Multiple causes of death
Usually, statistics about how people die are based on the condition initiating the chain of events which lead to death, also known as the underlying cause of death. But medical death certificates contain other information that can be useful in understanding why a death occurred. Looking beyond the underlying cause of death can provide more insights into the health of Australians, and why they die.
Many Australians die with more than one condition involved in their death. In 2024:
- almost 4 in 5 deaths had more than one condition recorded on their medical death certificate
- almost one quarter (24%) of people who died had 5 or more conditions recorded (see Table S8.1)
The number of conditions mentioned on a medical death certificate also differs by the underlying cause of death. For example, people who died in 2024 from
- cardiovascular diseases had an average of 3.5 conditions recorded
- neurological conditions had an average of 3 conditions recorded
- cancer had an average of 2.5 conditions recorded (see Table S8.2)
Example: More than one health condition involved in death
A person has died, and the medical practitioner completes their medical cause of death certificate.
The medical practitioner records that the person died with an underlying cause of death as coronary heart disease.
The death certificate also recorded the health condition leading directly to death was an acute myocardial infarction (heart attack), which was due to the coronary heart disease.
Diabetes and chronic alcohol use were recorded as other conditions that significantly contributed to the death.
Traditional mortality statistics are based on the underlying cause of death. This is important to identify where an intervention could have potentially happened to prevent the death occurring.
When we consider all the conditions on a death certificate we can understand:
- consequences and complications of the underlying cause (such as heart attacks due to coronary heart disease, or end of life impacts for those living with dementia or cancer)
- conditions, diseases or contextual factors which didn’t directly lead to or cause death, but their presence contributed to the death (this can include long-term health conditions such as diabetes, risk factors such as smoking, and social/personal circumstances)
- the interplay of multiple diseases or conditions and the role (direct, underlying, or contributory) played by each.
Consideration of all these cause types (underlying, direct, and contributory) is referred to as ‘multiple’ causes of death (see Cause of death terminology). Assessment of multiple causes of death offers greater insight to understanding why Australians die to help inform health services and decision-makers to develop strategies to reduce the impact of diseases and promote better health.
The short video below explains how diseases, conditions, and health events are recorded on a death certificate, and how this information is translated for statistical purposes. For a detailed description of how events that cause death are reported (certified) in Australia and translated into data, see Where do cause of death statistics come from? in the report What do Australians die from?