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Associated causes of death
Associated causes of death refer to conditions other than the underlying cause of death and can include diseases that are part of the chain of events leading to death, risk factors and co-morbid conditions (ABS 2020). People with multiple associated causes of death recorded will be counted in more than one category.
AIHW analysis of the National Mortality Database showed that of drug-induced deaths in 2021 (Table S1.3):
- 2 in 5 (42%) had mental and behavioural disorders due to psychoactive substance use as an associated cause of death.
- Of the 1,075 mentions of these disorders as an associated cause of death, most were mental and behavioural disorders due to the use of opioids or depressants (Table S2.9).
- 1 in 3 (29%) had mood (affective) disorders as an associated cause of death.
- Of the 532 mentions of mood (affective) disorders as an associated cause of death, the majority were for depressive episode (80%) and the remaining 20% were for bipolar affective disorder (Table S2.9).
Box IMPACT1: National data sources on deaths related to drugs and alcohol
A number of nationally representative data sources are available to analyse recent trends in deaths related to drugs and alcohol. The ABS has released data on drug-induced causes of death and opioid-induced death, using data from the Registrar of Births, Deaths and Marriages in each state and territory, and the National Coronial Information System (NCIS) for those deaths certified by a coroner. The National Drug and Alcohol Research Centre (NDARC), Australian Institute of Health and Welfare (AIHW) and the Penington Institute use data provided by the ABS to report on drug deaths in Australia.
Causes of death are coded by the ABS to the International Standard Classification of Diseases and Related Health Problems (ICD). Where different numbers of deaths are reported, differences in data collection purpose, scope and terminology (outlined below) account for this variation.
The ABS, AIHW, NDARC and the Penington Institute use the terminology of drug-induced deaths to define those deaths that are directly attributable to drug use (that is, where drug overdose is the underlying cause of death). Drug-related deaths – where a drug has played a contributory role (for example, a traffic accident) – are excluded.
The ABS, AIHW and NDARC all report drug-induced deaths using the Drug-induced death tabulation (see ABS 3303.0 - Causes of Death, Australia). This tabulation outlines the ICD-10 codes for causes of death attributable to drug-induced mortality. This excludes deaths solely attributable to alcohol and tobacco.
The Penington Institute report drug-induced deaths that include the classification utilised by the above agencies, but also include some deaths attributable to alcohol use. This includes acute alcohol toxicity and harmful use, but may not capture deaths arising from all chronic health conditions that are wholly or partly attributable to alcohol use.
This report includes data on the harmful consumption of alcohol including alcohol-induced and alcohol-related deaths. This provides an update to previous reporting by the ABS (ABS 2018) and uses the same tabulation for alcohol-induced deaths (see ABS 3303.0 - Causes of Death, Australia).
Drug-induced deaths data are reported for the whole of the population across all data sources (Chrzanowska et al. 2022; Penington Institute 2021; see also the Technical notes for information about the AIHW analysis of the National Mortality Database).
Deaths due to harmful alcohol consumption
For related content on deaths due to harmful alcohol consumption, see also:
Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use (that is, where an alcohol-related condition is recorded as the underlying cause of death), as determined by toxicology and pathology reports. This may be the result of a chronic condition directly related to alcohol use (for example, alcoholic liver cirrhosis) or from an acute condition directly related to harmful consumption (for example, alcohol poisoning).
Alcohol-related deaths include deaths directly attributable to alcohol use (as defined above) and deaths where alcohol was listed as an associated cause of death (for example, a motor vehicle accident where a person recorded a high blood alcohol concentration) (ABS 2018). See also the Technical notes.
Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database (Table S1.4) showed that in 2021:
- The number of alcohol-related deaths (4,616) increased in 2021, from 4,546 deaths in 2020. After adjusting for population growth and ageing, the rate of alcohol-induced deaths increased from 5.2 per 100,000 population in 2020 to 5.4 per 100,000 population in 2021.
- People were 3.1 times as likely to have alcohol certified at death as a related (or associated) cause (4,616 alcohol-related deaths) than to have died from an alcohol-induced death (1,559). (Table S1.4).
Australian Bureau of Statistics data on Causes of Death show that in 2021:
- The number of alcohol-induced deaths reached a 10-year peak of 1,559 (1,156 males and 403 females) after a previous high of 1,452 deaths in 2020, a 7.4% increase.
- The majority (74%) were recorded for males (26% females).
- After adjusting for population differences, Remainder of states had a higher rate of deaths than Capital cities (6.8 and 4.7 per 100,000 population, respectively). However, Remainder of states had a lower number of alcohol-induced deaths (691 deaths in Remainder of states and 859 deaths in Capital city areas) (ABS 2022).
Burden of disease
The Australian Burden of Disease Study 2018 shows that tobacco use and alcohol use collectively accounted for 12.8% of the total burden of disease in Australia in 2018. Declines were observed for most leading risk factors with the exception of illicit drug use for which the age-standardised DALY rate increased by 35% between 2003 and 2018 (AIHW 2021c).
Burden of disease analysis is used to compare the impact of different diseases, conditions or injuries on a population (AIHW 2021ca). It combines the burden of living with ill health (non-fatal burden) with the burden of dying prematurely (fatal burden). This is measured through the calculation of disability-adjusted life years (DALY) – one DALY is one year of 'healthy life' lost due to illness and/or death.
Tobacco, alcohol and illicit drug use contribute to increased chronic disease, injury, poisoning and premature death and are among the leading risk factors contributing to disease burden in Australia (AIHW 2021c) (Figure IMPACT3). Analysis of data from the Australian Burden of Disease Study 2018 for tobacco, alcohol and illicit drug use based on the latest evidence of linked diseases indicated the following:
- Tobacco, alcohol and illicit drug use collectively accounted for 15.4% of the total burden of disease in Australia in 2018.
- Tobacco use contributed to 8.6% of the total burden of disease in Australia in 2018. It was responsible for 39% of the burden of respiratory diseases, 22% of cancers, 10.7% of cardiovascular diseases, and 6.2% of infections (AIHW 2021b, Table 6.3).
- Alcohol use contributed to 4.5% of the total burden of disease in Australia in 2018 and was the leading risk factor for males aged 15–44 (12.3% compared to females 3.9%). Males experienced a greater proportion of disease burden attributable to alcohol use than females.
- Alcohol use was responsible for 100% of the burden due to alcohol use disorders, 40% of liver cancer burden, 25% of road traffic injuries – motor vehicle occupant burden, 19% of chronic liver disease burden and 14% of suicide burden (Table S2.4).
- Illicit drug use contributed to 3.0% of the total burden of disease in Australia in 2018, most of which was experienced by people aged 15–44. Males aged 15–44 experienced a greater proportion of total disease burden attributable to illicit drug use than females in this age group (10.6% compared to 4.4%).
- Illicit drug use was responsible for 100% of the burden of drug use disorders (excluding alcohol) and 72% of the poisoning burden. It was also responsible for 74% of the acute Hepatitis C burden, 33% of the acute Hepatitis B burden, and 7.2% of the HIV/AIDS burden.
- Opioid use accounted for the largest proportion (31%) of the illicit drug use burden, followed by amphetamine use (24%), cocaine (10.9%) and cannabis (10.2%). In addition, 17.8% of the burden was from diseases contracted through unsafe injecting practices (Table S2.5) (AIHW 2021b).
The Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 describes the impact of 219 diseases and injuries among Aboriginal and Torres Strait Islander people in terms of fatal and non-fatal burden. Some key findings from the Study show:
Tobacco use: Tobacco use was the highest risk factor, accounting for 12% of total disease burden, an increase from 10% in 2003.
- Over 800 deaths were attributed to tobacco use in 2018, 23% of all deaths among the Indigenous population.
- Tobacco use contributed to the highest portion of the total health gap between Indigenous and non-Indigenous Australians, accounting for 20% of the gap. Total health gap is measured by the difference in DALY (disability-adjusted life years) rates between Indigenous and non-Indigenous Australians (Table S3.7) (AIHW 2022a).
Alcohol use: Alcohol use was the second highest risk factor, accounting for 10% of total disease burden.
- 350 deaths were attributed to alcohol use in 2018, 9.7% of all deaths among the Indigenous population.
- Alcohol use contributed to 12% of the health gap between Indigenous and non-Indigenous Australians. Alcohol use accounted for a larger proportion of the health gap for males compared to females (18% and 7.7%, respectively) (Table S3.7).
Illicit drug use: Illicit drug use was the 4th highest risk factor, accounting for 6.9% of total disease burden.
- 224 deaths were attributed to illicit drug use in 2018, 6.2% of all deaths among the Indigenous population.
- Illicit drug use saw the highest increase in total attributable burden age-standardised rate (ASR) between 2003 and 2018 at 77% (13 attributable DALY ASR in 2003, 23 attributable DALY ASR in 2018) (AIHW 2022a).