Causes of Death, Australia

The unprecedented events of 2020 has raised questions about their impact on the health of the Australian population. In January many regions in Australia were in the midst of a severe bushfire season. At this time there was also growing concern globally about COVID-19, a respiratory infection caused by severe acute respiratory syndrome coronavirus 2. By 11 March the World Health Organization had declared COVID-19 a pandemic.

The emergence of COVID-19 and its potential direct and indirect health effects made tracking of mortality more important than ever. Civil registration based mortality data provided important insights into deaths from COVID-19 and deaths from other causes, highlighting the broader impacts of the pandemic and related measures on population health and health service delivery.

The ABS has published provisional mortality counts for doctor-certified deaths during the pandemic period. These data provide an early indicator of changes in patterns of mortality, but do not include information on deaths that were coroner referred including accidents, assaults and suicides.

This report provides snapshots for selected causes of death for 2020 for both doctor and coroner certified deaths. Further information on causes of death in 2020 can be found in accompanying articles and the datacubes available from the data downloads section of this publication. 

COVID-19 is a respiratory infection caused by a new coronavirus. On 11 March 2020 the World Health Organization (WHO) declared COVID-19 to be a pandemic. Information relating to COVID-19 mortality for both 2020 and 2021 is also published in the Provisional Mortality Statistics publication. 

For the 898 people who died from COVID-19 in 2020:

• COVID-19 was the 38th leading cause of death.
• Their median age at death was 86 years.
• Just over half were female (460 female deaths, 438 male deaths).
• People who died from the virus under the age of 70 were more likely to be male.
• Dementia was the most common pre-existing condition (275 deaths).
• Chronic cardiac conditions, hypertension and diabetes were also commonly reported comorbidities.
• The majority of deaths occurred in people with a usual residence of Victoria (800 deaths).

Tracking deaths from all causes shows how mortality patterns changed during the pandemic from all conditions, not just from COVID-19 itself. To show the mortality pattern over the last decade the age-standardised death rates (SDRs) are presented below for males, females and persons. The SDRs for 2017-2019 have been adjusted to account for late registrations. See Technical note: Victorian additional registrations and time series adjustments in Causes of death, Australia, 2019, for detailed information on this issue.

• When adjusted for late registrations the SDR in 2020 was 6% lower than in 2019 (488.8 versus 519.1). 
• While SDRs have been generally decreasing over time, the 6% decrease between 2019 and 2020 is the largest single year change in the last 10 years.
• Both males and females recorded the lowest SDR for the last decade.
• Australia is one of a small number of countries including New Zealand and Denmark which recorded a lower death rate during the first year of the COVID-19 pandemic.

Data is presented in the table below as age-specific death rates (ASDRs) for selected age-groups. ASDRs for 2017-2019 have been adjusted to account for late registrations. See Technical note: Victorian additional registrations and time series adjustments in Causes of death, Australia, 2019, for detailed information on this issue.

In 2020:

• The age-specific death (ASDR) rate decreased across all age groups.
• Young males (0-24 years) and older females (85 years and over) recorded the largest proportional decreases in sex-specific death rates from 2019, at 6.3% and 7.0% respectively.
• People aged 85 and over recorded the largest proportional decrease in ASDRs at 6.6%. 

Leading causes of death give an indication of the health of a population and help to ensure that health resources are directed to where they are needed most. During the pandemic many countries saw a change in mortality patterns, including COVID-19 becoming a leading cause of death.

In 2020:

• The top five leading causes of death remained the same as in 2019 (Ischaemic heart disease, Dementia including Alzheimer's disease, Cerebrovascular diseases, Lung cancer and Chronic lower respiratory diseases) .
• The age-standardised death rate decreased for all top five leading causes of death from 2019. 
• Deaths due to chronic lower respiratory diseases (including emphysema) had the highest proportional rate decrease from 2019 at 17.8%.
• The reduction in acute respiratory conditions such as pneumonia contributed to a decrease in the top five leading causes of death.
• All top five leading causes of death are non-communicable diseases (they are not passed from person to person).

Tracking respiratory diseases through the pandemic has been important for a number of reasons. Some countries have experienced increased levels of mortality from pneumonia, indicating some misclassified COVID-19 mortality. Tracking the number of deaths from respiratory diseases can also provide insights into the success of public health measures. Many acute respiratory diseases (such as influenza and some types of pneumonia) are transmitted via droplets, so measures put in place to prevent the spread of COVID-19 such as increased personal hygiene and social distancing can also reduce the spread of other communicable diseases.

Respiratory diseases include acute manifestations such as influenza and pneumonia but also chronic diseases such as emphysema, asthma and interstitial lung disease. People with chronic lung diseases can be particularly vulnerable to poor outcomes from contracting infectious diseases including COVID-19. 

In 2020:

• There was a 23.9% decrease in the age-standardised death rate from respiratory diseases.
• Influenza and pneumonia mortality had the highest proportional rate decrease of all respiratory diseases with a drop of 45.8% from 2019.
• There were 55 people who died from influenza. This compares to 1,080 in 2019.
• Pneumonia is also a common terminal cause of death, especially for older people who have long term chronic conditions. There was a decrease of more than 20% in influenza and pneumonia as an associated cause of death (where it was not the underlying cause of death). 
• The decrease in the respiratory disease death rate from 2019 is the largest recorded over the last ten years.

Potentially avoidable deaths are deaths that are either preventable or treatable from a current health care and public health perspective. They include both natural diseases, including many types of cancer, ischaemic heart disease, diabetes and infectious diseases, and external causes of death (e.g. suicide, assault) of people aged under 75. 

For people who died from potentially avoidable causes in 2020:

• There were 26,995 people who died from potentially avoidable causes (17,231 males and 9,764 females). This compares to 27,979 deaths in 2019 (17,854 males and 10,125 females). 
• The age-standardised death rate is the lowest in the ten year time series for both males and females, with the largest decrease occurring between 2019 and 2020.
• While the mortality rate has decreased the sex ratio has remained constant at 1.8 (male to female).
• The potentially avoidable mortality rate for all people was less than 100 per 100,000 people for the first time in the ten year time series

For people who died by suicide in 2020: 

• There were 3,139 deaths due to suicide (2,384 males and 755 females). This compares to 3,318 suicides in 2019 (2,502 males and 816 females). 
• The age-standardised suicide rate was 12.1 deaths per 100,000 people, a 6.2% decrease from 2019.
• For females, the suicide rate was the lowest since 2013 and for males the lowest since 2016.
• The median age at death for people who died by suicide was 43.5.
• Suicide was the 15th leading cause of death compared to the 13th in 2019.
• Over 90% of people who died by suicide had risk factors identified including depression, substance use and abuse, and issues in spousal relationships.

There were 1,163 people who died from a motor vehicle accident (870 males and 293 females). This compares to 1,282 in 2019 (966 males and 316 females)

• The death rate from motor vehicle accidents decreased by over 10% from 2019.
• The rate decrease was highest for males with 96 less males dying in motor vehicle accidents than in 2019.
• For both males and females the mortality rate was the lowest in the ten year time series.
• For males, those aged under 25 had the largest numerical decrease with 46 less deaths than in 2019.
• For females, those aged over 45 had less deaths than in 2019. Among younger women the number of deaths increased by 36.

There were 241 people who died by assault (167 males and 74 females). This was similar to the number of deaths in 2019 (245 deaths).

• The age-standardised rate of assault mortality decreased slightly to 0.9 from 1.0 in 2019. The rate in 2020 is equal to the lowest rate (2017) in the ten year time series. 
• The number of females who died by assault increased slightly (74 deaths 2020, 71 deaths 2019). This resulted in a slight increase in the assault rate for females (0.6 in 2020 versus 0.5 in 2019). 
• For males, those aged over 25 had a decrease in deaths due to assault.

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

There were 1,842 drug-induced deaths (1,187 males and 655 females). This compares to 1,874 in 2019 (1,188 males and 686 females). 

• There was a 4% decrease in the age-standardised rate of drug-induced deaths from 2019.
• The rate for all people is the lowest since 2013.
• The rate decrease from 2019 was 5.8% for females, a higher proportional decrease than for males over the same period (2.1% reduction).
• Opioids were the most common drug class identified in toxicology for drug-induced deaths.

Alcohol-induced deaths are those where the underlying cause can be directly attributed to alcohol use, including acute conditions such as alcohol poisoning or chronic conditions such as alcoholic liver cirrhosis. 

There were 1,452 people who died of an alcohol-induced death (1,056 males and 396 females). 

• There was an 8.3% increase in the age-standardised rate of alcohol-induced deaths, with 108 additional deaths since 2019.
• For females, the rate is equal to the highest in the ten year time series at 2.8 deaths per 100,000 people (12.0% increase).
• While there was a 6.9% increase in the rate for males, it is not the highest rate increase or rate in the ten year times series. 
• The rate increase is largely due to conditions associated with long term alcohol use including liver cirrhosis.

• In 2020 there were 161,300 deaths, a decrease from 2019. 
• Ischaemic heart diseases were the leading cause of death, accounting for 10.3% of all deaths. 
• Deaths from the top five leading causes all decreased from 2019.
• The top five leading causes of death have remained the same since 2011.
• There were 898 deaths from COVID-19, ranking as the 38th leading cause of death.

There were 161,300 deaths registered in Australia in 2020.

In 2020 for people who died:

• 52.4% were male (84,588) and 47.6% were female (76,712).
• Their median age at death was 81.7 years (78.9 for males, 84.6 for females).
• The top five leading causes accounted for more than one-third of all registered deaths.

Identifying and comparing leading causes of death in populations is useful for tracking changes in patterns of mortality and identifying emerging trends. For more information related to the tabulation of leading causes, see the Methodology section of this publication.

In 2020: 

• The leading cause of death was ischaemic heart diseases (IHD).
• Dementia, including Alzheimer's disease was the second leading cause of death. People who died from dementia had a high median age at death of 89.1.
• Cerebrovascular diseases, lung cancer and chronic lower respiratory diseases rounded out the top five leading causes. 
• Deaths from the five leading causes all decreased from 2019.
• There were 55 deaths due to influenza. Influenza and pneumonia dropped to the 17th leading cause of death (down from the 9th leading cause in 2019). The ranking of influenza and pneumonia is influenced by the severity of the flu season. 
• Suicide was the 15th leading cause of death. People who died from suicide had median age at death of 43.5.
• COVID-19 was the 38th leading cause of death, with 898 deaths recorded through the civil registration system. 

From 2011 to 2020:  

• Deaths due to Ischaemic heart diseases and Cerebrovascular diseases decreased by 22.9% and 15.8% respectively.
• Deaths due to Dementia, including Alzheimer's disease increased by 47.8% (4,711 deaths).

Age-standardised death rates enable the comparison of death rates over time as they account for changes in the size and age structure of the population. Refer to Mortality tabulations and methodologies, Age-standardised death rates (SDRs) in the Methodology section of this publication for more information.

For age-standardised death rates from 2011 to 2020:

• Ischaemic heart diseases decreased by 39.7%.
• There has been a stabilisation in the rate of deaths due to dementia since 2014. 
• The gap between ischaemic heart diseases and dementia has narrowed. 
• Cerebrovascular diseases decreased by 34.6%.
• Malignant neoplasms of trachea, bronchus and lung (lung cancer) and chronic lower respiratory diseases decreased by 19.7% and 16.7%, respectively.

Years of potential life lost (YPLL) is a measure of premature mortality which weights age at death to gain an estimate of how many years a person would have lived had they not died prematurely. Causes of death with a median age less than the life expectancy will have a higher number of YPLL. When considered in terms of premature mortality, the leading causes of death have a notably different profile. Refer to Mortality tabulations and methodologies - Years of potential life lost (YPLL) in the Methodology section of this publication for more information.

In 2020:

• Suicide was a leading cause of premature death with 109,525 YPLL. People who died by suicide had a median age at death of 43.5. 
• Ischaemic heart diseases has the highest number of premature deaths but had the second number of YPLL at 69,449 years. People who died from ischaemic heart diseases had a median age of death of 84.1. 
• People who die of external causes of death have median ages below the average life expectancy. People who died from Accidental poisoning and Motor vehicle crashes had the 4th and 5th highest YPLL, with median ages at 44.7 and 42.6, respectively.

For the 84,588 males who died in 2020: 

• Ischaemic heart diseases were the leading cause of death (10,040 deaths), with almost twice the number of deaths compared with the second ranked cause (dementia). 
• Dementia, including Alzheimer's disease remains the second leading cause, after overtaking lung cancer in 2019.
• Prostate cancer, was the sixth leading cause of death and second leading cause of cancer deaths. 
• Suicide was the 10th leading cause. More than three-quarters (75.9%) of people who died from suicide were male. 
• 438 males died from COVID-19, which was the 37th leading cause of death. 

For males from 2011 to 2020

• The death rate for Dementia, including Alzheimer's disease increased by 14.1%.
• The death rate for lung cancer decreased by 27.6%.

For the 76,712 females who died in 2020: 

• Dementia including Alzheimer's was the leading cause of death (9,325 deaths). 
• Dementia mortality increased by 14.1% over the last decade. Close to two-thirds of people who died from dementia were female. 
• Ischaemic heart diseases were the second leading cause with 6,547 deaths. The rate of death from heart disease has decreased by 45.5% since 2011.
• Breast cancer was the sixth leading cause overall and second leading cause of cancer deaths with 3,110 deaths. Breast cancer is the leading cause of premature death for women.
• 460 females died from COVID-19, which was the 32nd leading cause of death.

In 2020, there were 4,063 deaths of Aboriginal and Torres Strait Islander people (2,216 males and 1,847 females) in Australia.

• Their median age at death was 61.8 years.
• Ischaemic heart diseases were the leading cause of death (445 deaths). 
• There were no deaths of Aboriginal and Torres Strait Islander people from COVID-19.

Measures of mortality relating to Aboriginal and Torres Strait Islander people are key inputs into the Closing the Gap strategy. This strategy aims to enable Aboriginal and Torres Strait Islander people to overcome inequality and achieve life outcomes equal to all Australians across areas such as life expectancy, mortality, education and employment.  In July 2020 all Australian governments committed to 17 targets under the National Agreement on Closing the Gap (Australian Government, 2020). Mortality data will continue to be a key indicator to measure progress against these targets.  

In 2020 there were 3,611 Aboriginal and Torres Strait Islander people who died across the five jurisdictions. 

• Their median age at death was 61.6 years. 
• Ischaemic heart diseases were the leading cause of death for both males and females. 
• Those who had a usual residence in Northern Territory had the highest mortality rate.

To measure changes over time for Aboriginal and Torres Strait Islander people, age-standardised death rates for males, females and all persons are presented in the graph below.

For Aboriginal and Torres Strait Islander people who died between 2011-2020: 

• The highest age-standardised death rate (SDR) occurred in 2020 at 966.3 deaths per 100,000 people. 
• The SDR is consistently higher for males than females.
• The rate ratio ranged between 1.2 to 1.4 male deaths for every female death.
• The SDR ranged between 902.6 to 966.3 for all people. 

For Aboriginal and Torres Strait Islander people who died between 2011 and 2020: 

• The five leading causes of death account for over one-third of all deaths. 
• The five leading causes of death have remained the same between 2011-2015 and 2016-2020, with slight changes in ranking. 
• The age-standardised death rate decreased for the first and second leading causes of death (Ischaemic heart diseases and Diabetes) between 2011-2015 and 2016-2020. 
• Intentional self-harm remains the fifth leading cause of death in 2020.

For Aboriginal and Torres Strait Islander males and females who died between 2011 and 2020: 

• In 2020, four of the five leading causes of death are the same for males and females, with slight changes in ranking.
• Suicide was the second leading cause of death for males compared to 10th for females. 
• Dementia, including Alzheimer's disease was the fifth leading cause of death for females and the 13th leading cause for males.
• Smoking related lung diseases increased for both males and females. When comparing 2011-15 with 2016-2020, there was a 16.3% increase in lung cancer death rates for males and a 26.0% increase in chronic lower respiratory disease death rates for females. 

Mortality data can provide important insights into population health concerns relevant to different groups within the Australian population. Patterns of death among Aboriginal and Torres Strait Islander people differ considerably to those of non-Indigenous people. Mortality rates for Aboriginal and Torres Strait Islander people are generally higher than those for non-Indigenous people. The median age at death for Aboriginal and Torres Strait Islander people was 61.6 years in 2020, compared to 81.8 for the non-indigenous population.

Among the top 20 leading causes of death in 2020:

• Age standardised death rates are higher in Aboriginal and Torres Strait Islander people for all 20 leading causes of death, except for blood cancers.
• Aboriginal and Torres Strait Islander people had rates five times higher than non-Indigenous people for diabetes, and three times higher for chronic lower respiratory diseases, liver diseases and urinary diseases. 

During 2020:

• 3,139 people died by suicide.
• The age-standardised suicide rate was 12.1 per 100,000 people. 
• Suicide was the 15th leading cause of death.

In order to measure changes in suicide over time, age-standardised suicide rates for males, females and all persons are presented in the graph below. Upper and lower bounds (confidence intervals) are included to show the potential variability of the annual suicide rates and can be used in measuring statistical significance in annual rate change.

In 2020 there were 2,384 males who died by suicide.

• Suicide was the 10th leading cause of death.
• Their median age at death was 43.6 years. 
• Three quarters of people who died by suicide were male. 
• The suicide rate for males decreased by 6.1% from 2019.  
• The suicide rate for males increased between 2011 and 2020 from 16.2 to 18.6 deaths per 100,000.

In 2020 there were 755 females who died by suicide.

• Suicide was the 22nd leading cause of death. 
• Their median age at death was 43.1 years. 
• The suicide rate for females decreased by 7.9% from 2019. 
• The suicide rate for females increased between 2011 and 2020 from 5.1 to 5.8 deaths per 100,000.

• All states except Northern Territory and the Australian Capital Territory had decreases in the number of suicides between 2019 and 2020.
• Almost three-quarters of people who died by suicide had a usual residence in New South Wales, Victoria and Queensland.
• Those living in the Northern Territory had the highest suicide rate at 20.4 per 100,000 people. 
• The national suicide rate at 12.1 per 100,000 people was the lowest since 2016.

The following sections cover various age and sex breakdowns of suicide. Understanding how suicide manifests across these key demographics is important in helping to target policies and prevention activities. 

The graph below shows the age distribution for those who died by suicide and provides an insight into the proportion of those deaths that occurred within each age cohort. 

• Young and middle aged people are more likely to die by suicide than those in older age cohorts.
• 83.6 percent of people who died by suicide are aged under 65 years.
• People who died by suicide had a median age of 43.5 years compared to 81.7 years for all deaths.
• Over one-third of deaths in 15-24 year olds are due to suicide.
• The age distribution of suicide is similar for males and females. 

Age-specific death rates show how suicide manifests across age cohorts by relating the number of deaths to the size and structure of the underlying population.

Males aged over 85 years:

• Had the highest age-specific suicide rate.
• Accounted for the smallest proportion (3.1%) of suicides of males. 

Males aged between 40 - 54 years: 

• Have the highest age-specific suicide rates of those aged under 85 years.
• Accounted for over one quarter (26.7%) of suicides of males. 

Females aged 45-49 years:

• Had the highest female age-specific suicide rate.
• Accounted for the highest proportion (10.9%) of suicides of females.

Suicide accounted for the highest number of years of potential life lost among leading cause groups of conditions. This is due to the high proportion of suicides that occur within younger age groups. Conditions such as coronary heart disease account for more premature deaths than suicide, but less years of potential life lost.

In 2020:

• Suicide was the leading cause of death for 15-44 year olds. 
• Suicide was a leading cause of premature mortality with 109,525 years of life lost.
• A person who died by suicide lost on average 34.9 years of life. 

Deaths of children by suicide is an extremely sensitive issue. The number of deaths of children attributed to suicide can be influenced by coronial reporting practices. Reporting practices may lead to differences in counts across jurisdictions and this should be taken into account when interpreting tabulations and analysis of suicide deaths in children presented below. For more information on issues associated with the compilation and interpretation of suicide data, see Deaths due to intentional self-harm (suicide) section of the methodology in this publication. For the purposes of the following analysis, children are defined as those aged between 5 and 17 years of age. The ABS is not aware of any recorded suicides of children under the age of 5 years. The tabulation below shows the number and age-specific death rate for children who died by suicide over the last five years. 

In 2020, for children who died by suicide:

• There were 99 suicides of children. 
• Suicide remained the leading cause of death of children in Australia. 
• Males had a suicide rate of 2.9 per 100,000 children (61 deaths).
• Females had a suicide rate of 1.9 per 100,000 children (38 deaths). 
• Over 73% of children who died by suicide were aged between 15 and 17 years. 
• Suicides rates differed by jurisdiction of usual residence. Children in the Northern Territory had the highest suicide rate. See Datacube 11 for more information. 

The sex ratio for children aged 5-17 years was 1.6 males per female death. This compared to a sex ratio of 3.2 for people of all ages who died by suicide. 

Circumstances relating to a suicide are complex and multifaceted. It is the combination of multiple factors rather than a single reason that contribute to a person dying by suicide. Risk factors should not be considered in isolation. 

The ABS codes causes of death from information contained on the National Coronial Information System (NCIS), including police, pathology, toxicology and coroners reports. These reports provide a breadth of information relating to these deaths, much of which is highly important from a public health perspective. As part of the investigative process for a suicide risk factors are often mentioned in these reports. For suicide, a risk factor could be one of many factors including mental health conditions, lifestyle factors, or chronic diseases that can interact and increase the "risk" of suicide. While a risk factor may have been present in the life of a person who died by suicide it may not have been a direct cause. Risk factors provide important insights that can help guide prevention and intervention activities.

The risk factors mentioned in the reports on the NCIS are captured as part of the ABS coding process and assigned codes within the framework of the International Classification of Diseases, 10th revision. It is important to note that the capture of information on associated causes of death is reliant on the documentation available for any given death. This in turn can be affected by the length of the coronial process, the type of information available across different jurisdictions and administrative processes affecting report availability. As such, the information presented in this section reflects information contained within reports available on NCIS at the time of coding and does not necessarily reflect all causes associated with all suicides that have occurred. Risk factors are included and made available as part of the associated causes in the national mortality dataset.  

In 2020: 

• Over 90% of people who died by suicide had at least one risk factor reported. 
• Psychosocial risk factors were the most commonly reported risk factor. 
• Both mental and behavioural disorders and psychosocial risk factors were present in over two-thirds of deaths of people who died by suicide. 
• People who died by suicide had an average of 3-4 risk factors mentioned. 

Risk factors can vary by socio-economic demographics including age and sex. Understanding this can help for targeted suicide prevention and intervention initiatives to be implemented. The ten most common risk factors for selected ages, males and females are presented in the tables. 

In 2020:

• Mood disorders (including depression) were the most common risk factor to be mentioned in all age groups (except those aged 5-24 years).
• Younger people were more likely to have issues with substance use (both acute toxicity and chronic use) mentioned as a risk factor. 
• For those aged 85 years and over, limitation of activities due to illness and disability were the most common associated cause.
• Older people had a higher proportion of chronic health conditions such as cancer, coronary heart disease, and diabetes as a risk factor than younger people.  
• Those aged 25-64 years were more likely to have problems related to un/employment mentioned as a risk factor than other ages. 

In 2020 for males who died by suicide: 

• Mood disorders (including depression) were the most common risk factor for all males. 
• For those aged under 44 years presence of alcohol and drugs (including intoxication) was the most common risk factor. 
• Issues in spousal relationships was the third most common risk factor for males compared to seventh for females.
• Males across all ages had a history of suicide ideation or self-harm. 

In 2020 for females who died by suicide:

• Mood disorders (including depression) were the most common risk factor, being captured as a risk factor in over 40% of suicides across all age groups.
• Over 40% of those aged 5-24 years had a history of self-harm as a risk factor. 
• Death of a family member or friend was a risk factor across all ages with the youngest and oldest age groups having the highest proportion. 
• Personality disorders was the 10th most common risk factor for females, compared to the 29th for males. 

Psychosocial risk factors have been coded by the ABS since 2017. The addition of psychosocial factors to the national mortality dataset added to information on risk factors that were already captured such as mental health disorders and chronic diseases. Over these four years, there have been small changes to the capture of information for specific codes, mostly those relating to psychosocial risk factors. As many coronial investigations in 2017 are now closed, data for that year is considered "final" (see revisions section in methodology for more information). Information on risk factors across the four years is presented below.

For suicides across 2017-2020:

• Risk factors were identified in 97.0% of suicides in 2017 where coronial investigations have been completed and the data is now final. The proportion of risk factors present for other years is likely to increase as investigations are finalised. 
• Mood disorders were the most common risk factor for each year. 
• Presence of alcohol and drugs (including intoxication) were the second most common risk factor for each year. 
• Suicide ideation has been captured in a higher proportion of deaths by suicide in 2020. 
• Problems in spousal relationship circumstances and previous history of self harm are the two most common psychosocial risk factor identified each year.

For more information on associated causes for suicide deaths, see Tables 11.17 - 11.21 in Data Cube 11 in this publication.

The impact of COVID-19 on mortality has been of high importance since the start of the pandemic, including deaths from the virus itself as well as non-COVID-19 diseases, suicides, accidents and assaults. For some individuals the effects of COVID-19 on the economy (e.g, changes in employment), the health system (e.g. changes in access to the health system and temporary cessation of elective surgery) and social contact (e.g. social isolation) could lead to risk factors for ill health (including suicide) to increase. While there was a 5.4% reduction in the number of suicides from 2019 to 2020, there were 99 people who died by suicide who had the COVID-19 pandemic mentioned in either a police, pathology or coronial finding report. For people who died by suicide and had the COVID-19 pandemic mentioned as a risk factor, it did not appear as an isolated risk. 

When COVID-19 was mentioned as a risk factor it manifested in different ways for individuals. For some people direct impacts from the pandemic such as job loss, lack of financial security, family and relationship pressures and not feeling comfortable with accessing health care were noted. For others, a general concern or anxiety about the pandemic and societal changes were stated or anxiety about contracting the virus itself. The ICD-10 codes assigned by the ABS was dependant on how the risk factor was described as part of the coronial investigation. The table below outlines the three ICD-10 codes used by the ABS to capture different scenarios where the COVID-19 pandemic was stated to be a risk factor for an individual. 

For the 99 people who died by suicide with issues relating to the COVID-19 pandemic as a risk factor: 

• 3.2% of all suicides had issues relating to the COVID-19 pandemic noted as a risk factor. 
• Had on average 5 risk factors. 
• Had on average 3 psychosocial risk factors.

The table below shows the frequency of co-occurring risk factors alongside the frequency of issues relating to the COVID-19 pandemic. Categories are not mutually exclusive and an individual may appear in multiple categories. 

For the 99 people who died by suicide with issues relating to the COVID-19 pandemic as a risk factor: 

• Almost 60% of people had both mood disorders (including depression) and issues related to the COVID-19 pandemic as a risk factor.  
• Over 50% of people had both problems related to un/employment and issues related to the COVID-19 pandemic as a risk factor. 
• There were 25 people who had both problems related to the social environment including social isolation and issues related to the COVID-19 pandemic as a risk factor.  

Lifeline: 13 11 14
Suicide Call Back Service: 1300 659 467
Kids Helpline (for young people aged 5 to 25 years): 1800 55 1800

Since 2009, Australian Governments have worked together through the Closing the Gap strategy to overcome inequality across areas such as life expectancy, mortality, education and employment. Measures of mortality relating to Aboriginal and Torres Strait Islander people are key inputs into this strategy. Targets set in 2008 were revised in July 2020, with a reduction in the suicide rate among Aboriginal and Torres Strait Islander people as a specific target area. 

In 2020, there were 223 Aboriginal and Torres Strait Islander people who died by suicide across Australia. 

• 31.4% had a usual residence in Queensland.
• The median age of death was 31.3 years. 
• The number of suicides of Aboriginal and Torres Strait Islander people increased across all jurisdictions, except South Australia and Western Australia, when comparing 2011-15 with 2016-20.

In 2020, 197 Aboriginal and Torres Strait Islander people died by suicide across the five jurisdictions. 

• Their median age was 31.3 years.
• Suicide was the 5th leading cause of death.
• Those living in Western Australia had the highest age-standardised suicide rate.

To enable comparison of suicide rates over time for Aboriginal and Torres Strait Islander people, age-standardised death rates for males, females and all persons are presented in the graph below. Upper and lower bounds (confidence intervals) are included to show the potential variability of the annual suicide rates and can be used in measuring statistical significance in annual rate change.

• The age-standardised suicide rate was 27.9 deaths per 100,000 persons.
• The suicide rate for males increased between 2011 and 2020 from 31.7 to 42.9 deaths per 100,000. 
• The suicide rate for females has remained relatively stable over time.

In 2020 there were 147 Aboriginal and Torres Strait Islander males who died by suicide. 

• Suicide was the 2nd leading cause of death.
• Their median age at death was 31.5 years.
• Almost three quarters of Aboriginal and Torres Strait Islander people who died by suicide were male.

In 2020 there were 50 Aboriginal and Torres Strait Islander females who died by suicide.  

• Suicide was the 10th leading cause of death.
• Their median age at death was 31.0 years.

For Aboriginal and Torres Strait Islander people who died by suicide between 2011 and 2020:

• The suicide rate increased from 22.2 to 25.6 between 2011-15 and 2016-20. 
• People with a usual residence in New South Wales had a lower suicide rate than those living elsewhere across both periods.
• Those living in Western Australia recorded the highest suicide rate in both of the two five year periods, but the rates have decreased the most over the same time.
• Over one third of people who died by suicide during the 2016-20 time period had a usual residence in Queensland.

Age-specific death rates provide insights into how suicide manifests across age cohorts by relating the number of deaths to the size and structure of the underlying population.

For Aboriginal and Torres Strait Islander people who died by suicide between 2016-2020:

• 81.9 percent were aged between 15-44 years.
• For males, the highest suicide rate was for those aged 35-44 years at 74.1 deaths per 100,000. 
• For females, the highest suicide rate was for those aged 15-24 years at 26.4 deaths per 100,000.

During the period 2016-2020:

• Suicide was the leading cause of death for Aboriginal and Torres Strait Islander children.
• Almost one-third (31.9%) of deaths of Aboriginal and Torres Strait Islander children were due to suicide. 
• Over 73% of Aboriginal and Torres strait islander children who died by suicide were aged between 15 and 17 years. 
• Just over half (53.8%) of Aboriginal and Torres Strait Islander children who died by suicide were female.

For more information on suicides in Aboriginal and Torres Strait Islander children see Table 11.12 in Data Cube 11 in this publication.

Mortality data can provide important insights into population health concerns relevant to different groups within the Australian population. Patterns of death among Aboriginal and Torres Strait Islander people differ considerably to those of non-Indigenous people, as is the case with suicide.

For Aboriginal and Torres Strait Islander deaths due to suicide, in the two 5 year periods between 2011-15 and 2016-20:

• Aboriginal and Torres Strait Islander people had a suicide rate double that of non-Indigenous people.
• Aboriginal and Torres Strait Islander males have the largest rate increase across the two 5 year periods.

In 2020:

• Suicide was the 5th leading cause of death for Aboriginal and Torres Strait Islander people compared to 13th for non-Indigenous people. 
• The median age for suicides was 31.3 years for Aboriginal and Torres Strait Islander people compared to 45.2 years for non-Indigenous people. 

Lifeline: 13 11 14
Suicide Call Back Service: 1300 659 467
Kids Helpline (for young people aged 5 to 25 years): 1800 55 1800

02/11/2021 - Updates to terminology for stillbirths where the sex was not specified as male or female have been made. The Mortality Data Centre team would like to acknowledge Morgan Carpenter from Intersex Human Rights Australia for his assistance and guidance on terminology for stillbirths where the sex of the infant is not specified.

05/11/2021 - Updates to alcohol-induced death tabulation to include ICD-10 code K85.2 Alcohol-induced acute pancreatitis. Tables affected by this change are 13.11-13.16 in Drug and alcohol-induced deaths (Australia).

This release previously used catalogue number 3303.0