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Deaths statistics are usually compiled using the underlying cause of death only. However, in most cases, more than one disease contributes to death.
The underlying cause of death is the disease or injury that initiated the train of events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury. Deaths are referred to here as 'due to' the underlying cause of death.
Associated causes of death are all causes listed on the death certificate, other than the underlying cause of death. They include the immediate cause, any intervening causes, and conditions which contributed to the death but were not related to the disease or condition causing the death.
Multiple causes of death are defined here as all causes listed on the death certificate. This includes the underlying cause of death and all associated causes of death. This information is useful for describing the role of all diseases involved in deaths especially for chronic disease causes of death where there is usually more than one disease contributing to the death.
Examining multiple causes of death may offer better insights into all the disease processes occurring at the end of life, which in turn can be useful for developing better prevention and treatment policies and practices, refining disease surveillance activities, guiding research investment and enhancing burden of disease estimates.
Of the 153,580 deaths in Australia in 2014, 92% were due to natural causes. These are deaths that were not due to external causes such as accidents, injury and poisoning, or due to ill-defined causes.
In 2014, 82% of natural deaths had more than 1 cause and, on average, 3.3 diseases or conditions were recorded on the death certificate (Table S1).
Factors that may affect the number of causes of death recorded include the person's age, the underlying cause of death, coding changes and variations in certification practices. See more on Multiple causes of death in Australia.
Australians who die of chronic disease often have more than 1 cause of death recorded on their death certificate. For example, deaths due to coronary heart disease had 3.6 causes of death on average, deaths due to asthma had 3.9 and deaths due to diabetes had 4.8 (Table S2).
Coronary heart disease
Influenza and pneumonia
Source: AIHW National Mortality Database (Table S2).
Chronic diseases that are more likely to be reported as the underlying cause of death rather than as an associated cause of death include prostate, breast, colorectal (bowel), liver and lung cancers (Figure 2).
Chronic diseases that are more likely to be reported as associated causes of death include chronic and unspecified kidney failure, diabetes, asthma, COPD, and dementia and Alzheimer disease.
When deaths are reported by the underlying cause of death only, the involvement of certain diseases in overall mortality may be underestimated. This is particularly evident for chronic and unspecified kidney failure, diabetes, asthma and COPD.
Note: Underlying refers to deaths with the disease recorded as the underlying cause of death, regardless of whether the disease was also recorded as an associated cause of death. Associated refers to deaths with the disease recorded only as an associated cause of death.
Source: AIHW National Mortality Database (Table S3).
AIHW 2012. Multiple causes of death in Australia: an analysis of all natural and selected chronic disease causes of death 1997–2007.