Deaths referred to the coroner
In 2020–21, there were 2,400 head injury deaths recorded in the AIHW National Mortality Database (NMD). There were 1,300 finalised records of deaths that were referred to the coroner in the National Coronial Information System (NCIS), which may or may not also be included as head injury deaths in the NMD. These NCIS deaths only include closed cases, where the coronial investigation has been completed and cause of death established.
A death is usually referred to a coroner if the death:
- is unexpected
- is caused by an accident or injury
- occurred while in care or custody
- is healthcare related
- is for a person with an unknown identity (NCIS 2023)
Injury deaths make up a large proportion of deaths referred to the coroner. In 2019, the NCIS reported that 43.5% of reportable deaths were caused by an injury (NCIS 2022). In 2020–21, 70% of all injury deaths in the NMD were referred to the coroner. This is substantially higher than the proportion of all deaths referred to the coroner, which the ABS estimates to be between 11-14% (ABS 2023), meaning that injury deaths are much more likely to receive a coronial investigation than other causes of death.
Of the 1,300 head injury deaths referred to the coroner in 2020–21:
- 2 in 3 were male (66.6%)
- most (65%) were aged 65 and over (Figure 21).
Figure 21: NCIS head injury deaths, by age group and sex, 2020–21
A chart showing that the 65 and over age group had the highest numbers of head injury deaths, and that males have higher numbers than females across all age groups except for the 0–14 age group where numbers are similar.
Among deaths with recorded ICD-10 head injuries, the most common head injury diagnosis was traumatic subdural haemorrhage (425). This was followed by unspecified injury of head (330) and other intracranial injuries (145).
Among all deaths, the most common terms used in the cause of death fields after head (724) and injury (690) were:
- fall (419)
- intracranial bleed (340)
- elderly (134) (Figure 22).
This text analysis reinforces that head injury deaths disproportionately affect older Australians, and that falls are the most common cause of injury death among people aged 65 and over in Australia (AIHW 2022e).
Figure 22: Word cloud of most frequent terms used in the NCIS medical cause of death fields, 2020–21
Alcohol was also mentioned 50 times, indicating that intoxication may have been partially responsible for those head injury deaths. This is consistent with the findings for all alcohol-related injury hospitalisations and deaths, where the head and neck are the most common body parts injured (AIHW 2023a).
The most frequent places where incidents causing death occurred were the home (50%), medical service areas (22%) and transport areas (15%) (Figure 23).
Over half (51%) of head injury deaths did not occur at the same location as the incident that caused death. The most frequent place where deaths occurred were medical service areas (73%).
Figure 23: NCIS head injury deaths, by place of fatal incident and death occurrence, 2020–21
Over 4 in 5 head injury deaths had blunt force as their primary mechanism of fatal injury (81%). Of these:
- 740 cases (73%) were aged 65 and over
- males made up 640 cases (63%)
- 89% of female deaths and 77% of male deaths were attributed to blunt force
The 65 and over age group had the highest number of deaths across all primary mechanism groups, except for threat to breathing, where the 25–44 had the highest number.
Primary mechanism can be further differentiated into specific mechanism. In 2020–21, the leading specific mechanisms of fatal injury were (Figure 24):
- contact with static, stationary object (61%), of which the most common objects were:
- floor or related fitting/feature (45%)
- unspecified object (25%)
- ground surface (18%).
- vehicle occupant (9.4%)
- shot by firearm, gun (>7%).
Figure 24: NCIS head injury deaths, by specific mechanism, 2020–21
A bar chart showing that the most common specific mechanism is contact with static, stationary object, making up over 60% of NCIS deaths.
In some cases, the cause of death can be attributed to a specific object or substance that produced the injury. In 2020–21:
- 399 deaths were caused by building components or fittings (floors, walls, stairs etc)
- 180 deaths were caused by a land vehicle or land transport
- 96 deaths were caused by a weapon, which can include firearms, sharp objects, and combat weapons. People aged 45 and over made up 77% of these cases.
Over 4 in 5 head injury deaths were unintentional (84%). The second highest proportion of head injury deaths were due to suicide (14%) which was 7.2 times more common in males than females (151 and 21 deaths respectively).
Suicide
170 head injury deaths were attributed to suicide. This represents 5.5% of the total injury suicide deaths recorded in 2020–21 (AIHW 2023c).
Males have consistently made up the majority of suicide deaths in Australia (AIHW 2023). Head injury deaths by suicide have a higher proportion of males (88%) compared with all injuries (76%).
Suicides due to head injuries differ by mechanism between males and females, with:
- firearms being used in over half of male suicides (58%)
- hanging as the most common mechanism for females (52%).
This differs from all suicide deaths, where hanging is the leading mechanism for both males and females (AIHW 2022d). Ambiguity in classifying hanging as a suicide caused by a head injury (hypoxic brain injury) could explain this difference.
Transport
180 head injury deaths were caused by transport. Patterns in age and sex are very similar to all injury deaths caused by transport (AIHW 2023):
- males made up over three-quarters of head injury and all injury deaths (77% each)
- the 25–44 age group made up over a quarter of deaths (27% and 28% respectively)
Children and young adults are disproportionately affected by transport deaths. A land vehicle or land transport caused 64% of deaths in the 0–14 age group, and 59% of deaths in the 15–24 age group.
In 2020–21:
- Light transport vehicles were the most common mode of transport (45%).
- 2 in 3 deaths occurred when the person was the driver, rider or operator of the vehicle
- 30% of deaths were a result of the vehicle colliding with a fixed or stationary object
Over a quarter of fatal injuries occurred while the person was undertaking a vital personal activity (27%), which includes sleeping, eating, showering, and walking (Figure 25). This was followed by being taken care of (23%).
In 2020–21:
- 1 in 3 females were being taken care of (33%)
- 1 in 4 males were undertaking a vital personal activity (25%)
- being taken care of was the leading activity during injury for the 65 and over age group (34%).
Figure 25: NCIS head injury deaths, by activity and sex, 2020–21
A bar chart showing that the most common activity for males at the time of the head injury-related fatal incident was a vital personal activity, and for females, being taken care of. Males had higher numbers than females across all activity groups except for leisure, play, sports and exercise, and paid work, where a sex breakdown is unavailable.
ABS (Australian Bureau of Statistics) (2023), Provisional Mortality Statistics, ABS, Australian Government, accessed 6 June 2023.
AIHW (2022d) Deaths by suicide over time, AIHW, Australian Government, accessed 12 July 2023.
AIHW (2022e) Falls in older Australians 2019–20: hospitalisations and deaths among people aged 65 and over, AIHW, Australian Government, accessed 17 July 2023.
AIHW (2023a) Alcohol-related injury: hospitalisations and deaths, 2019–20, AIHW, Australian Government, accessed 20 September 2023.
AIHW (2023c) Intentional self-harm and suicide, AIHW, Australian Government, accessed 12 July 2023.
NCIS (National Coronial Information System) (2022) NCIS fact sheet: Injury deaths in Australia in 2019, NCIS, accessed 12 July 2023.
NCIS (2023) Explanatory notes, NCIS, accessed 15 June 2023.