provider dependency
• Z91.0-Z91.2, Z91.4, Z91.6-Z91.8: Personal history of other risk factors
• Z91.5: Personal history of self-harm

Deaths due to intentional self-harm (suicide)

Coding of suicide

The ABS accesses the National Coronial Information System (NCIS) to obtain causes of death information for coroner referred deaths including suicides. Information regarding the causes of death and associated factors is obtained from various reports including police, toxicology, autopsy and coronial findings.

The number of deaths attributed to intentional self-harm for 2021 is expected to increase as data is subject to the revisions process. At the time of coding 2021 data, there was a higher proportion of open coroner cases at preliminary coding than seen in previous years (67.2% in 2021 versus a 5-year average for 2015-2019 of 56.2%). This is reflected in the 2021 dataset by a higher rate of deaths due to other ill-defined and unspecified causes of mortality (R99). For further information, see the Data quality section of the methodology and the Causes of Death Revisions, 2018 Final Data (Technical Note) and 2019 Revised Data (Technical Note) in Causes of Death, Australia, 2020.

From 2006 onwards, the ABS implemented a revisions process for coroner certified deaths (such as suicides), which has enabled additional suicide deaths to be identified beyond initial processing. It is recognised that in the four years prior to the implementation of the revisions process (2002-2005), suicide deaths may have been understated as the ABS began using the National Coronial Information System as the sole source for coding coroner referred deaths.

In addition to the revisions process, new coding guidelines were applied for deaths registered from 1 January 2007. The new guidelines improve data quality by enabling deaths to be coded to suicide if evidence indicates the death was from intentional self-harm. Previously, coding rules required a coroner to determine a death as intentional self-harm for it to be coded to suicide. However, in some instances the coroner does not make a finding on intent. The reasons for this may include legislative or regulatory barriers around the requirement to determine intent, or sensitivity to the feelings, cultural practices and religious beliefs of the family of the deceased. Further, for some mechanisms of death it may be very difficult to determine suicidal intent (e.g. single vehicle incidents, drowning). In these cases the burden of proof required for the coroner to establish that the death was as a result of intentional self-harm may make a finding of suicide less likely.

Under the new coding guidelines, in addition to coroner-determined suicides, deaths may also be coded to suicide following further investigation of information on the NCIS. Further investigation of a death would be initiated when the mechanism of death indicates a possible suicide and the coroner does not specifically state the intent as accidental or homicidal. Information that would support a determination of suicide includes indications by the person that they intended to take their own life, the presence of a suicide note, or knowledge of previous suicide attempts. The processes for coding open and closed coroner cases are illustrated in the below diagrams (open/closed case coding decision trees).

Over time, the NCIS has worked with jurisdictions to improve the timeliness and completeness of information flowing from the coronial systems to the NCIS database. These improvements lead to changes in the information available to ABS coding staff. It is therefore important that data users are aware of any significant improvements in the management of coronial data to enable better interpretation of data within, and between, reference periods.

Coronial cases are more likely to be affected by a lag in registration time, especially those which are due to external causes, including suicide, homicide and drug-related deaths. Due to small numbers these lagged coroner referred registrations can create large yearly variation in some causes of deaths of Aboriginal and Torres Strait Islander people. Caution should be taken when making year to year analysis.

More broadly, change in administrative systems highlights how various factors (including administrative and system changes, certification practices, classification updates or coding rule changes) can impact on the mortality dataset. Data users should note this particular change and be cautious when making comparisons between reference periods. The change does not explain away differences between years, but is a factor to consider. It should also be noted as a factor that may influence the magnitude of any increases in suicide numbers as revisions are applied.

The two flow charts below highlight the guidelines used by the ABS when coding a death to intentional self-harm for open and closed coroner cases, where the intent status at the time of coding is neither intentional self-harm nor assault. In these cases, the ABS considers additional information available on NCIS, such as the mechanism and other available data (e.g. the presence of a suicide note or previous suicide attempts) when determining the intent of such deaths for coding purposes.

Coding of closed cases on the NCIS to Intentional self-harm

Flow chart begins with: Closed case on NCIS is the first option with only one option.

Flows to: Has the coroner made a determination of intentional self-harm or assault? With two options Y or N.

Y flows to Code to relevant code for intentional self-harm (X60-X84,Y87.0) or assault (X85-Y09,Y87.1).

N flows to: Does the mechanism indicate a possible suicide (e.g. deaths due to hanging, falling from a man-made or natural structure, a firearm, a sharp or blunt object, or carbon monoxide poisoning due to exhaust fumes)? With two options Y or N.

N flows to: Code death to an ICD-10 code with an intent other than intentional self-harm.

Y flows to: Coders assess available data such as: (List of 3)
Mention of intent to self inflict or self harm.
Wording such as 'there is no evidence to suggest this death was accidental or suspicious'.
Mention of a suicide note, previous suicide attempts or a history of mental illness in the police and pathology reports

Diagram flows to: Is there sufficient evidence to indicate the death was a suicide? With two options Y or N.

Y flows to: Code to relevant intentional self-harm code (X60-X84, Y87.0).

N flows to: Code mechanism to an ICD-10 code with an intent other than intentional self-harm.

End of flow chart

Coding of open cases on the NCIS to intentional self-harm

Flow chart begins with: Open case on NCIS is the first option with only one option.

Flows to: Is there any cause information available? With two options Y or N.

N flows to: Code to ICD-10 code R99.

Y flows to: Is there an external cause? With two options Y or N.

N flows to: Code to ICD-10 codes A00-Q99.

Y flows to: Does the record have an initial intent status of intentional self-harm or assault? With two options Y or N.

Y flows to: Code to relevant intentional self-harm code (X60-X84, Y87.0) or assault code (X85-Y09, Y87.1)

N flows to: Does the mechanism indicate a possible suicide (e.g. deaths due to hanging, falling from a man-made or natural structure, a firearm, a sharp or blunt object, or carbon monoxide poisoning due to exhaust fumes)? With two options Y or N.

N flows to: Code death to an ICD-10 code with an intent other than intentional self-harm.

Y flows to: Coders assess available data such as: (List of 3)
Mention of intent to self inflict or self harm.
Wording such as 'there is no evidence to suggest this death was accidental or suspicious'.
Mention of a suicide note, previous suicide attempts or a history of mental illness in the police and pathology reports

Diagram flows on to: Is there sufficient evidence to indicate the death was a suicide? With two options Y and N.

Y flows to: Code to relevant intentional self-harm code (X60-X84, Y87.2)

N flows to: Does the record have an initial intent status of accident? With two options Y or N.

Y flows to: Code mechanism to relevant accident code (V01-X59, Y85, Y86)

N flows to: Code to relevant undetermined intent code (Y10-Y34, Y87.2)

End of flow chart

Suicides registered in Victoria

As a result of two reconciliation exercises conducted jointly between the ABS and the Victorian Registry of Births Deaths and Marriages (Victorian RBDM), additional historical registrations of suicide were identified that had not been previously provided to the ABS. To best reflect a more accurate time series, deaths due to suicide are presented by registration year throughout this publication. As a result, some totals may not equal the sum of their components and suicide data presented in this publication may not match that previously published by reference year. Time series adjustments have been made to Victorian suicides to more accurately reflect the pattern of registration of suicide deaths as follows:

• the first exercise (conducted in the first quarter of 2020) resulted in the identification of an additional 180 suicides that were registered in Victoria in 2017 (88 suicides) and 2018 (92 suicides) but not previously supplied to the ABS. Whilst these are included in overall total numbers of all cause deaths for 2019 in line with ABS scope rules, a time series adjustment has been made whereby these suicide deaths have been re-allocated to the year in which they were registered. See Technical note: Victorian additional registrations and time series adjustment in Causes of Death, Australia, 2019 for more information.
• the second exercise (conducted in the first quarter of 2022) resulted in the identification of an additional 72 suicides that were registered in Victoria in 2013 (20 suicides), 2014 (14 suicides), 2015 (8 suicides) and 2016 (30 suicides) that were not previously supplied to the ABS. These registrations are not included in the total numbers of all cause deaths. However, a time series adjustment has been made whereby these suicide deaths have been re-allocated to the year in which they were registered. See Technical note: Victorian additional registrations (2013-2016) for more information.

Suicides registered in New South Wales

In 2012, the implementation of JusticeLink in the NSW coronial system significantly changed how information is exchanged between the NSW coroners courts and the NCIS. This system enables nightly uploads of all new information to the NCIS, and as a result information pertaining to NSW coronial cases is available earlier in the investigation process and the information is more complete for the purposes of coding causes of death.

There is evidence that the system change in NSW has improved the quality of preliminary coding in relation to deaths due to intentional self-harm. There has been an increase in the number of preliminary intentional self-harm deaths registered in NSW when comparing counts for 2012 onwards with those of 2011, coupled with fewer cases of deaths of undetermined intent (Y10-Y34).

Deaths of Aboriginal and Torres Strait Islander people

The Aboriginal and Torres Strait Islander origin of a deceased person is captured through the death registration process. It is noted on the Death Registration Form and the Medical Certificate of Cause of Death. However it is recognised that not all such deaths are captured through these processes, leading to under-identification. While data is provided to the ABS for the Aboriginal and Torres Strait Islander origin of the deceased for around 99% of all deaths, there are concerns regarding the accuracy of the data.

The ABS Death Registrations collection identifies a death as being of an Aboriginal and Torres Strait Islander person where the deceased is recorded as Aboriginal, Torres Strait Islander, or both on the Death Registration Form (DRF). The Aboriginal and Torres Strait Islander origin is also derived from the Medical Certificate of Cause of Death (MCCD) for South Australia, Western Australia, Tasmania, the Northern Territory and the Australian Capital Territory from 2007. From 2015 data onwards, the Queensland Registry of Births, Deaths and Marriages also used MCCD information to derive the Aboriginal and Torres Strait Islander origin. For New South Wales and Victoria, the Aboriginal and Torres Strait Islander origin of the deceased is derived from the DRF only. If the Aboriginal and Torres Strait Islander origin reported in the DRF does not agree with that in the MCCD, an identification from either source that the deceased was an Aboriginal and/or Torres Strait Islander person is given preference over non-Indigenous or an unknown status.

There are several data collection forms on which people are asked to state whether they are of Aboriginal and Torres Strait Islander origin. Due to a number of factors, the results are not always consistent. The likelihood that a person will identify, or be identified, as an Aboriginal and Torres Strait Islander person on a specific form is known as their propensity to identify.

Propensity to identify as an Aboriginal and Torres Strait Islander person is determined by a range of factors, including:

• how the information is collected (e.g. census, survey, or administrative data);
• who provides the information (e.g. the person in question, a relative, a health professional, or an official);
• the perception of why the information is required, and how it will be used;
• educational programs about identifying as an Aboriginal and Torres Strait Islander person; and
• cultural aspects and feelings associated with identifying as Aboriginal and Torres Strait Islander Australian.

In addition to those deaths where the deceased is identified as an Aboriginal and Torres Strait Islander person, a number of deaths occur each year for which the Aboriginal and Torres Strait Islander origin is not stated on the death registration form. In 2021, there were 1,106 deaths registered in Australia for whom the Aboriginal and Torres Strait Islander origin was not stated, representing 0.6% of all deaths registered, a slight decrease from 2020 (0.7%). This difference was largely driven by fewer deaths with a not stated Aboriginal and Torres Strait Islander origin registered in New South Wales (from 538 in 2020 to 463 in 2021).

Data presented in this publication may therefore underestimate the level of Aboriginal and Torres Strait Islander deaths and mortality in Australia. Caution should be exercised when interpreting data for Aboriginal and Torres Strait Islander Australians presented in this publication, especially with regard to year to year changes.

Information on causes of death relating to Aboriginal and Torres Strait Islander persons is included in articles throughout this publication. Data cube 12 also provides information on causes of death for Aboriginal and Torres Strait Islander Australians. In Data cube 12, numbers and rates of death are reported by jurisdiction of usual residence for New South Wales, Queensland, South Australia, Western Australia and the Northern Territory only. Data for Victoria, Tasmania and the Australian Capital Territory has been excluded in line with national reporting guidelines.

Individual state/territory disaggregations of deaths of Aboriginal and Torres Strait Islander Australians by WHO Leading Causes for the 2020 reference year are presented for New South Wales, Queensland, Western Australia and the Northern Territory only. No data is presented for South Australia, due to the small number of deaths by WHO leading causes - most causes have a count of fewer than 20 deaths, which is too small for the production of robust age-standardised death rates (SDRs).

In this publication, age-standardised and age-specific death rates for Aboriginal and Torres Strait Islander persons for the 2012-2021 reference years have been calculated using 2016 Census-based population estimates (projections and backcasts). Non-Indigenous estimates have been derived by subtracting the 2016 Census-based Aboriginal and Torres Strait Islander population estimates from the total 2021 Census-based estimated resident population (ERP).  Rates calculated from population denominators derived from different Censuses may cause artificially large rate differences. Rate comparisons should not be made with previous publications for Aboriginal and Torres Islander data. See Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2006 to 2031 for more information.

Coronial cases are more likely to be affected by a lag in registration time, especially those which are due to external causes, including suicide, homicide and drug-induced deaths. Due to small numbers these lagged coroner referred registrations can create large yearly variation in some causes of deaths of Aboriginal and Torres Strait Islander people. Caution should be taken when making year to year comparisons.

The ABS undertakes significant work aimed at improving Aboriginal and Torres Strait Islander identification. The ABS works closely with the state and territory RBDMs through the Civil Registration and Vital Statistics Australasia committee (CRVSA) to progress strategies aimed at improving Indigenous identification in a nationally consistent way.

Quality studies conducted as part of the Census Data Enhancement (CDE) project have investigated the levels and consistency of Aboriginal and Torres Strait Islander identification between the 2011 Census and death registrations. See Information Paper: Death registrations to Census linkage project - Methodology and Quality Assessment, 2011-2012 (cat. no. 3302.0.55.004).

An assessment of various methods for adjusting incomplete Aboriginal and Torres Strait Islander death registration data for use in compiling Aboriginal and Torres Strait Islander life tables and life expectancy estimates is presented in Discussion Paper: Assessment of Methods for Developing Life Tables for Aboriginal and Torres Strait Islander Australians, 2006 (cat. no. 3302.0.55.002), released on 17 November 2008. Final tables based on feedback received from this discussion paper, using information from the Census Data Enhancement (CDE) study, can be found in Life Tables for Aboriginal and Torres Strait Islander Australians, 2010-2012 (cat. no. 3302.0.55.003).

Perinatal deaths

Scope of perinatal death statistics

The scope of the perinatal death statistics includes all registered fetal deaths (at least 20 weeks' gestation or at least 400 grams' birth weight) and all registered neonatal deaths (all live born babies who die within 28 completed days of birth, regardless of gestation or birth weight). The ABS scope rules for fetal deaths are consistent with the legislated requirement for all state and territory Registries of Births, Deaths and Marriages to register all fetal deaths which meet the above-mentioned gestation and birth weight criteria. Based on this legislative requirement, in the case of missing gestation and/or birth weight data, the fetal record is considered in scope and included in the dataset. A record is only considered out of scope if both gestation and birth weight data are present, and both fall outside the scope criteria (i.e. gestation of 19 weeks or less and birth weight of 399 grams or fewer). This scope was adopted for the 2007 Perinatal Deaths collection, and was applied to historical data for 1999-2006. For more information on the changes in scope rules see Perinatal Deaths, Australia, 2007 (cat. no. 3304.0) Explanatory Notes 18-20. These rules have been applied to all perinatal data presented in this publication.

The World Health Organization (WHO) definition of a perinatal death differs to that used by the ABS. The WHO definition includes all neonatal deaths, and those fetuses weighing at least 500 grams or having a gestational age of at least 22 weeks. A summary table based on the WHO definition of perinatal deaths is included in the Perinatal data cube in this release. See Coding of perinatal deaths below for more details on the interpretation of this table.

Fetal deaths are registered only as a stillbirth, and are not in scope of either the Births, Australia or Deaths, Australia collections. Fetal deaths are part of the Perinatal collection, but not the Causes of Death collection. Neonatal deaths are in scope of the Deaths, Causes of Death and Perinatal collections.

Given the small number of perinatal deaths which occur in some states and territories, some data provided on a state/territory basis in this publication has been aggregated for South Australia, Western Australia, the Northern Territory, the Australian Capital Territory and Other Territories.

This publication only includes information on registered fetal and neonatal deaths. Registered deaths are sourced through jurisdictional Registries of Births, Deaths and Marriages. This scope differs from other Australian data sources on perinatal deaths. For this reason alternative datasets are not directly comparable and caution should be taken when using multiple sources for analysis.

Perinatal death data reported by the ABS is not comparable with the National Perinatal Mortality Data Collection (NPMDC) coordinated by the AIHW. The ABS data is sourced from state and territory Registries of Births, Deaths and Marriages. This differs from the NPMDC whose data is sourced from health systems, including clinical records. The table below was published in the Australia's mothers and babies: Stillbirths and neonatal deaths - Australian Institute of Health and Welfare. The table shows that the ABS perinatal dataset is affected by delayed registrations which results in an under count of perinatal deaths, especially those of stillbirths. Caution should be taken when interpreting these data.

Number of perinatal deaths reported by Australian Bureau of Statistics (ABS) and the National Perinatal Mortality Data Collection (NPMDC) by Year of Death, Australia, 2013–2019 (sourced from AIHW, NPMDC, 2022)
NPMDC StillbirthsABS StillbirthsNPMDC Neonatal deathsABS Neonatal deaths
20132,1941,708822794
20142,2251,723796743
20152,1491,722688692
20162,1141,660751701
20172,1741,718800762
20182,1161,590718702
20192,1831,632714694

Coding of perinatal deaths

For perinatal data output in the Causes of Death, Australia, 2013 publication, the ABS began a review of its method of coding perinatal deaths, which resulted in an interim change to how this data was output. One significant change was that neonatal deaths were not assigned an underlying cause of death when output in tables of all ages, as had previously occurred. (Details of this change can be found in the Changes to Perinatal Death Coding Technical Note in Causes of Death, Australia, 2013 (cat. no. 3303.0)). Further review and consultation has now been undertaken with the national and international coding community, and has resulted in the ABS applying a new method of coding perinatal deaths. The new method creates a sequence of causes on a Medical Certificate of Cause of Perinatal Death which allows for an underlying cause of death to be assigned to a neonatal death. This aligns the output for neonatal deaths to deaths of the general population which are certified using the Medical Certificate of Cause of Death. The change in coding method reinstates the condition arising in the mother being assigned as an underlying cause of death. This method has been applied to the 2014 data onwards, and has also been applied retrospectively to the 2013 neonatal data that is output in tables of all ages in this publication, thus enabling a consistent time-series. Please see the Changes to Perinatal Death Coding Technical Note in Causes of Death, Australia, 2014 (cat. no. 3303.0) for further details.

From the 2013 reference year onwards, process changes have led to a reduction in the number of both stillbirths and neonatal deaths where a 'main condition in mother' was recorded, compared to previous years. This has led to a reduction in the number of records assigned within the code block P00-P04: Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery, as main condition in the mother. These changes will affect data output in the Perinatal data cube of this publication only.

Doctor certified neonatal deaths with no causes of death information are coded to Conditions originating in the perinatal period, unspecified (P969). As these deaths have been certified by a doctor, the assumption is made that the neonate died of natural causes. Where a neonatal death is referred to a coroner, but no causes of death information is available, these deaths are coded to Other ill-defined and unspecified causes of mortality (R99). As a reportable death, it cannot be determined whether the neonate died of natural or external causes, in the absence of further information.

The count of fetal deaths in scope for the World Health Organization (WHO) definition of perinatal deaths differs to those previously published for 2012 and 2015. This is due to an enhancement to birth weight and gestation information, which resulted in some deaths no longer meeting the World Health Organization definition of a fetal death (that is, a gestational age of at least 22 weeks or weighing at least 500 grams). For 2012, there are two fewer fetal deaths than previously published (1 male and 1 female). For 2015, there are 38 fewer fetal deaths than previously published (18 males, 19 females, 1 death where sex was not specified). Some corresponding death rates have also been affected. Table 14.21 in the Perinatal data cube presents fetal and neonatal data according to the WHO scope. No other tables in the Perinatal data cube are affected by these changes.

Live births and the number of fetal deaths are used as the denominator in the calculation of mortality rates for perinatal deaths. See the 'Data Used in Calculating Death Rates' Appendix for details of the number of live births registered which have been used to calculate the fetal, neonatal and perinatal death rates shown in this publication. This Appendix also provides data on fetal deaths used in the calculation of fetal and perinatal death rates. These also enable further rates to be calculated.

South Australian fetal deaths

In 2019 an issue was identified with the derivation of the Aboriginal and Torres Strait Islander origin for fetal deaths registered in South Australia. As a consequence, there was an undercount of Aboriginal and Torres Strait Islander fetal deaths in South Australia in ABS outputs over a number of years. The ABS worked with the SA RBDM to revise the Aboriginal and Torres Strait Islander origin of all fetal deaths for the years 2014 to 2018. Data for these years presented in Tables 19 and 20 of the Perinatal data cube in this publication was revised in the 2019 issue.

Sex not specified

There are a very small number of stillbirth (fetal deaths) registrations provided to the ABS each year where the sex of the infant has not  been specified as male or female. This can be due to administrative processes where the sex of the stillbirth has not been supplied to the ABS. Additionally, in a small number of births a clinical determination of sex may not be able to be clearly determined. This may be due to a number of reasons and may include extreme prematurity or some congenital conditions. Where the sex of an infant has not been specified for a stillbirth, these deaths are included in total person counts only for tabulations by fetal deaths and all perinatal deaths (both fetal and neonatal deaths). There were 18 stillbirths registered in 2021 where the sex of the infant was not specified.

Appendix - data used in calculating death rates

Show all

The following tables contain data used in calculating the various rates referred to in this publication.

Table A1.1 presents Estimated Resident Population (ERP) as at 30 June 2021. This data has been used to calculate Standardised Death Rates, Age-specific death rates and Years of Potential Life Lost for 2021 data. This data has rebased the population estimates to the 2021 Census of Population, and was released in National, state and territory population, December 2021 on 28 June 2022.

The rates produced for Aboriginal and Torres Strait Islander persons in this publication are based on estimates and projections. Aboriginal and Torres Strait Islander population data is based on Series B population projections released in Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 2006 to 2031, which have backcast estimates of the Aboriginal and Torres Strait Islander and non-Indigenous population for the period 30 June 2006 to 30 June 2016. These estimates have been derived on the 2016 Census data. When comparison rates are produced for non-Indigenous persons, the denominator is derived by subtracting the Aboriginal and Torres Strait Islander population estimates/projections from the 2021 Census-based ERP. Rates calculated from population denominators derived from different Censuses may cause artificially large rate differences. Rate comparisons should not be made with previous publications for Aboriginal and Torres Islander data. See Estimates and Projections, Aboriginal and Torres Strait Islander Australians for more information.

A1.1 Estimated resident population by age and sex, 30 June 2021
MalesFemalesPersons
Under 1153,352145,507298,859
1-4622,938588,1621,211,100
5-9831,593785,1811,616,774
10-14835,444788,4481,623,892
15-19762,032717,6001,479,632
20-24837,110786,2741,623,384
25-29918,413903,6181,822,031
30-34940,528959,0921,899,620
35-39928,244939,1431,867,387
40-44815,889838,6111,654,500
45-49817,302832,7331,650,035
50-54794,156817,3981,611,554
55-59762,539787,9681,550,507
60-64711,192753,8331,465,025
65-69617,537662,6061,280,143
70-74554,692592,0811,146,773
75-79387,842419,353807,195
80-84249,962295,446545,408
85-89135,745187,559323,304
90-9458,779102,202160,981
95 and over14,29335,68249,975
All ages12,749,58212,938,49725,688,079

Table A1.2 presents the number of live births for Australia for 2012 to 2021. This data has been used in calculating infant death rates - the number of deaths of children under one year of age per 1,000 live births in the same period. Data for 2012 to 2020 was released in Births, Australia, 2020. At the time of this publication's release, a summary of births data for 2021 is presented in Deaths, Australia, 2021.

A1.2 Live births registered by sex, 2012, 2017-2021
MalesFemalesPersons
2012158,988150,594309,582
2017159,221149,921309,142
2018162,088153,059315,147
2019157,476148,356305,832
2020150,943143,426294,369
2021158,917151,079309,996

Perinatal death rate

For comparison and measuring purposes, perinatal deaths in this publication have also been expressed as rates. These rates are defined as follows:

• for fetal deaths and total perinatal deaths, the rates represent the number of deaths per 1,000 all births, which comprises live births and fetal deaths combined (where gestation is at least 20 weeks or birth weight is at least 400 grams).
• for neonatal deaths, the rates represent the number of deaths per 1,000 live births.

20 weeks' gestation or 400 grams' birth weight

The following tables contain births data used in calculating perinatal death rates. Tables A1.3 and A1.4 are used to calculate perinatal death rates based on the 20 weeks' gestation or 400 grams' birth weight definition for fetal deaths. In this publication, this definition has been applied to all 2012-2021 reference year data, with exception to one table in the Perinatal data cube, which applies the World Health Organization definition of a perinatal death (see details further below).

A1.3 All births by sex of child and state or territory of usual residence of mother, 2012-2021(a)
NSWVic.QldSAWATas.NTACTAust.(d)
2021
Live Births
Male52,10238,45132,83510,11417,4663,1141,9232,894158,917
Female49,23036,91231,2769,64316,5732,9201,8612,649151,079
Persons101,33275,36364,11119,75734,0396,0343,7845,543309,996
Stillbirths(c)
Male27321423227100222816912
Female25618623039101111910852
Persons(b)529405466682033351271,782
Total
Male52,37538,66533,06710,14117,5663,1361,9512,910159,829
Female49,48637,09831,5069,68216,6742,9311,8802,659151,931
Persons101,86175,76864,57719,82534,2426,0673,8355,570311,778
2020
Live Births
Male48,93337,69830,5209,49516,6372,9341,9592,752150,943
Female46,52635,84528,9709,03115,7892,8461,7932,616143,426
Persons95,45973,54359,49018,52632,4265,7803,7525,368294,369
Stillbirths(c)
Male28119622332127221410905
Female26918020630125221612860
Persons(b)554383431622544533221,784
Total
Male49,21437,89430,7439,52716,7642,9561,9732,762151,848
Female46,79536,02529,1769,06115,9142,8681,8092,628144,286
Persons96,01373,92659,92118,58832,6805,8253,7855,390296,153
2019
Live Births
Male50,94039,70131,7939,99217,3182,9731,8842,866157,476
Female47,96637,51929,9429,49816,2212,7681,7742,654148,356
Persons98,90677,22061,73519,49033,5395,7413,6585,520305,832
Stillbirths(c)
Male23119423149108182513869
Female2341892043299161610800
Persons(b)472386438822083542231,686
Total
Male51,17139,89532,02410,04117,4262,9911,9092,879158,345
Female48,20037,70830,1469,53016,3202,7841,7902,664149,156
Persons99,37877,60662,17319,57233,7475,7763,7005,543307,518
2018
Live Births
Male55,21640,35431,8859,82817,1132,8552,0852,732162,088
Female52,12738,13430,0469,28516,1442,6921,9652,642153,059
Persons107,34378,48861,93119,11333,2575,5474,0505,374315,147
Stillbirths(c)
Male27724716725109202315883
Female2381881623899201815778
Persons(b)518442332642094045321,682
Total
Male55,49340,60132,0529,85317,2222,8752,1082,747162,971
Female52,36538,32230,2089,32316,2432,7121,9832,657153,837
Persons107,86178,93062,26319,17733,4665,5874,0955,406316,829
2017
Live Births
Male49,53642,30831,7209,86717,7432,8431,9813,208159,221
Female47,05539,78629,4389,20516,7552,7671,9012,999149,921
Persons96,59182,09461,15819,07234,4985,6103,8826,207309,142
Stillbirths(c)
Male24924721227131161618916
Female23721517633105181820822
Persons(b)491471390602363834401,760
Total
Male49,78542,55531,9329,89417,8742,8591,9973,226160,137
Female47,29240,00129,6149,23816,8602,7851,9193,019150,743
Persons97,08282,56561,54819,13234,7345,6483,9166,247310,902
2016
Live Births
Male49,22042,43831,49510,24018,3963,0522,0332,647159,537
Female46,86340,45430,3469,53217,0332,9161,8942,505151,567
Persons96,08382,89261,84119,77235,4295,9683,9275,152311,104
Stillbirths(c)
Male23724921230130291811916
Female225204190389620911793
Persons(b)465460406682264928221,724
Total
Male49,45742,68731,70710,27018,5263,0812,0512,658160,453
Female47,08840,65830,5369,57017,1292,9361,9032,516152,360
Persons96,54883,35262,24719,84035,6556,0173,9555,174312,828
2015
Live Births
Male51,34237,83231,85010,01818,0762,9322,1092,910157,088
Female48,73735,73629,8959,56917,0592,7481,8952,632148,289
Persons100,07973,56861,74519,58735,1355,6804,0045,542305,377
Stillbirths(c)
Male29416820549126201618896
Female24017219235115172110802
Persons(b)540348400842423838281,718
Total
Male51,63638,00032,05510,06718,2022,9522,1252,928157,984
Female48,97735,90830,0879,60417,1742,7651,9162,642149,091
Persons100,61973,91662,14519,67135,3775,7184,0425,570307,095
2014
Live Births
Male46,68938,05732,29210,37018,1843,0292,0722,883153,592
Female44,38536,16730,77410,01417,2192,9061,9542,669146,105
Persons91,07474,22463,06620,38435,4035,9354,0265,552299,697
Stillbirths(c)
Male20219723145125341123868
Female20119419042113351720812
Persons(b)405402424882386929431,698
Total
Male46,89138,25432,52310,41518,3093,0632,0832,906154,460
Female44,58636,36130,96410,05617,3322,9411,9712,689146,917
Persons91,47974,62663,49020,47235,6416,0044,0555,595301,395
2013
Live Births
Male51,87538,05632,75910,43517,6743,0352,0252,831158,706
Female48,58735,91330,5959,65516,8423,0142,0282,714149,359
Persons100,46273,96963,35420,09034,5166,0494,0535,545308,065
Stillbirths(c)
Male28124320539115242212941
Female2782041683690181715826
Persons(b)561450376772054439291,781
Total
Male52,15638,29932,96410,47417,7893,0592,0472,843159,647
Female48,86536,11730,7639,69116,9323,0322,0452,729150,185
Persons101,02374,41963,73020,16734,7216,0934,0925,574309,846
2012
Live Births
Male50,64139,65632,87610,51717,2543,1442,0782,803158,988
Female47,86737,74930,9619,91616,3733,0242,0262,658150,594
Persons98,50877,40563,83720,43333,6276,1684,1045,461309,582
Stillbirths(c)
Male28321921637118271521943
Female2302112333412118818875
Persons(b)517435452712394523411,832
Total
Male50,92439,87533,09210,55417,3723,1712,0932,824159,931
Female48,09737,96031,1949,95016,4943,0422,0342,676151,469
Persons99,02577,84064,28920,50433,8666,2134,1275,502311,414

(a) All births consists of all live births, plus all fetal deaths that conform to the 20 weeks' gestation or 400 grams birth weight definition.
(b) The stillbirths count for 'Persons' includes those stillbirth deaths for which the sex could not be determined. The sum of male and female stillbirths may therefore not sum to the Persons total.
(c) Includes those where it is unknown if heartbeat ceased before or after the delivery.
(d) Includes Other Territories.

A1.4 All births by sex, 2012-2021(a)
Live BirthsStillbirths(b)Total
MalesFemalesPersonsMalesFemalesPersons(c)MalesFemalesPersons
2021158,917151,079309,9969128521,782159,829151,931311,778
2020150,943143,426294,3699058601,784151,848144,286296,153
2019157,476148,356305,8328698001,686158,345149,156307,518
2018162,088153,059315,1478837781,682162,971153,837316,829
2017159,221149,921309,1429168221,760160,137150,743310,902
2016159,537151,567311,1049167931,724160,453152,360312,828
2015157,088148,289305,3778968021,718157,984149,091307,095
2014153,592146,105299,6978688121,698154,460146,917301,395
2013158,706149,359308,0659418261,781159,647150,185309,846
2012158,988150,594309,5829438751,832159,931151,469311,414

(a) All births consists of all live births, plus all fetal deaths that conform to the 20 weeks' gestation or 400 grams' birth weight definition.
(b) Includes those where it is unknown if heartbeat ceased before or after the delivery.
(c) The stillbirths count for 'Persons' includes those stillbirth deaths for which the sex could not be determined. The sum of male and female stillbirths may therefore not sum to the Persons total.

22 weeks' gestation or 500 grams' birth weight

Table A1.5 contains births data used in the calculation of perinatal death rates based on the WHO definition of all neonatal deaths and those fetal deaths of 22 weeks' gestation or 500 grams' birth weight. A time series of perinatal death counts based on the WHO definition is presented in the Perinatal datacube.

A1.5 All births by sex, World Health Organization definition of perinatal deaths, 2012-2021(a)(b)
Live BirthsStillbirths(c)Total
MalesFemalesPersonsMalesFemalesPersons(d)MalesFemalesPersons
2021158,917151,079309,9966996681,374159,616151,747311,370
2020150,943143,426294,3697147041,433151,657144,130295,802
2019157,476148,356305,8326996561,365158,175149,012307,197
2018162,088153,059315,1477536651,433162,841153,724316,580
2017159,221149,921309,1427727181,508159,993150,639310,650
2016159,537151,567311,1047676751,451160,304152,242312,555
2015157,088148,289305,3777757141,504157,863149,003306,881
2014153,592146,105299,6977597381,513154,351146,843301,210
2013158,706149,359308,0658307601,603159,536150,119309,668
2012158,988150,594309,5827847181,514159,772151,312311,096

(a) All births consists of all live births, plus all fetal deaths that conform to the 22 weeks' gestation or 500 grams' birth weight definition.
(b) The count of fetal deaths in scope for the World Health Organization (WHO) definition of perinatal deaths differs to those previously published for 2012 and 2015. This is due to an enhancement to birth weight and gestation information, which resulted in some deaths no longer meeting the World Health Organization definition of a fetal death (that is, a gestational age of at least 22 weeks or weighing at least 500 grams). For 2012, there are two fewer fetal deaths than previously published (1 male and 1 female). For 2015, there are 38 fewer fetal deaths than previously published (18 males, 19 females, 1 death of undetermined sex). Some corresponding death rates have also been affected.
(c) Includes those where it is unknown if heartbeat ceased before or after the delivery.
(d) The stillbirths count for 'Persons' includes those stillbirth deaths for which the sex could not be determined. The sum of male and female stillbirths may therefore not sum to the Persons total.

Technical Note: Victorian additional registrations (2013-2016)

1. As a result of two reconciliation exercises conducted jointly between the ABS and the Victorian Registry of Births Deaths and Marriages (Victorian RBDM), additional historical Victorian death registrations have been added to the Causes of Death dataset. This was due to an issue associated with the Registry's previous processing system (replaced in 2019) which resulted in some death registrations not being delivered to the ABS in the year they were registered.

2. Details of the first reconciliation exercise, which resulted in an additional 2,812 death registrations from 2017 to 2019 being included in the 2019 reference year and a time series adjustment being applied to selected causes, are provided in Technical note: Victorian additional registrations and time series adjustments in Causes of Death, Australia, 2019.

3. A subsequent exercise was conducted in the first quarter of 2022 with the aim of identifying if there were any further registrations that had not been provided to the ABS prior to 2017 as a result of the same system issue. This exercise identified a further 1,864 deaths that had been registered between 2013 to 2016 that had not previously been provided to the ABS. While these registrations are in scope for the 2021 reference year counts according to the ABS deaths collection scope (see Scope of causes of death statistics section in the methodology), they are not considered representative of 2021 deaths and have been excluded from current year counts. Instead the 1,864 death registrations are included only in outputs disseminated by year of occurrence and historical time series for deaths due to suicide. This technical note provides details of these registrations, how they are reflected in published data and time series considerations for datasets disseminated by reference year.

Details of the Victorian additional death registrations

4. Of the 1,864 additional deaths reported to the ABS, 31.7% were registered in 2013, 24.6% in 2014, 7.7% in 2015 and the remainder in 2016 (36.1%). These deaths occurred across the years 2012 to 2016. The table below shows the year of registration and year of occurrence of these deaths.

Year of registration and year of occurrence of death, Victorian additional registrations (2013-2016)
Year of registrationYear of occurrence of death
2012-74
2013590630
2014459407
2015143144
2016672609
TOTAL1,8641,864

5. The majority of additional registrations (1,162 or 62.3%) were certified by a doctor with the remaining 702 (37.7%) certified by a coroner. The number of coroner certified deaths were over-represented in these registrations - on average annually approximately 13% to 16% of all deaths registered in Victoria are certified by a coroner.

6. Conditions that are more likely to be certified by a coroner including external causes and ischaemic heart diseases are prevalent in the additional registrations. The table below shows the distribution of the Victorian additional registrations by ICD-10 chapter.

Cause of death by chapter and year of registration, additional registrations included by registration year, Victoria (state of registration), 2013 to 2016
2013201420152016Total 2013- 2016
CHAPTER I Certain infectious and parasitic diseases (A00-B99)511213
CHAPTER II Neoplasms (C00-D48)16111345111430
CHAPTER III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)14217
CHAPTER IV Endocrine, nutritional and metabolic diseases (E00-E90)2724743101
CHAPTER V Mental and behavioural disorders (F00-F99)222153078
CHAPTER VI Diseases of the nervous system (G00-G99)3228440102
CHAPTER VII Diseases of the eye and adnexa (H00-H59)02001
CHAPTER VIII Diseases of the ear and mastoid process (H60-H95)00000
CHAPTER IX Diseases of the circulatory system (I00-I99)16612934194523
CHAPTER X Diseases of the respiratory system (J00-J99)40451048143
CHAPTER XI Diseases of the digestive system (K00-K93)211462364
CHAPTER XII Diseases of the skin and subcutaneous tissue (L00-L99)34002
CHAPTER XIII Diseases of the musculoskeletal system and connective tissue (M00-M99)2103220
CHAPTER XIV Diseases of the genitourinary system (N00-N99)10911033
CHAPTER XV Pregnancy, childbirth and the puerperium (O00-O99)23015
CHAPTER XVI Certain conditions originating in the perinatal period (P00-P96)50348
CHAPTER XVII Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)311112
CHAPTER XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)17621844
CHAPTER XIX Injury, poisoning and certain other consequences of external causes (S00-T98)00000
CHAPTER XX External causes of morbidity and mortality (V01-Y98)724620140278
Accidental drug deaths (X40-X44)10213853
Unspecified accidents (X59)04032
Intentional self-harm (X60-X84, Y87.0)201483072
Intentional self-harm drugs (X60-X64)711718
Assault (X85-Y09, Y87.1)14219
Event of undetermined intent (Y10-Y34, Y87.2)234611
Undetermined drug deaths (Y10-Y14)34359
TOTAL 5904591436721,864

Cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. Cells with a zero value have not been affected by confidentialisation.

Effect on time series

7. As the additional 1,864 deaths occurred more than five years prior to the 2021 reference year, they are not considered to be representative of mortality in 2021 and are excluded from the 2021 reference year counts. These death registrations are presented in the publication in the following outputs:

• In the year of occurrence data cubes.
• For the 72 deaths which were due to suicide, these deaths are presented in the time series in the year in which they were registered in both the data cubes and commentary.
• The Victorian additional registrations are excluded from all other tables and commentary.

8. For most causes, changes in the coded data at the ICD-10 chapter level would have a small impact on the mortality rate and not have any great impact on the time series continuity, at both the Victoria and national level. There are other deaths such as accidental drug overdose and assaults where the proportional increase is higher and consideration should be given as to the impact of the additional registrations on a topic of interest. The table below provides an adjusted time series where the additional death registrations are included in the year in which they were registered. It also shows the percentage increase of each cause of death if the additional registrations were included.

Total including additional registrations% increase
20132014201520162013201420152016
CHAPTER I Certain infectious and parasitic diseases (A00-B99)5936677257290.90.60.30.3
CHAPTER II Neoplasms (C00-D48)11,07310,88711,53011,6061.51.00.41.0
CHAPTER III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)1371321391100.72.30.71.9
CHAPTER IV Endocrine, nutritional and metabolic diseases (E00-E90)1,6491,5951,6091,6061.71.50.42.8
CHAPTER V Mental and behavioural disorders (F00-F99)1,9762,1152,3242,3861.11.00.21.3
CHAPTER VI Diseases of the nervous system (G00-G99)2,0472,1602,3362,5391.61.30.11.6
CHAPTER VII Diseases of the eye and adnexa (H00-H59)0441npnpnp
CHAPTER VIII Diseases of the ear and mastoid process (H60-H95)1413npnpnpnp
CHAPTER IX Diseases of the circulatory system (I00-I99)10,57311,20611,45011,0771.61.20.31.8
CHAPTER X Diseases of the respiratory system (J00-J99)3,2603,6313,7973,6841.21.30.31.3
CHAPTER XI Diseases of the digestive system (K00-K93)1,3211,4841,4941,4781.61.00.41.6
CHAPTER XII Diseases of the skin and subcutaneous tissue (L00-L99)971011221181.01.0
CHAPTER XIII Diseases of the musculoskeletal system and connective tissue (M00-M99)3003143653851.43.30.61.0
CHAPTER XIV Diseases of the genitourinary system (N00-N99)8279041,0209671.21.00.41.0
CHAPTER XV Pregnancy, childbirth and the puerperium (O00-O99)4515npnpnpnp
CHAPTER XVI Certain conditions originating in the perinatal period (P00-P96)117103891204.51.11.7
CHAPTER XVII Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)1691671541612.42.50.71.9
CHAPTER XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)2853572583186.31.71.26.0
CHAPTER XIX Injury, poisoning and certain other consequences of external causes (S00-T98)0000
CHAPTER XX External causes of morbidity and mortality (V01-Y98)2,1032,7262,6902,8203.51.70.75.2
Accidental drug deaths (X40-X44)2412792913674.31.10.711.6
Unspecified accidents (X59)316279791.63.9
Intentional self-harm (X60-X84, Y87.0)5536716836633.82.11.24.7
Intentional self-harm drugs (X60-X64)821061041039.31.92.07.3
Assault (X85-Y09, Y87.1)336761666.51.53.46.5
Event of undetermined intent (Y10-Y34, Y87.2)355041389.42.02.518.8
Undetermined drug deaths (Y10-Y14)1725212513.34.25.025.0
TOTAL 36,53238,55940,10940,1111.61.20.41.7

— nil or rounded to zero (including null cells)

np not available for publication but included in totals where applicable, unless otherwise indicated.

Cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. Cells with a zero value have not been affected by confidentialisation.

Deaths due to suicide

9. Data on suicide from the national mortality dataset is used extensively by government, researchers and non-governmental organisations to inform policy and planning. Time series data looking at changes in these causes of death over time is often used as a measure to understand the impacts of policy including prevention and intervention activities. It is important that the dataset accurately represent patterns of mortality over time in order to be a useful resource for informing these important decisions. For preventable causes of death with high policy impact such as suicide, it is important that information is represented correctly and easily understood by its users.

10. In acknowledgement of this the ABS has made an adjustment to all statistics presented in this publication for deaths due to suicide. For this cause, the additional death registrations received from the Victorian RBDM for 2013 to 2016 have been included in their respective registration years for all outputs in this publication. This adjustment creates a more accurate time series for the 2013 to 2016 reference period for this cause of death. The table below shows the unadjusted and adjusted time series for deaths due to suicide for Victoria and Australia.

Deaths due to intentional self-harm (X60-X84, Y87.0) by year of registration, with and without additional registrations included by registration year, Victoria (state of registration) and Australia, 2012 to 2021
2012201320142015201620172018201920202021
Victoria (state of registration)
Excluding Victorian additional deaths
Number of deaths512533657675633706694725696674
Change compared with previous year (no.)-182112418-4273-1231-29-22
Change compared with previous year (%)-3.44.123.32.7-6.211.5-1.74.5-4.0-3.2
Including Victorian additional deaths redistributed by Registration year
Number of deaths512553671683663706694725696674
Change compared with previous year (no.)-184111812-2043-1231-29-22
Change compared with previous year (%)-3.48.021.31.8-2.96.5-1.74.5-4.0-3.2
Australia
Excluding Victorian additional deaths
Number of deaths2,5792,6092,9233,0922,9093,2903,2053,3583,1393,144
Change compared with previous year (no.)18930314169-183381-85153-2195
Change compared with previous year (%)7.91.212.05.8-5.913.1-2.64.8-6.50.2
Including Victorian additional deaths redistributed by Registration year
Number of deaths2,5792,6292,9373,1002,9393,2903,2053,3583,1393,144
Change compared with previous year (no.)18950308163-161351-85153-2195
Change compared with previous year (%)7.91.911.75.5-5.211.9-2.64.8-6.50.2

Customised tables based on the data available in this publication is available through a paid data consultancy. Provide details through a Consultancy Request Form to find out more information. Access to a cause of death unit record file with data compiled and coded using ICD-10 is available for research purposes to eligible agencies. Applications for access can be made through the Australian Coordinating Registry

Glossary

Show all

Aboriginal and/or Torres Strait Islander person

Persons who identify themselves as being of Aboriginal and/or Torres Strait Islander origin.

Death of a Aboriginal and/or Torres Strait Islander person

The death of a person who is recorded as being an Aboriginal, Torres Strait Islander, or both on the Death Registration Form (DRF). The Aboriginal and Torres Strait Islander origin is also derived from the Medical Certificate of Cause of Death (MCCD) for South Australia, Western Australia, Tasmania, the Northern Territory and the Australian Capital Territory from 2007 and for Queensland from 2015. If the Aboriginal and Torres Strait Islander origin reported in the DRF does not agree with that in the MCCD, an identification from either source that the deceased was an Aboriginal and/or Torres Strait Islander person is given preference over non-Indigenous. For New South Wales and Victoria, the Aboriginal and Torres Strait Islander origin of the deceased is derived from the DRF only.

Age-specific death rate

Age-specific death rates (ASDRs) are the number of deaths (occurred or registered) during the reference year at a specified age per 100,000 of the estimated resident population of the same age at the mid-point of the year (30 June). ASDR for deaths under 1 year of age are calculated based on 1,000 live births for that year.

All births

All births comprises all live births plus all fetal deaths (gestation at least 20 weeks or birth weight at least 400 grams) for a specific year. This is the denominator used in calculating perinatal and fetal death rates in this publication. For data tables pertaining to the World Health Organization definition of a perinatal death, all births comprises all live births plus all fetal deaths with gestation of at least 22 weeks or a birth weight of at least 500 grams. See Appendix Data used in calculating death rates for further information.

Associated causes of death

All causes listed on a death certificate other than the underlying cause.

Australian Statistical Geographic Standard (ASGS)

The ASGS provides a common framework of statistical geography and thereby enables the production of statistics that are comparable and can be spatially integrated. See Classifications section of the methodology in this publication for more information.

Cause of death

The causes of death to be entered on the Medical Certificate of Cause of Death are all those diseases, morbid conditions or injuries that either resulted in or contributed to death and the circumstances of the accident or violence that produced any such injuries.

Certifier type

Deaths may be certified by either a medical practitioner, using the Medical Certificate of Cause of Death or Medical Certificate of Cause of Perinatal Death (doctor certified), or coroner (coroner certified). Natural causes are predominantly certified by doctors, whereas external and unknown causes are usually certified by a coroner. However, some deaths for natural causes are referred to coroners for investigation, for example, unaccompanied deaths.

Confidentialised

From 2006, data cells with small values have been randomly assigned to protect confidentiality. As a result some totals will not equal the sum of their components. It is important to note that cells with 0 values have not been affected by confidentialisation. Data presented at the Australia level is not confidentialised - the death counts presented are exact counts.

Coroner certified deaths

Deaths that were certified by a coroner. Deaths certified by a coroner represent 11-14% of all deaths each year. Coroner cases remain open while cause of death investigations are undertaken, and are closed when coronial investigations are complete. Following completion, causes of death information is passed to the Registrar of Births, Deaths and Marriages, as well as to the National Coronial Information System (NCIS). All coroner certified deaths registered after 1 January 2006 will be subject to a revision process.

Country of birth

The classification of countries used is the Standard Australian Classification of Countries (SACC). For more detailed information refer to the Standard Australian Classification of Countries (SACC).

Counts of death

A form of multiple causes of death analysis that is a calculation of the number of people who have died with a particular disease/s or disorder/s.

Counts of mentions

A form of multiple causes of death analysis that calculates the total number of incidences of particular disease/s or disorder/s listed on the death certificates.

Crude death rate

The crude death rate (CDR) is the number of deaths registered during the reference year per 100,000 estimated resident population at 30 June.

Data cubes

Data cubes are a series of spreadsheets which present Causes of Death data. Causes of Death data cubes can be found on the web page under the Data downloads section.

Death

Death is the permanent disappearance of all evidence of life after birth has taken place. The definition excludes all deaths prior to live birth. For the purposes of the Deaths and Causes of Death collections of the Australian Bureau of Statistics (ABS), a death refers to any death that occurs in, or en route to, Australia and is registered with a state or territory Registry of Births, Deaths and Marriages.

Doctor certified deaths

Deaths that were certified by a doctor or medical practitioner, which were not required to be referred on to a coroner. Deaths certified by a doctor represent around 86%-89% of all deaths each year. Doctor certified deaths are not subject to the revisions process.

Early neonatal death

Death of a live born baby within seven days of birth.

Estimated resident population (ERP)

The official measure of the population of Australia is based on the concept of usual residence. It refers to all people, regardless of nationality, citizenship or legal status, who usually live in Australia, with the exception of foreign diplomatic personnel and their families. It includes usual residents who are overseas for fewer than 12 months over a 16-month period and excludes overseas visitors who are in Australia for fewer than 12 months over a 16-month period.

External causes of death

Deaths due to causes external to the body (for example suicide, transport accidents, falls, poisoning etc.). These relate to ICD-10 codes V01-Y98.

External territories

Australian external territories include Australian Antarctic Territory, Coral Sea Islands Territory, Territory of Ashmore and Cartier Islands, and Territory of Heard and McDonald Islands.

Fetal death

A fetal death is a death prior to the complete expulsion or extraction from its mother as a product of conception of at least 20 completed weeks of gestation or with a birth weight of at least 400 grams (or at least 22 weeks' gestation or 500 grams' birth weight when using the World Health Organization definition of a fetal death). The death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

​​​​​​​Fetal death rate

The number of fetal deaths in a reference year per 1,000 all births (live births plus fetal deaths of relevant scope) in the same year. See 'All births' above.

ICD

International Statistical Classification of Diseases and Related Health Problems. The purpose of the ICD is to permit the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. The ICD, which is endorsed by the World Health Organization (WHO), is primarily designed for the classification of diseases and injuries with a formal diagnosis. The ICD-10 is the current classification system, which is structured using an alphanumeric coding scheme. Each disease or health problem listed on the death certificate is assigned a 3-character identification code. Causes of death statistics can be produced for aggregates of these, for example, chapter level (letter), 2-character code (first two characters of the assigned code), and 3-character code (first three characters of the assigned code).

Indirect standardised death rate (ISDR)

See Standardised Death Rate (SDR).

Infant death

An infant death is the death of a live born child who dies before reaching his/her first birthday.

Infant death rate

The number of deaths of children under one year of age in a reference year per 1,000 live births in the same reference year.

Intent

The manner or intent of an injury that leads to death is determined by whether the injury was inflicted purposefully or not (in some cases, intent cannot be determined). The determination of "intent" for each death is essential for determining the appropriate ICD-10 code to use for a death.

Late neonatal death

Death of a live born baby after seven completed days and within 28 completed days of birth.

Leading causes of death

Ranking causes of death is a useful method for describing patterns of mortality in a population and allows comparison over time and between populations. The ranking of leading causes of death in this publication is based on research presented in the Bulletin of the World Health Organization, Volume 84, Number 4, April 2006, 297-304. For details of the main differences between the WHO defined leading cause groupings and the leading cause groupings presented in this publication, refer to the Mortality tabulations and methodologies section of the methodology.

Live births

A live birth is the complete expulsion or extraction of a child from its mother as a product of conception, irrespective of the duration of pregnancy, which after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born. This is the denominator used in calculating neonatal and infant death rates in this publication, and contributes to the denominator used for calculating fetal and total perinatal death rates.

Mechanism of death

Mechanisms of external cause of death by which a person may die include: poisoning; hanging and other threats to breathing; drowning and submersion; firearms; contact with sharp object; and falls.

Median age at death

This refers to the age at death at the 50th percentile for the relevant demographic group.

Morbid train of events

The events and diseases that lead to death.

See Death.

Multiple causes of death

All morbid conditions, diseases and injuries entered on the death certificate. These include those involved in the morbid train of events leading to death which were classified as either the underlying cause, the immediate cause, or any intervening causes, and those conditions that contributed to death but were not related to the disease or condition causing death. For deaths where the underlying cause was identified as an external cause (for example, injury or poisoning, etc.) multiple causes include circumstances of injury and the nature of injury as well as any other conditions reported on the death certificate.

National Coronial Information System (NCIS)

The NCIS is a national data storage system which contains information about all deaths referred to a coroner since July 2000 (January 2001 for Queensland).

Natural cause of death

Deaths due to diseases (for example diabetes, cancer, heart disease etc.) that are not external or unknown.

Neonatal death

A neonatal death is death of a live born baby within 28 completed days of birth.

Neonatal death rate

The number of deaths in a reference year of live born babies within 28 completed days of birth per 1,000 live births in the same reference year.

Neonatal period

The neonatal period commences at birth and ends 28 completed days after birth.

Other territories

Following the 1992 amendments to the Acts Interpretation Act, the Indian Ocean Territories of Christmas Island and the Cocos (Keeling) Islands are included as part of geographic Australia. As of 01 July, 2016, Norfolk Island is now also considered part of geographic Australia, due to the introduction of the Norfolk Island Legislation Amendment Act 2015. Jervis Bay Territory (previously included with the Australian Capital Territory), Christmas Island, the Cocos (Keeling) Islands and Norfolk Island appear as "Other Territories", which is another category that has been created at the same level as states and territories within the Australian Statistical Geography Standard (ASGS).

Perinatal death

A death that is either a fetal death (i.e. a death prior to the complete expulsion or extraction from its mother as a product of conception of 20 completed weeks of gestation or with a birth weight of at least 400 grams (or 22 weeks' gestation or 500 grams' birth weight according to World Health Organization scope)), or a neonatal death (i.e. death of a live born baby within 28 completed days of birth).

Perinatal death rate

For comparison and measuring purposes, perinatal deaths in this publication have also been expressed as rates. Perinatal death rates are the number of perinatal deaths in a reference year (i.e. fetal and neonatal deaths) per 1,000 all births in the same reference year. See 'All births'.

Perinatal period

The perinatal period commences at 20 weeks of gestation and ends within 28 completed days of birth.

Period of gestation

Period of gestation is measured from the first day of the last normal menstrual period to the date of birth and is expressed in completed weeks.

Post neonatal death

Death of a live born baby after 28 days and within one year of birth.

Rate difference

Rate difference is calculated by subtracting the standardised death rate for one group (such as all persons with a usual residence of Queensland) from the standardised death rate for the total relevant population (such as all persons with a usual residence of Australia).

Rate ratio

Rate ratio is calculated by dividing the standardised death rate for one group (such as all persons with a usual residence of Queensland) by the standardised death rate for the total relevant population (such as all persons with a usual residence of Australia).

Reference year

The year that presented data refers to. For example, this publication presents data for the 2021 reference year, as well as some historical data for the 2012 to 2020 reference years. Data for a particular reference year includes all deaths registered in Australia for the reference year that are received by the ABS by the end of the March quarter of the subsequent year. For example, data for the 2021 reference year includes all deaths registered in Australia in 2021 that was received by the ABS by the end of March 2022.

Registration year

Data presented on a year of registration basis relate to the date the death was registered with the relevant state or territory Registrar of Births, Deaths and Marriages. In most cases the year of registration and year of occurrence for a particular death will be the same, but in some cases there may be a delay between occurrence and registration of death.

Registry of Births, Deaths and Marriages

Each state and territory has a Registry of Births, Deaths and Marriages. It is a legal requirement that all deaths are recorded by the relevant Registry for the state or territory in which the death occurred.

Reportable deaths

Deaths which are reported to a coroner. See Scope of causes of death statistics section of the methodology for further information on what constitutes a reportable death.

Revisions process

When additional information about an 'open' coroner certified death is received by the ABS, a more specific ICD-10 code may be applied, thereby 'revising' the cause of death. See Revisions process in the Data quality section of the methodology for further information on this process.

Sex not specified

Sex not specified refers to stillbirths where the deceased has not been specified as male or female. Stillbirths where sex is not specified are included in person totals for data presented for stillbirths and perinatal deaths.

Sex ratio

The number of males per 100 females. The sex ratio is defined for total population, at birth, at death and among age groups by appropriately selecting the numerator and denominator of the ratio.

Standardised death rate (SDR)

Standardised death rates (SDRs) enable the comparison of death rates between populations with different age structures by relating them to a standard population. The current standard population is all persons in the Australian population at 30 June 2001. SDRs are expressed per 100,000 persons. There are two methods of calculating standardised death rates:

• The direct method - this is used when the populations under study are large and the age-specific death rates are reliable. It is the overall death rate that would have prevailed in the standard population if it had experienced at each age the death rates of the population under study.
• The indirect method - this is used when the populations under study are small and the age-specific death rates are unreliable or not known. It is an adjustment to the crude death rate of the standard population to account for the variation between the actual number of deaths in the population under study and the number of deaths that would have occurred if the population under study had experienced the age-specific death rates of the standard population.

Throughout this publication, when SDRs are produced for comparison between the Aboriginal and Torres Strait Islander population and the non-Indigenous population, they are produced according to the principles outlined in Appendix: Principles on the use of direct age-standardisation, from Deaths, Australia, 2010 (cat. no. 3302.0). Rates based on a total persons death count of fewer than 20 deaths are not published, in accordance with Principle 3. Standardised Death Rates for the total population have been produced according to the same principles, with the main exception being the use of data up to the 85 and over year age grouping.

State or territory of registration

State or territory of registration refers to the state or territory in which the death was registered. It is the state or territory in which the death occurred, but is not necessarily the deceased's state or territory of usual residence.

State or territory of usual residence

State or territory of usual residence refers to the state or territory in which the person has lived or intended to live for a total of six months or more in a given reference year.

See fetal death.

Underlying cause of death

The disease or injury that initiated the train of morbid events leading directly to death. Accidental and violent deaths are classified according to the external cause, that is, to the circumstances of the accident or violence which produced the fatal injury rather than to the nature of the injury.

Unknown cause of death

Deaths for which it is not possible to determine between a natural and an external cause.

Usual residence

Usual residence within Australia refers to that address at which the person has lived or intended to live for a total of six months or more in a given reference year.

Year of occurrence

Data presented on a year of occurrence basis relates to the date the death occurred rather than when it was registered with the relevant state or territory Registrar of Births, Deaths and Marriages.

Years of Potential Life Lost (YPLL)

YPLL measures the extent of 'premature' mortality, where 'premature' mortality is assumed to be any death at age 1-78 years inclusive. By estimating YPLL for deaths of people aged 1-78 years it is possible to assess the significance of specific diseases or trauma as a cause of premature death.

Abbreviations

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 ABS Australian Bureau of Statistics ACS Automated coding system ACT Australian Capital Territory AIDS Acquired Immune Deficiency Syndrome AIHW Australian Institute of Health and Welfare ASDR Age-specific death rate ASGC Australian Standard Geographical Classification ASGS Australian Statistical Geography Standard Aust. Australia cat. no. Catalogue number CDR Crude death rate CM Clinical Modification COAD Chronic obstructive airways disease CRVSA Civil Registration and Vital Statistics Australasia DRF Death registration form ERP Estimated resident population HIV Human Immunodeficiency Virus ICD-10 International Classification of Diseases 10th Revision IHD Ischaemic heart disease IMR Infant mortality rate ISDR Indirect age-standardised death rate MCCD Medical certificate of cause of death MCCPD Medical certificate of cause of perinatal death METeOR Metadata Online Registry MMDS Mortality Medical Data System no. Number NCHS National Center for Health Statistics NCIS National Coronial Information System NPMDC National Perinatal Mortality Data Collection NSW New South Wales NT Northern Territory Qld Queensland RBDM Registry of Births, Deaths and Marriages SA South Australia SA2 Statistical Area 2 SACC Standard Australian Classification of Countries SDR Age-standardised death rate SIDS Sudden Infant Death Syndrome Tas. Tasmania URC Update and Revision Committee Vic. Victoria WA Western Australia WHO World Health Organization YPLL Years of potential life lost