Reporting of alcohol as a contributor to death in Australian national suicide statistics and its relationship to post‐mortem alcohol concentrations

Abstract

Aim To describe the assignment of International Classification of Disease (ICD)‐10 alcohol codes as underlying or contributory causes of death by the Australian Bureau of Statistics during mortality coding for suicides according to the blood alcohol concentration (BAC) detected at autopsy. Design Population‐based case‐series descriptive analysis. Setting and participants Data for all alcohol‐related (Alc+) suicide deaths (aged 15+) in Australia from 2010–2015 (n = 3132) from the National Coronial Information System. Measurements Alc+ suicides were categorised as those with a post‐mortem BAC ≥0.05 g/100 mL. The outcome variable was whether the case was assigned an ICD‐10 alcohol code (F10.0–F10.9, R78.0, T51, X45 and/or X65). We estimated OR for the assignment of codes in Alc+ suicides using BAC as the key predictor. We also examined several covariates that have been implicated in the risk of Alc+ suicides. Findings An ICD‐10 alcohol code was assigned during the mortality coding process in 47.6% (n = 1491) of Alc+ suicides. Higher BAC was associated with higher odds of having a code assigned; cases with a BAC over 0.20 g/100 mL over were twice as likely to have an alcohol code assigned (adjusted OR [AOR] = 2.06, 95% CI = 1.59, 2.67) compared with cases with a BAC of 0.050–0.075 g/100 mL. Compared with New South Wales, higher likelihood of code assignment was found in Northern Territory (AOR = 3.85, 95% CI = 2.32, 6.63) and Western Australia (AOR = 2.89, 95% CI = 2.27, 3.68). Compared with 15–24 year olds, 25–44 (AOR = 0.79, 95% CI = 0.63, 0.99) and 65–84 year olds (AOR = 0.63, 95% CI = 0.43, 0.93) were less likely to have a code assigned. Conclusions An ICD‐10 alcohol code was not assigned as an underlying or contributory cause of death in over half of suicides in Australia (2010–2015) with a BAC ≥0.05 g/100 mL. The higher the BAC detected at autopsy, the more likely cases were to be assigned an alcohol code during the mortality coding process.

Co-occurrence of Aggression and Suicide Attempt Among Young People and Related Factors: Findings from Iranian Youth Cohort Study in Ravansar

“…35 Previous studies also suggested an association between alcohol drinking and suicide attempt. [36][37][38][39] The results of the present study on the relationship between suicide attempt and substance abuse and alcohol drinking can be a challenging finding that should be considered in future research in the same community.…”

Tuberculosis mortality: quantifying agreement in clinical cause of death assessments

“…Alternatively, assigning cause of death may be avoided entirely by reporting all‐cause mortality during a defined period, such as within 12 months of notification. This, however, runs counter to existing Australian death classification systems, and may introduce other problems such as under‐recognition of secondary conditions contributing to the risk of disease‐specific mortality 12 …”

“…This, however, runs counter to existing Australian death classification systems, and may introduce other problems such as under-recognition of secondary conditions contributing to the risk of disease-specific mortality. 12 While the differences highlighted here reflect several thematic issues, broad consensus on death classification is critical for monitoring this key outcome measure. NTAC intends to develop a national policy statement to contextualise these findings and improve within-jurisdictional and cross-jurisdictional standardisation.…”

Analysis of Multiple Causes of Death: A Review of Methods and Practices

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