The collection, processing, compilation and dissemination of death statistics in Australia are the joint responsibility of various stakeholders. Registration of deaths in Australia is considered a state responsibility rather than a Commonwealth responsibility. Each state and territory has its own legislation covering the death registration process, as well as the role and responsibilities of the Registrars of Births, Deaths and Marriages (RBDMs).
REGISTRATION OF DEATH
The primary purpose of Death Registrations is to allow for the legal identification of persons who are deceased and to ascertain the cause of death. Death registrations are used in a number of areas including for legal purposes in the finalisation of a deceased person’s estate, distribution of the estate and also to ascertain whether the death is “suspicious” and that further legal investigations need to occur. The Death Registration is also a very valuable source of information on deaths and mortality in Australia. From a statistical point of view, the inclusion of any particular item(s) on the statement should be based on, and justified by, its potential for meeting clearly defined data requirements, while establishing and maintaining comparability between states and territories as well as conforming to international standards where possible.
The registration of deaths is the responsibility of the individual State and Territory RBDMs. Information about the deceased is supplied by a relative or other person acquainted with the deceased or by an official of the institution where the death occurred. As part of the registration process, information on the causes of death is either supplied by the medical practitioner certifying the death on a Medical Certificate of Cause of Death, or supplied as a result of a coronial investigation. Death records are provided electronically to the ABS by individual registrars, on a monthly basis. Each death record contains both demographic data and medical information from the Medical Certificate of Cause of Death where available. Information from coronial investigations are provided to the ABS through the National Coroners Information System (NCIS).
There are three components of a death registration and all components must be completed in order for the RBDM to consider a registration finalised:
- Death Notification Form - completed by a funeral director, based on information supplied by relatives/friends of the deceased. This form is submitted to the RBDM.
- Medical Certificate of Cause of Death, - this is either completed by a doctor who attended the patient prior to death and forwarded to the RBDM or, if the death is suspicious or due to an unnatural cause (approx 14% of all deaths), a Coroner will be responsible for investigating and determining the cause of death. Coroners pass this information on to the National Coronial Information System (NCIS) and to the RBDM.
- Certificate of Burial or Cremation - completed by the funeral director. This form is submitted to the RBDM.
The ABS only collects a subset of data items from the registration process. Only data items which are required for statistical purposes are forwarded to the ABS by the RBDM
CERTIFICATION OF DEATH
Deaths are certified by a doctor using the Medical Certificate of Cause of Death
, or by a coroner, depending on whether the death is reportable to the coroner.
Doctors are required to complete the Medical Certificate of Cause of Death
for non-coronial deaths. The legislation covering doctor certified deaths varies between jurisdictions. The ABS provides guidance to certifiers on how to complete the Medical Certificate of Cause of Death
in the booklet Information Paper: Cause of Death Certification Australia, 2004
(cat. no. 1205.0.55.001) (ABS 2005a).
Doctors are required to lodge the Medical Certificate of Cause of Death
with their Registrar of Births, Deaths and Marriages.
What constitutes a 'reportable death' varies by jurisdiction. In general, a death must be reported to a coroner in the following instances:
- where the person died unexpectedly and the cause of death is unknown
- where the person died in a violent or unnatural manner
- where the person died during or as a result of an anaesthetic
- where the person was ‘held in care’ or in custody immediately before they died
- where a doctor has been unable to sign a death certificate giving the causes of death
- where the identity of the person who has died is not known.
It is the role of the coroner to investigate the circumstances surrounding all reportable deaths and to establish wherever possible the circumstances surrounding the death, and the cause(s) of death. The coroner may or may not require a full autopsy to be completed to assist with a decision regarding the medical causes of death. Whether or not such an examination is undertaken, the coroner will also be provided with sufficient information from a police investigation such that the circumstances of the death, so far as are known or can be interpreted, are available to assist with a determination of the legal cause of death relating to the intent.
When coronial investigations are complete, causes of death information is passed to the Registrar of Births, Deaths and Marriages, as well as to the NCIS from where it is accessed by the ABS. In some cases, coronial records may be accessed by the ABS directly from the coroner, if required for causes of death coding.
NATIONAL CORONERS INFORMATION SYSTEM (NCIS)
The National Coroners Information System (NCIS) is a national secure internet based data storage and retrieval system for Australian coronial cases (NCIS 2007b). Information about every death reported to an Australian coroner since July 2000 (January 2001 for Queensland) is stored within the system. By January 2008 there were over 134,000 cases recorded on the system.
The NCIS has a primary role to assist coroners in their role as death investigators, by providing them with the ability to review previous coronial cases that may be similar in nature to current investigations, enhancing their ability to identify and address systematic hazards within the community. Approved research and government agencies also utilise the NCIS to obtain valuable information concerning the circumstances of reported fatalities, to assist in the development of community health and safety strategies. The NCIS is an initiative of the Australasian Coroners Society, and is based at and managed by the Victorian Institute of Forensic Medicine. The NCIS is funded by a range of Commonwealth and State/Territory agencies.
Upon notification of a reportable death, basic details are entered by coronial staff into their local case management system, which is subsequently uploaded to the NCIS (usually nightly). Coronial clerks code the data required in their local systems (or direct to the NCIS) such as injury, intent, drugs etc. and load the relevant documents if available. The point at which this occurs varies according to local practices, and may occur progressively during the coronial investigation or not until the case has been closed. The NCIS then performs quality checks of the information on the system, and provides feedback to coroners' offices, requesting amendments to any coding if required.
For coronial deaths, the NCIS is the source of information for ABS coding. The data elements on the NCIS which are required for causes of death coding of these cases include:
- location of the incident
- intent (both suspected at time death reported and final)
- mechanism of injury (primary, secondary and tertiary)
- object or substance involved (primary, secondary and tertiary)
- medical cause of death
- where the death is related to a motor vehicle accident
- vehicle type
- counterpart (what was impacted e.g. car vs car, car vs. stationary object etc.)
Additionally, full text reports with details that may assist with the assignment of specific codes which may be available on the NCIS are:
- police narrative of circumstances
- autopsy report
- toxicology report
- coronial finding.