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In Australia, either a medical practitioner or a coroner is required to certify the cause of death. They should report on all medical conditions that directly caused or contributed to the death and, where appropriate, the circumstances (for example, the type of accident or violence) that led to the death. Important demographic information, such as the sex of the person and their age at death, is also reported.
All deaths are registered with the Registrars of Births, Deaths and Marriages in each state and territory and additional information about coroner-certified deaths are maintained by the National Coronial Information System. Demographic and other important information about the deceased person is captured on a deaths registration statement.
The Registrars of Births, Deaths and Marriages (RBDMs) in each jurisdiction are responsible for maintaining registers of deaths. Individual state and territory legislation governs the registration process and the roles and responsibilities of the registries.
The National Coronial Information System (NCIS) is a data storage, retrieval, analysis, interpretation and dissemination system for coronial information. It enables coroners, their staff, public sector agencies, researchers and other agencies to access coronial data to inform death and injury prevention activities. It contains data about deaths reported to an Australian coroner from July 2000 (from 1 January 2007 for Queensland), and to a New Zealand coroner from July 2007 (closed cases only), and is an initiative of the Australasian Coroners Society. The NCIS is managed by the Victorian Department of Justice on behalf of a Board of Management, and is based at the Coronial Services Centre in Southbank, Victoria.
The Australian Bureau of Statistics (ABS) is Australia’s national statistical agency. The ABS provides key statistics on a wide range of economic, environmental and social issues. This includes information about the Australian population for which deaths information is required. The ABS also codes the causes of deaths to an international standard making the data useable for statistical purposes. The ABS sources information about the circumstances of the death for coroner-certified deaths from the NCIS. This information facilitates coding of the cause of death. In addition to coding causes of death, the ABS enhances the statistical utility of the data by coding various sociodemographic items such as area of usual residence and country of birth.
The Australian Coordinating Registry (ACR) is an agency appointed for managing a particular activity on behalf of the all RBDMs. A coordinating registry undertakes the coordination and management of the designated activity. The underlying legal responsibility is retained by the collective Registrars.
The ABS sources information about deaths and their causes from the RBDMs in each state and territory. The ABS compiles these data and codes the causes of death to an international standard, called the International Statistical Classification of Diseases and Related Health Problems (ICD). Coding causes of death to an international standard enables the comparability of statistics over time and between countries.
The ICD is revised periodically and currently in its tenth revision (ICD-10). The ICD-10 has been used for Australian causes of death statistics since 1997 and comprises more than 14,000 causes of death and illness; analysis of groups of causes is therefore more manageable than individual causes.
The coding produces an underlying cause—the disease or condition which initiated the sequence of events resulting in death—and, for most deaths, associated causes (any other diseases or conditions that contributed to the death but were not the underlying cause).
Once coded, causes of death can be categorised into disease groupings. Disease groupings are useful for tabulating causes of death in a meaningful way and for examining patterns and trends by cause of death and other important population attributes.
A common method of grouping causes is by ICD chapters (see Table 1). The chapters are arranged according to the type of disease (for example, ‘Certain infectious or parasitic diseases’), the body system affected (for example, ‘Diseases of the circulatory system’) or the circumstance causing death (for example, ‘External causes of morbidity and mortality’, which include injury and poisoning).
For some public health purposes, information about causes of death needs to be more specific; coding causes of death enables identification of specific causes such as influenza, stroke or motor vehicle accident.
There are other methods of grouping diseases that are useful for public health purposes. For example, see Classifying causes of death.
Deaths data and information about causes of death are compiled by the ABS. Newer information becomes available to the AIHW after the ABS releases their summaries of causes of death for each year.
The AIHW applies to access these data via the ACR.
Another factor related to the timeliness of deaths data is the processing cycle and revisions to the causes of death. Data are processed according to a reference year; all deaths that are received by the ABS for a reference year and within a specified time period are captured and counted for that reference year. Once the deaths for the reference year are compiled to represent a year of registration, the deaths are coded with an underlying cause of death and associated causes of death where applicable.
The first release of the coded causes of death is referred to as the ‘preliminary’ version. In this version, deaths that were reported to the coroner but remain as an open case usually have a non-specific cause (unknown) cause of death.
Following the release of the preliminary cause of death data, the cause of death for coroner-certified deaths are revised to ascertain a more specific cause of death for any subsequently closed coroner cases. This revision results in a ‘revised’ version of the cause of death data.
The same process occurs again to produce a ‘final’ version of cause of death data.
Aspects of these processes that can influence the accuracy and timeliness of data are that:
For a more detailed description of the coverage and processing of deaths data, including deaths certified by the coroner, refer to the Explanatory Notes in ABS Causes of death, Australia (ABS Catalogue No. 3303.0), which is available from the ABS website.