Dying due to dementia compared to dying with dementia
The discussion about dementia deaths among Australians has so far been restricted to deaths due to dementia, that is, where dementia was recorded as the underlying cause of death (UCOD). In addition to the underlying cause of death, the National Mortality Database contains information on up to 19 associated causes of death (ACOD) – that is, other causes that were instrumental or significantly contributed to the death. Given that people with dementia often have other health conditions and there can only be one underlying cause of death recorded, it is important to also account for all other cases where Australians died with dementia (where dementia was recorded as either the underlying cause or an associated cause of death).
In 2022, around 17,800 people died due to dementia (nearly 11,300 women and just under 6,600 men). In comparison, around 34,800 people died with dementia (nearly 20,500 women and just over 14,300 men) (Table S3.7).
Leading underlying causes of death
In 2022, the leading underlying causes of death for people who had dementia recorded as an associated cause of death were:
- COVID-19 (almost 2,400 deaths)
- coronary heart disease (almost 2,200 deaths)
- cerebrovascular disease (almost 1,700 deaths)
- diabetes (almost 1,100 deaths)
- accidental falls (almost 1,000 deaths) (Figure 3.7; Table S3.8).
As a person may have multiple types of dementia, it is possible for a person to have dementia recorded as both the underlying and associated cause of death. For example, a person may have Alzheimer’s disease as the underlying cause and Vascular dementia as an associated cause of death. Among the 17,500 people who died with at least one type of dementia recorded as an associated cause, almost 490 (2.8%) also had dementia recorded as the underlying cause of death.
Figure 3.7: Leading 5 underlying causes of death when dementia was an associated cause of death, by sex and age, in 2022
This figure shows the leading 5 underlying causes of death in Australia by sex and age in 2022, when dementia was an associated cause of death.
The leading underlying causes of death were fairly similar for men and women where dementia was an associated cause, but varied somewhat with increasing age – Accidental falls was more common with increasing age, whereas deaths due to Parkinson disease decreased with increasing age. Between 2013 and 2022 the age-standardised rate of deaths where dementia was the underlying cause of death increased from 38 to 45 deaths per 100,000 population. In contrast, the rate of deaths where dementia was an associated cause of death slightly decreased between 2013–2020 from 41 to 36 deaths per 100,000 population then increased in 2020–2022 from 36 to 45 deaths per 100,000 population (Figure 3.8; Table S3.9).
While we cannot be certain why the rate of deaths where dementia was an associated cause of death is decreasing, it may be due to various factors:
- Australians are living longer and are more likely to be dying from dementia than from other conditions. Notably, there have been decreases in fatal heart attacks and strokes over time. This is resulting in dementia being increasingly attributed as the underlying cause of death, whereas in the past it was more likely to be recorded as an associated cause of death or not recorded at all.
- Over time, dementia awareness could have significantly improved among health professionals who record and code cause of death information, leading to an increase in dementia being recorded as the underlying cause of death.
- Changes to coding rules implemented from 2013 have meant that Unspecified dementia is more likely to be recorded as the underlying cause of death rather than as an associated cause of death among people who die with dementia and other specific conditions (including Pneumonitis due to food and vomit). This resulted in an increase in the number of deaths with Unspecified dementia as an underlying cause (ABS 2015).
Since 2020 and the start of the COVID-19 pandemic, if COVID-19 is certified on the Medical Certificate as the cause of death, it is recorded as the underlying cause of death unless there is a clear different causal pathway. In 2020, the rate of dementia deaths was lower than previous years (Figure 3.8), likely associated with reduced transmission of other common respiratory diseases (AIHW 2021). Between 2020–2022, people with dementia who died due to COVID-19 would have dementia recorded as an associated cause of death. In 2022, where dementia was an associated cause of death, COVID-19 became the leading underlying cause of death for the first time.
For more information on COVID-19 and dementia see Dementia deaths during the COVID-19 pandemic in Australia.
Figure 3.8: Dementia-related deaths in Australia: number and age-standardised rates, by whether dementia was recorded as the underlying cause of death or an associated cause of death, between 2013–2022
This line graph shows a brief decrease in the underlying cause of death in 2020 and an increase in the associated cause of death between 2020 and 2022.
ABS (Australian Bureau of Statistics) (2015) Causes of death, Australia, 2013, ABS website, accessed 11 July 2022
AIHW (Australian Institute of Health and Welfare) (2021) Dementia deaths during the COVID-19 pandemic in Australia, AIHW, Australian Government, accessed 22 August 2024.