Causes of Death, Australia

Australia recorded significantly lower than expected mortality during the first year of the COVID-19 pandemic with death rates reaching historical lows. Deaths decreased across many causes, but the decrease in respiratory disease deaths was most notable. The experience of Australia was different from that of many other countries, where significant increases in mortality were recorded, due largely to deaths from COVID-19.

As Australia entered the second year of the pandemic, COVID-19 continued to circulate with the Delta variant emerging and triggering public health response measures. The roll out of COVID-19 vaccines began in February 2021. Monitoring patterns of mortality during 2021 remained important, with Provisional Mortality Statistics reports continuing to provide timely insights into the direct and indirect effects of the virus on patterns of death. These reports showed that the mortality rate remained low during 2021 with key causes certified by a doctor being cancers, ischaemic heart diseases and dementia. These provisional reports did not include information on the causes of coroner referred deaths due to the time required to complete coronial investigations.

With the majority of information on 2021 deaths now available, the Causes of Death report is able to provide a more complete picture of deaths registered in 2021, including preliminary cause of death information for coroner referred deaths and other key mortality indicators such as leading causes of death.

To show the mortality pattern over the last decade, age-standardised death rates (SDRs) are presented below for males, females and persons.

In 2021:

• The mortality rate remained low at 507.2 deaths per 100,000 people.
• Whilst this was a 3.2% increase on the previous year, the mortality rate in 2020 was at a historical low.
• Mortality rates increased from 2020 by 2.3% for males and 4.1% for females, but remained below 2019 rates.

Data is presented in the table below as age-specific death rates (ASDRs) for selected age groups. In 2020, age-specific death rates decreased for all age groups. In contrast, 2021 saw an increase in ASDRs for all age groups except those aged 25-44, which continued to decline.

In 2021:

• The death rate for those aged 25-44 was the lowest in the 10-year time series.
• In 2020, the largest proportional rate decrease was for females aged 85 and over (6.9%). The mortality rate for this cohort increased by 5.6% in 2021, signifying a return to expected mortality rates.
• ASDRs for those aged 85 and over were similar to those seen in 2018, which was a year of particularly low influenza and pneumonia mortality.
• Almost all ASDRs remained below 2019 rates, excluding those for females aged 0-24.

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.

In 2021:

• The top five leading causes of death remained the same.
• All of the top five leading causes recorded increases in their (crude) mortality rates. This follows a decrease in all of these causes during the first year of the pandemic.
• The rate difference between ischaemic heart diseases and dementia continues to narrow – in 2017 the mortality rate of ischaemic heart disease was approximately 38% higher than deaths due to dementia. In 2021 the rate was approximately 9% higher.
• Excluding 2020, both the number and rate of deaths due to ischaemic heart diseases (IHD) have been decreasing over time. While there was a 4.5% increase in the number of deaths due to IHD in 2021, this follows a 7.4% decrease between 2019 and 2020.
• Crude death rates due to dementia were the highest in the time series.
• All top five leading causes of death are non-communicable diseases (they are not passed from person to person).

Respiratory diseases include acute manifestations such as influenza and pneumonia as well as chronic diseases such as emphysema, asthma and interstitial lung disease.

Tracking respiratory diseases through the COVID-19 pandemic has provided valuable 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 can also reduce the spread of other communicable diseases. In addition, people with chronic lung diseases can be particularly vulnerable to poor outcomes from contracting infectious diseases such as influenza and COVID-19. Historically, respiratory disease mortality rates have reflected the severity of the annual influenza season, with higher rates observed during years with severe flu seasons such as 2017 and 2019.

In 2021:

• The mortality rate from respiratory diseases remains low at a rate of 39.1 per 100,000 people.
• This is the second lowest mortality rate on record from respiratory diseases (after 2020).
• There was a 3.5% increase in the mortality rate from respiratory diseases from 2020.
• The increase in 2021 was driven by deaths due to chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease.

Acute respiratory diseases:

• There were 2 people who died from influenza, which is the lowest number of annual flu deaths on record. This compares to 55 in 2020 and 1,076 in 2019.
• Influenza and pneumonia as a combined group decreased by 12.5% from 2020. This follows a 45.9% decrease in 2020 after a high influenza mortality rate in 2019.
• Pneumonia is a common terminal cause of death, especially for older people who have long term chronic conditions. There was an increase of 2.3% in the rate of influenza and pneumonia as an associated cause of death. However, this remains 28.3% lower than the pre-pandemic rate (2015-2019 average).
• For those who died with pneumonia as a terminal cause, the most common underlying causes of death were dementia and Alzheimer’s disease (14.7%), chronic lower respiratory diseases (13.9%), and COVID-19 (6.1%).

COVID-19 is a respiratory infection caused by the novel coronavirus, SARS-CoV-2. On 11 March 2020 the World Health Organization (WHO) declared COVID-19 to be a pandemic. Mortality data for 2021 largely covers deaths that occurred during the Delta wave of the pandemic, which began in Australia in mid-2021 and continued through to the end of the year. Further information relating to COVID-19 mortality in Australia, including 2022 data, can be found here.

• There were 1,122 deaths due to COVID-19 registered in 2021.
• 98.9% occurred during the Delta wave of the COVID-19 pandemic (July – December 2021). The ABS do not receive information on specific variants of COVID-19, and this information is based on date of death only.
• COVID-19 was the 34th leading cause of death.
• There were a further 31 people who died of other causes (e.g., cancer), with COVID-19 as a contributory cause of death.

The profile of people who died from COVID-19 during the Delta wave differed from those who died during Waves 1 and 2 of the pandemic. Of these Delta wave deaths:

• The median age at death was 79.1. This compares with a median age of 86.9 in 2020.
• Over half were male (660 male deaths, 462 female deaths). In 2020, just over half the people who died from COVID-19 were female.
• Pneumonia was the most common acute disease outcome and was present in 60.0% of COVID-19 deaths in 2021, compared with 31.2% of COVID-19 deaths in 2020.
• Cardiac conditions were the most commonly reported pre-existing conditions (287 deaths). The most commonly reported pre-existing condition in 2020 was dementia including Alzheimer’s disease.
• New South Wales (557 deaths) and Victoria (553 deaths) had the highest number of deaths. In 2020, most deaths occurred during Wave 2 in Victoria.

2021 also saw the introduction of COVID-19 vaccinations globally. The World Health Organization subsequently issued the ICD-10 emergency code U12.9 (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.

The source of all cause of death data for the ABS is either the Medical Certificate of Cause of Death for doctor certified deaths, or the pathology report or coronial findings for coroner referred deaths (accessed via the National Coronial Information System). This includes deaths which may be caused by the COVID-19 vaccine. 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. The ABS and the TGA have communicated and understand that there are differences in how a death may be categorised as being related to a COVID-19 vaccine. These differences may include scope (as described) and the timing of coding and investigations (the TGA regularly updates data in relation to vaccines, whereas the ABS is reporting on coded data at a point in time). The ABS and the TGA will continue to work together to ensure that datasets remain consistent as possible whilst taking into account the known differences in each agency’s reporting scopes.

• In Australia in 2021, there were 15 deaths for which the information provided to the ABS indicated that COVID-19 vaccination was the underlying cause of death.
• Of these, 13 were certified by a coroner and 2 were certified by a doctor.
• Ten of these deaths involved vaccine-induced thrombocytopaenic conditions.
• The majority of deaths (92.3%) assigned as being due to the COVID-19 vaccine have open coronial cases meaning they are in scope of the ABS revisions process. Additional information will be reviewed by the ABS in relation to these deaths as it is received.

• As of October 6 2022, the TGA has identified 14 reports where the cause of death was linked to vaccination. Further details on the TGA’s vaccine safety monitoring process can be found here. 

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 referred deaths dataset in 2021, compared with a historical average of 6.3% for preliminary data. Of the 2021 coroner referred 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 referred deaths (e.g. suicide, assault and drug-induced deaths) should be interpreted with caution due to the expectation that these data will change during revisions.

Potentially avoidable deaths are defined as deaths from conditions that are potentially preventable through individualised care and/or treatable through existing primary or hospital care (METeOR, 2021). 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.

On average, 40% of potentially avoidable deaths are referred to a coroner (compared with 11-14% of all deaths). The following data is preliminary for 2021 and 2020 - interpretation should take into account that numbers of potentially avoidable deaths will increase when the ABS revisions process is applied. See Completeness of coroner referred deaths data in 2021 for further information.

For people who died from potentially avoidable causes in 2021:

• There were 26,967 people who died from potentially avoidable causes (17,113 males and 9,854 females). This compares to 26,995 deaths in 2020 (17,231 males and 9,764 females).
• The mortality rate is the lowest in the ten year time series for both males and females.
• While the mortality rate has decreased, the sex ratio has remained relatively constant at 1.8 (male to female).

The following data is preliminary for 2021 and 2020 - interpretation should take into account that numbers of deaths due to suicide will increase when the ABS revisions process is applied. Revised data for deaths due to suicide in 2021 will be published in early 2023. See Completeness of coroner referred deaths data in 2021 for further information.

For people who died by suicide in 2021:

• There were 3,144 deaths due to suicide (2,358 males and 786 females). This compares to 3,139 suicides in 2020 (2,384 males and 755 females).
• The suicide rate was 12.0 deaths per 100,000 people, similar to that recorded in 2020 (12.1).
• The suicide rate increased for females and decreased for males.
• The median age at death for people who died by suicide was 44.8 (45.8 for males and 42.9 for females).
• Suicide remained the 15th leading cause of death.
• Almost 90% of people who died by suicide had risk factors identified including psychosocial stressors, mental health conditions, chronic diseases, and substance abuse disorders.

For people who died from a motor vehicle accident in 2021:

• There were 1,206 deaths from motor vehicle accidents (917 males and 289 females). This compares to 1,163 in 2020 (870 males and 293 females).
• The death rate from motor vehicle accidents increased by 2.9% from 2020, but remained 7.0% lower than the 2019 rate.
• The rate increased for males and decreased for females.
• For males, those aged under 25 had the largest numerical increase with 36 more deaths than in 2020.
• For females, the rate decrease was driven by those aged under 35, with 31 fewer deaths in this group than in 2020.

The following data is preliminary for 2021 and 2020 - interpretation should take into account that numbers of deaths due to assault are expected to increase when the ABS revisions process is applied. Revised data for deaths due to assault in 2021 will be published in early 2023. See Completeness of coroner referred deaths data in 2021 for further information.

For people who died due to assault in 2021:

• There were 213 deaths due to assault (152 males and 61 females). This was lower than the number of deaths in 2020 (241 deaths).
• The rate of assault mortality decreased slightly from 0.9 to 0.8 in 2021. This is the lowest rate seen in the ten-year time series.
• The number and rate of deaths due to assault decreased for both males and females.
• The largest numerical decrease was for males aged between 35 and 44 (16 fewer deaths than in 2020).

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

The following 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. See Completeness of coroner referred deaths data in 2021 for further information.

For people who died of a drug-induced death in 2021:

• There were 1,704 drug-induced deaths (1,069 males and 635 females). This compares to 1,842 in 2020 (1,187 males and 655 females).
• There was an 8.2% decrease in the rate of drug-induced deaths from 2020.
• Deaths registered in Victoria had the greatest rate decrease since 2020 (16.1%).
• The rate decrease from 2020 was greater for males than females (10.4% and 3.8% respectively).
• 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.

On average, 71% of alcohol-induced deaths are certified by a doctor. These deaths are primarily caused by chronic alcohol-induced conditions. As a result, alcohol-induced deaths data are less likely to be impacted by revisions than causes with a higher proportion of coroner referred deaths such as drug-induced deaths and suicides.

For people who died of an alcohol-induced death in 2021:

• There were 1,559 people who died of an alcohol-induced death (1,156 males and 403 females).
• There was a 5.8% increase in the rate of alcohol-induced deaths, with 107 additional deaths since 2020.
• For males, the rate is the highest in the ten year time series at 8.3 deaths per 100,000 people (8.1% increase since 2020).
• The rate for females remained the same as in 2020.
• The rate increase over the last 10 years is largely due to conditions associated with long term alcohol use including liver cirrhosis.

• In 2021 there were 171,469 deaths, with an age-standardised death rate of 507.2 deaths per 100,000 people.
• Ischaemic heart disease was the leading cause of death, accounting for 10.1% of all deaths. 
• The rank order of the top 5 leading causes has remained the same since 2018.
• Influenza and pneumonia did not appear in the 20 leading causes of death for the first time in the ten year time series. 
• There were 1,122 deaths from COVID-19, ranking as the 34th leading cause of death.

There were 171,469 deaths registered in Australia in 2021.

In 2021 for people who died:

• 52.1% were male (89,401) and 47.9% were female (82,068).
• Their median age at death was 82.0 years (79.4 for males, 84.8 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 2021: 

• The leading cause of death was Ischaemic heart disease.
• 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 89.2.
• Cerebrovascular diseases, lung cancer and chronic lower respiratory diseases rounded out the top five leading causes. 
• Deaths from the five leading causes all increased from 2020. This followed a decrease of all of the five leading causes in 2020, with many causes of death recording historical low mortality rates in the first year of the COVID-19 pandemic. 
• The number of influenza and pneumonia deaths remained low in 2021. Influenza and pneumonia was not in the top 20 leading causes in 2021 (ranked 22nd). 
• There were only 2 deaths recorded as being due to influenza, the lowest on record. 
• Suicide was the 15th leading cause of death. People who died by suicide had a median age at death of 44.8.
• COVID-19 was the 34th leading cause of death, with 1,122 deaths recorded through the civil registration system. 

From 2012 to 2021:  

• Deaths due to Ischaemic heart diseases and Cerebrovascular diseases decreased by 13.8% and 9.1% respectively. 
• Deaths due to Dementia, including Alzheimer's disease increased by 53.8% (5,573 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 2012 to 2021:

• Ischaemic heart diseases decreased by 32.0%.
• The gap between ischaemic heart disease and dementia has narrowed.
• While the number of dementia deaths has increased over the 10 year period, the age-standardised death rate for dementia has been more stable. This reflects the ageing population in Australia. 
• Cerebrovascular diseases decreased by 28.9%.
• Malignant neoplasms of trachea, bronchus and lung (lung cancer) and Chronic lower respiratory diseases decreased by 18.0% and 9.5%, 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 2021:

• Suicide was the leading cause of premature death with 107,068 YPLL. People who died by suicide had a median age at death of 44.8. 
• Ischaemic heart disease had the highest number of premature deaths but had the second highest number of YPLL at 70,308 years. People who died from ischaemic heart disease had a median age at death of 84.3. 
• People who died from Lung cancer, Motor vehicle crashes and Accidental poisoning had the 3rd, 4th and 5th highest YPLL, with median ages at 74.7, 45.9 and 45.4, respectively.

For the 89,401 males who died in 2021: 

• Ischaemic heart disease was the leading cause of death (10,371 deaths), remaining considerably higher than the second ranked cause (dementia at 5,664 deaths). 
• Prostate cancer was the sixth leading cause of death and second leading cause of cancer deaths. 
• Suicide was the 10th leading cause. Three-quarters of people who died by suicide were male. 
• COVID-19 was the 33rd leading cause, accounting for 660 male deaths. 

• Influenza and pneumonia was not in the top 20 leading causes for males in 2021 (ranked 23rd).

For males from 2012 to 2021:

• The age-standardised death rate (SDR) for Ischaemic heart diseases decreased by 29.2%.
• The SDR for Dementia, including Alzheimer's disease increased by 19.6%.
• The SDR for lung cancer decreased by 23.0%.

For the 82,068 females who died in 2021: 

• Dementia including Alzheimer's was the leading cause of death (10,276 deaths). 
• The death rate for dementia increased by 21.5% over the last decade. Close to two-thirds of people who died from dementia were female. 
• Ischaemic heart disease was the second leading cause with 6,960 deaths. 
• Breast cancer was the sixth leading cause overall and second leading cause of cancer deaths with 3,129 deaths.
• COVID-19 was the 32nd leading cause, accounting for 462 female deaths. 
• Deaths due to falls are the most common external cause of death. Falls were the 12th leading cause of death for females. 

In 2021, there were 4,081 deaths of Aboriginal and Torres Strait Islander people (2,229 males and 1,852 females). The table below presents for Aboriginal and Torres Strait Islander people: numbers of deaths, crude death rates and age-standardised mortality rates for each jurisdiction in 2021. Age-standardised rates enable the comparison of populations with different age structures. 

• Ischaemic heart disease was the leading cause of death (411 deaths). 
• There were 17 deaths due to COVID-19 in Aboriginal and Torres Strait Islander people.
• The Northern Territory recorded the highest mortality rate. 

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 2021 there were 3,696 Aboriginal and Torres Strait Islander people who died across the five jurisdictions. 

• Their median age was 62.5 years.
• Ischaemic heart disease was the leading cause of death for males. 
• Diabetes was the leading cause of death for females for the first time since 2013. 
• Those who had a usual residence in the 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 2012 and 2021: 

• 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 compared to females.
• The rate ratio ranged between 1.2 to 1.3 male deaths for every female death.

For Aboriginal and Torres Strait Islander people who died between 2012 and 2021: 

• The five leading causes of death (Ischaemic heart diseases, diabetes, chronic lower respiratory diseases, lung cancer and suicide) accounted for over one-third of all deaths. 
• The five leading causes of death have remained the same between 2012-2016 and 2017-2021. 
• The age-standardised death rate decreased for the first and second leading cause of death (Ischaemic heart disease and diabetes) between 2012-2016 and 2017-2021. 
• Intentional self-harm remains the fifth leading cause of death in 2021. The age-standardised death rate increased from 2012-2016 to 2017-2021. 

For Aboriginal and Torres Strait Islander males and females who died in 2021: 

• Four of the five leading causes of death for males were the same compared to females. 
• Suicide was the second leading cause of death for males in 2021, compared to 7th for females. 
• Dementia, including Alzheimer's disease was the fifth leading cause of death for females and the 9th leading cause for males.

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 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 in 2021 was 62.5, compared to 82.2 for the non-indigenous population.

Among the top 20 leading causes of death in 2021:

• 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 4.5 times higher than non-Indigenous people for diabetes, and three times higher for chronic lower respiratory diseases, liver diseases, transport accidents and accidental poisonings.  

During 2021:

• 3,144 people died by suicide.
• The age-standardised suicide rate was 12.0 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 2021 there were 2,358 males who died by suicide.

• Suicide was the 10th leading cause of death.
• Their median age at death was 45.8 years. 
• Three quarters of people who died by suicide were male. 
• The suicide rate for males decreased by 2.3% from 2020.  
• The suicide rate for males increased between 2012 and 2021 from 17.0 to 18.2 deaths per 100,000.

In 2021 there were 786 females who died by suicide.

• Suicide was the 24th leading cause of death. 
• Their median age at death was 42.9 years. 
• The suicide rate for females increased by 5.0% from 2020. 
• The suicide rate for females increased between 2012 and 2021 from 5.6 to 6.1 deaths per 100,000.

• Almost three-quarters of people who died by suicide had a usual residence in New South Wales, Victoria and Queensland.
• Victoria, South Australia, Tasmania and the Northern Territory had decreases in the age-standardised suicide rate between 2020 and 2021.
• Queensland and the Australian Capital Territory both recorded an increase in the suicide rate between 2020 and 2021. 
• Those living in the Northern Territory had the highest suicide rate at 18.4 per 100,000 people. 

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.
• 81.9 percent of people who died by suicide are aged under 65 years.
• Almost one quarter of deaths in those aged 15-44 are due to suicide.
• People who died by suicide had a median age of 44.8 years compared to 82.0 years for all deaths.
• The proportional distribution of those aged under 25 who died by suicide differs for males and females. For females, 17.8% of suicides occur in those aged under 25 years. For males 12.5% of suicides occur in those aged under 25. 

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.

In 2021, males aged over 85 years:

• Had the highest age-specific suicide rate. 
• Accounted for 3.2% of suicides of males.

In 2021, males aged between 50-54 years: 

• Have the highest age-specific suicide rates of those aged under 80 years.
• Accounted for 9.1% of suicides of males. 

Between 2020 and 2021: 

• Males aged 80-84 years had the largest increase in age-specific suicide rates.
• Those aged 80-84 years have the 2nd leading age-specific suicide rate. This is a change from 2020, where those aged 80-84 had the 11th age-specific suicide rate. 
• Males aged 15-19 years had the largest proportional decrease in their age-specific suicide rate.

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.

Females aged 50-54 years:

• Had the highest female age-specific suicide rate.
• Accounted for the highest proportion (9.9%) of suicides of females.

Between 2020 and 2021:

• Females aged 50-54 moved from the 7th to the leading age group of suicides in females.
• Those aged 85 years and older increased by the highest proportion.
• Females aged 45-49 had the largest proportional decrease in their age-specific suicide rate.

Suicide accounted for the highest number of years of potential life lost among leading cause groups of conditions for both males and females. 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 2021:

• Suicide was the leading cause of death for 15-44 year olds. 
• Suicide was a leading cause of premature mortality with 107,068 years of life lost.
• A person who died by suicide lost on average 34.1 years of life. 

For males who died in 2021:

• Suicide was the leading cause of premature mortality with 78,231 years of life lost.
• Suicide was the 10th leading cause of death.
• Those who died by suicide lost on average 33.2 years of life.

For females who died in 2021:

• Suicide was the leading cause of premature mortality with 28,874 years of life lost.
• Suicide was the 24th leading cause of death.
• Those who died by suicide lost on average 36.7 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 2021, for children who died by suicide: 

• There were 112 suicides of children. 
• Suicide remained the leading cause of death of children in Australia. 
• Males had a suicide rate of 3.0 per 100,000 children (63 deaths).
• Females had a suicide rate of 2.4 per 100,000 children (49 deaths). 
• Over half (56.3%) of children who died by suicide were aged 16 or 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 1.3 males per female death. This compared to a sex ratio of 3.0 for people of all ages who died by suicide.
• The sex ratio for children has remained consistent over the last 10 years. 

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. 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 2021: 

• Almost 90% of people who died by suicide had at least one risk factor reported. 
• Psychosocial risk factors were the most commonly reported risk factor and were present in almost two-thirds of deaths of people who died by suicide. 
• Mental and behavioural disorders were present in almost 63 percent of deaths of people who died by suicide.
• People who died by suicide had an average of 3 to 4 risk factors mentioned. 

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

The types of risk factors experienced by a person can vary across their life. Risk factors more commonly seen in persons in older age groups, such as pain and limitation of activities due to chronic health conditions, are not as common in younger age groups. Similarly, problems related to employment and unemployment are most common in those included in the working age population (defined as 15-64 years). 

In 2021:

• Mood disorders (including depression) were the most common risk factor to be mentioned in all age groups except those aged 85 years and older.
• Suicide ideation was mentioned as a risk factor for at least one fifth of deaths across all age groups. Suicide ideation can include thoughts or contemplation of suicide, and both direct and indirect discussions or comments surrounding the intention or wish to end their life.
• People aged under 44 years were more likely to have issues with psychoactive substance use (both acute use and intoxication, as well as chronic use) mentioned as a risk factor. 
• For those aged 85 years and over, limitation of activities due to illness and disability was the most common risk factor.
• Older people had a higher proportion of chronic health conditions and pain as a risk factor than younger people.
• Factors relating to un/employment are more highly ranked as a risk factor for those aged 25-44 years and 45-64 years. 

Acute alcohol use was a risk factor in just over one fifth (20.6%) of suicides. Acute alcohol use can affect a death due to suicide in a number of ways including causing respiratory depression (especially when used in combination with other drugs) or affecting judgement and decision making processes. For suicides not due to poisoning, acute alcohol use was present in 21% of deaths. 

In 2021:

• Those aged 25-64 years were more likely to have issues with alcohol use (both acute use and intoxication, as well as chronic use) mentioned as a risk factor.
• Those aged under 45 years were more likely to have acute alcohol use and intoxication identified as a risk factor.

Psychoactive substance use was a risk factor in 15.2% of suicides. Similar to alcohol, acute use of psychoactive substances can affect a death due to suicide in a number of ways, including by impairing cognition, perception or moods, or by causing toxicity. People aged under 45 years were more likely to have psychoactive substances present at death.

For people aged under 45, in 2021:

• Acute psychoactive substance use and intoxication was identified as a risk factor in 20-23% of suicides.
• Acute psychoactive substance use and intoxication was present as a risk factor in a higher proportion of deaths due to suicide than acute alcohol use and intoxication for those aged under 45. 
• For those aged over 45 acute alcohol use and intoxication was a more common risk factor than acute psychoactive substance use and intoxication. 

In 2021 for males who died by suicide: 

• Mood disorders (including depression) were the most common risk factor to be mentioned in all age groups except those aged 85 years and older.
• Males aged 25-64 were more likely to have issues related to acute and chronic alcohol use than other older age groups.
• Acute psychoactive substance use was identified as a risk factor in over one quarter of deaths of those aged 25-44.
• Males aged under 44 years were more likely to have issues with chronic psychoactive substance abuse disorders.
• Issues in spousal relationships was the second most common risk factor for males.
• Males in younger age groups were more likely to have issues with spousal relationships than those in older age groups.
• A history of suicide ideation or self-harm was present as a risk factor across all age groups for males. 

In 2021 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 all female suicides.
• Over half of females aged 45-64 years had a mood disorder identified as a risk factor.
• Personal history of self-harm was the most common risk factor for those aged under 25 years. 
• Suicide ideation was mentioned as a risk factor in over one third of suicides of those aged over 85. 
• There was overall a higher proportion of acute substance abuse disorders than chronic abuse disorders identified.
• Acute psychoactive substance use was more likely to be identified as a risk factor in those aged under 44 than in older age groups.
• 15 percent of deaths for those aged 65-84 (where drugs or alcohol were not the mechanism of death) had acute psychoactive substance use identified as a risk factor. This compares to a proportion of 3.7% of males in the same age group.  
• Pain was more likely to be identified as a risk factor for those aged over 65 years, with pain being identified in almost one quarter of suicides in those aged 85 years and older.

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 five 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 and 2018 are now closed, data for those years are considered "final" (see revisions section in methodology for more information). Information on risk factors across the five years is presented below.

For suicides across 2017-2021:

• Risk factors were identified in 97.0% of suicides in 2017 and 94.3% in 2018, where the data is now final. The proportion of risk factors present for other years is likely to increase as coronial investigations are finalised. 
• Mood disorders were the most common risk factor for each year. 
• Problems in spousal relationship circumstances were the second most common risk factor from 2017-2019 and the third most common risk factor in 2020-2021.  
• Suicide ideation was the second most common risk factor reported in 2020 and 2021.
• Collectively, acute use and intoxication of alcohol and psychoactive substances were identified in at least one third of suicides across each year.
• Similarly, chronic alcohol and psychoactive substance abuse disorders were identified in at least one quarter of suicides across all years.

During the second year of the pandemic, the impact of COVID-19 on mortality continues to remain of high importance. This includes 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. In 2021 there were 81 people who died by suicide, who had the COVID-19 pandemic mentioned in either a police, pathology or coronial finding report. This represents an 18.2% decrease in the number of suicides which mention the COVID-19 pandemic as risk factor between 2020 and 2021. For most 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 were dependent 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 81 people who died by suicide with issues relating to the COVID-19 pandemic as a risk factor: 

• The pandemic was mentioned as a risk factor in 2.6% of all suicides. This is a reduction from 3.2% in 2020.
• They had on average 6 risk factors.
• They 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 81 people who died by suicide with issues relating to the COVID-19 pandemic as a risk factor: 

• Over 65% of people had both mood disorders (including depression) and issues related to the COVID-19 pandemic as a risk factor.  
• Almost 40% of people had both problems related to un/employment and issues related to the COVID-19 pandemic as a risk factor. 
• Over 30% of people had experienced suicide ideation.
• Over one quarter of people had a history of self-harm.
• Over one quarter of people had issues related to acute alcohol use and intoxication.
• There were 11 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.  

In 2021, for the 81 people who died by suicide with issues relating to the COVID-19 pandemic as a risk factor: 

• The majority of people lived in New South Wales, Victoria, or Queensland.

Between 2020 and 2021:

• The number of those living in Victoria who had an identified pandemic related risk factor decreased by 50 percent.
• There were also small changes in other states and territories.

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 2021, there were 219 Aboriginal and Torres Strait Islander people who died by suicide across Australia. 

• 26.0% had a usual residence in Queensland.
• Their median age of death was 30.2 years. 
• The number of suicides of Aboriginal and Torres Strait Islander people increased across all jurisdictions except Western Australia, when comparing 2012-16 with 2017-21.

In 2021, 196 Aboriginal and Torres Strait Islander people died by suicide across the five jurisdictions. 

• Their median age was 29.6 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 27.1 deaths per 100,000 people.
• The suicide rate for males increased between 2012 and 2021 from 26.9 to 38.6 deaths per 100,000. 
• The suicide rate for females is the highest in the 10 year time series (16.1 deaths per 100,000).

In 2021 there were 134 Aboriginal and Torres Strait Islander males who died by suicide. 

• Suicide was the 2nd leading cause of death.
• Their median age at death was 29.8 years.
• Over two thirds of Aboriginal and Torres Strait Islander people who died by suicide were male.

In 2021 there were 62 Aboriginal and Torres Strait Islander females who died by suicide.  

• Suicide was the 7th leading cause of death.
• Their median age at death was 27.7 years.

For Aboriginal and Torres Strait Islander people who died by suicide between 2012 and 2021:

• The suicide rate increased from 22.4 to 26.4 between 2012-16 and 2017-21. 
• People with a usual residence in New South Wales had a lower suicide rate than those living elsewhere across both periods.
• Those with a usual residence 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 2017-21 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 2017-2021:

• 83.7% were aged between 15-44 years.
• For males, the highest suicide rate was for those aged 35-44 years at 77.7 deaths per 100,000. 
• For females, the highest suicide rate was for those aged 15-24 years at 26.9 deaths per 100,000.

For Aboriginal and Torres Strait Islander people who died by suicide between 2012 and 2021:

• The age-specific suicide rate for all Aboriginal and Torres Strait Islander people increased across all age groups.
• Those aged 35-44 years had the largest rate increase between the two periods. 

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 analysis of suicide deaths in children. For more information on issues associated with the compilation and interpretation of suicide data, see Deaths due to intentional self-harm (suicide) and Deaths of Aboriginal and Torres Strait Islander people 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. 

During the period 2017-2021:

• Suicide was the leading cause of death for Aboriginal and Torres Strait Islander children.
• 29.7% of deaths of Aboriginal and Torres Strait Islander children were due to suicide. 
• Over three quarters (75.3%) of Aboriginal and Torres strait islander children who died by suicide were aged between 15 and 17 years. 
• Just over half (54.5%) 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 2012-16 and 2017-21:

• 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 periods.
• The rate ratio increased slightly for both males and females across the two periods. 

In 2021, for the five jurisdictions included in analysis (not including Victoria, Tasmania and Australian Capital Territory):

• Suicide was the 5th leading cause of death for Aboriginal and Torres Strait Islander people compared to 15th for non-Indigenous people. 
• The median age for suicides was 29.6 years for Aboriginal and Torres Strait Islander people compared to 47.0 years for non-Indigenous people. 

This release previously used catalogue number 3303.0