2019 news

Welcome to the winter edition of the National Coronial Information System newsletter.  Find out about recent research, database developments, training and upcoming deadlines for access applications.

Psychostimulants linked to 1 in 5 fatal strokes in young adults

A detailed analysis of national coronial records (External link) between 2009-2016 found that psychostimulants play a major role in fatal strokes among young adults. Researchers from the National Drug and Alcohol Research Centre (NDARC) (External link) at UNSW Sydney found that psychostimulant users made up nearly a fifth of the 279 cases of fatal stroke in adults aged 15-44 years. The majority had evidence of consumption immediately prior to the fatal stroke. The study, published in the Journal of Forensic Sciences, is the first to present national data of psychostimulant use in young adults who experienced a fatal stroke.

Methamphetamine was the most common drug implicated. However, less than half of methamphetamine linked stroke deaths involved high concentrations of the drug, which suggests that even low doses could trigger a deadly stroke. Cases of haemorrhagic stroke were also documented involving other illicit and licit psychostimulants. In no cases were medications for attention deficit hyperactivity disorder identified. None of the young people who died had histories of known stroke risk factors such as obesity, previous strokes, alcohol addictions or diabetes, though they were more likely to smoke.

The study found strokes in psychostimulant users usually occurred deep within the brain.  Lead researcher, Professor Shane Darke (External link) said “These strokes are far more dangerous and more likely to cause death or disability. Your risk of stroke is substantially increased if you use these drugs, and I don’t think the average user knows about this.” Professor Darke said in many cases, no one recognised the warning signs in the days before the fatal strokes. He said:

“If you are a user and you get a shocking headache or nausea, dizziness, and weakness down one side of your body, seek help immediately”

Shane Darke, Johan Duflou, Sharlene Kaye, Michael Farrell, Julia Lappin. Psychostimulant Use and Fatal Stroke in Young Adults (External link). Journal of Forensic Sciences, 2019.

‘You deserve better’: Warning on aged care facilities

An aged care expert has told the Royal Commission into Aged Care Quality and Safety (External link) that unless significant improvements are made, the state of nursing homes in Australia will deteriorate.

Professor Joseph Ibrahim (External link), the Head of the Health Law and Ageing Research Unit at Monash University’s Department of Forensic Medicine, says people living in residential aged care facilities are left “stateless” in a system waiting for them to die, and “no one seems to give a toss”.

Professor Ibrahim presented coronial data on the causes of deaths in nursing homes showing that almost 15% of 22,000 nursing home deaths between 2000 and 2014 were deemed ‘unnatural’, with falls making up the majority. “As most would know deaths reported to the coroner usually have some unusual aspect to them, and we remain curious to this day as to why 18,000 natural cause deaths have been reported,” Professor Ibrahim said.

“I think that residential aged care should have the goal that it’s a place where people can at least enjoy their last few months or years before they die,” he says. “What currently happens is most of us sit around waiting for them to die and if they die quickly then it’s a good job done, everyone sort of thinks it’s a good thing, and it’s clearly not.”

Listen to Prof Joseph Ibrahim speaking (External link) about Australia’s aged care system on the MJA podcast.

Seven older people die by suicide in Australia each week

A recently released NCIS fact sheet highlights an average of seven older people die by suicide in Australia each week.

The fact sheet Intentional self-harm deaths of older persons in Australia examines all closed case intentional self-harm deaths of persons aged 65 years or over reported to an Australian coroner between 1 January 2001 and 31 December 2016.

Key findings:

• The highest rate of suicide for older persons for 2016 occurred among those aged 85–89 years (17.4 deaths per 100,000).
• Intentional self-harm deaths occurred most frequently among those who were married or in a de facto relationship (51.8%), followed by those who were widowed (25.3%).
• Older men were at greatest risk, accounting for more than three quarters of intentional self-harm deaths (76%).

Supplementary data coverage

The NCIS integrates supplementary data to enhance the core coronial data set. Supplementary data is batch updated regularly. The table below displays the percentage of cases covered by supplementary data.

Data	Description	Coverage period	Cases
ICD-10 (Australia)	Australian Bureau of Statistics (ABS) assigns International Classification of Diseases (ICD) codes to deaths reported in Australia. Codes are provided to the NCIS in accordance with the Cause of Death, Australia file (cat. 3303.0)	2000– 2017	92%
ICD-10-AM (NZ)	New Zealand Ministry of Health (MoH) assigns International Classification of Diseases (ICD-AM) codes to deaths reported in New Zealand	2007– 2016	98%
Safe Work Australia	Applies to cases classified by Safe Work Australia as work related. Includes: Worker Type, Occupation, Industry of Employer and the Type of Occurrence Classification System (TOOCS)	2003– 2017	1.2%
Geocoding (Australia)	Residential address and incident locations are converted to coordinates and assigned geographic boundaries (excludes New Zealand) according to the ABS Australian Statistical Geography Standard and Local Government Areas	2000-2019	Residential: 93% Incident: 89%

NCIS Research Agenda

The NCIS Research Agenda has just been released. The agenda outlines research priorities, activities and outcomes for the 2018-21 calendar years. It focuses on identifying research needs that will enable comprehensive assessment of mortality trends in coronial data by organisations working to reduce preventable death and injury. The agenda has three key focus areas:

1. Reporting services: reports provided based on agreements and requests from external parties.
2. Research publications: publications generated by the NCIS and its data users.
3. Research tools: tools that provide online open access to specific data.

Closing dates for applications

New submission dates for access applications take effect from 1 July 2019.

The next closing date for new and renewing applications is 12 July 2019. Applications received by this date will be considered at the Justice Human Research Ethics Committee (External link) (JHREC) meeting on 19 September 2019. Applications for Victorian, Western Australian and Tasmanian data must also be reviewed by these jurisdictions for additional approval.

An average of seven older people die by suicide in Australia each week, according to a new report released by the National Coronial Information System (NCIS).

The fact sheet Intentional self-harm deaths of older persons in Australia examined all closed case intentional self-harm deaths of persons aged 65 years or over reported to an Australian coroner between 1 January 2001 and 31 December 2016.

The fact sheet includes frequencies, proportions and rates of intentional self-harm deaths among older persons reported to an Australian state or territory coroner. The variables included are: year of notification, jurisdiction of investigation, age range, sex, marital status, incident location type and mechanism of injury. For comparison purposes, the fact sheet includes data on intentional self-harm deaths of persons aged under 65 years.

The report reviewed the circumstances of 5,686 intentional self-harm deaths of persons aged 65 years or over reported in Australia and made a number of key findings, including:

• The highest rate of suicide for older persons for 2016 occurred among those aged 85–89 years (17.4 deaths per 100,000 persons).
• Intentional self-harm deaths occurred most frequently among those who were married or in a de facto relationship (51.8 per cent), followed by those who were widowed (25.3 per cent).
• Older men were at greatest risk, accounting for more than three quarters of intentional self-harm deaths (76.8 per cent).

Additional information

All NCIS fact sheets are publicly available..

The NCIS is a data repository containing information about deaths reported to a coroner in Australia and New Zealand. The NCIS was launched in 2000 in response to recommendations from the Royal Commission into Aboriginal Deaths in Custody.

Information contained within the NCIS helps identify systemic issues, patterns, or trends and aids coronial recommendations aimed at preventing similar deaths from occurring in the future. NCIS fact sheets is available for reproduction with appropriate citation.

Welcome to the new look National Coronial Information System newsletter.  We’ll be publishing NCIS news and updates here regularly. Find out about recent research, database updates, data set and quality developments, training, support and upcoming deadlines for access applications. Subscribe to our news.

NZ study raises concerns about zopiclone and clozapine

New research into poisoning related deaths in New Zealand (External link) shows a surprising number of deaths (62 in total) involved the prescription medicines zopiclone, a hypno-sedative drug used to treat insomnia, and clozapine, an antipsychotic drug.

The study was carried out by researchers from the University of Otago (External link) and the Best Practice Advocacy Centre (External link) and it represents the largest study of poisoning related deaths in New Zealand. Researchers reviewed New Zealand’s poison-related death findings recorded in the National Coronial Information System over a 6-year period (2008–2013). The review identified 1402 poisoning related deaths. Pharmaceuticals accounted for 52% of deaths. Methadone was the leading pharmaceutical cause of fatality and the third most common cause overall, followed by morphine and codeine, with zopiclone and clozapine equally ranked as the sixth most common cause.

About half (50.6%) were found to be intentional, 39.2% unintentional and 10.3% were unknown. Although the highest number of intentional deaths was among people 40-50 years of age, an unexpected finding from this study was that the highest proportion of intentional deaths occurred in people aged over 80 years (70.8%).

This study is the largest published review of New Zealand coronial data on poisoning related deaths and provides data for comparison with both national and international studies. Deaths by poisoning in New Zealand, 2008-2013 (External link), was recently published in the journal Clinical Toxicology.

“Poisoning-related fatalities are a significant public health issue in New Zealand and the coronial investigation is important if we are to increase our understanding of this problem” Dr John Fountain, University of Otago.

Work related fatalities latest report

Safe Work Australia (External link) has just released the 2017 report into Work-related traumatic injury fatalities (External link). The report provides comprehensive information on work-related injury fatalities, drawing on a number of sources including workers’ compensation data, coronial information from the NCIS, notifiable fatalities and the media.

The report covers national statistics on fatalities resulting from an injury sustained in the course of a work activity (worker fatalities) and as a result of someone else’s work activity (bystander fatalities). Despite an overall decrease of 48% since 2007, tragically 190 workers and bystanders were fatally injured in 2017 and a significant proportion of those killed were male (93%).

A total of 56 labourers were killed, accounting for the largest proportion (29%), closely followed by 55 drivers and machine operators.  The most common known causes of death were vehicle collisions (32%), being hit by moving objects (18%) and falling from a height (15%). The majority of fatalities (72%) occurred in three industries:

• transport, postal and warehousing (54)
• agriculture, forestry and fishing (52)
• construction (30).

New search guides

New database guides are available for general and topic based searching. Topics covered include how to search for: intentional self-harm; drug related deaths; drowning and water related incidents; indigenous origin and ethnicity; and transport related deaths.

We are committed to helping researchers and death investigators to return comprehensive search results from the NCIS database by providing support including personalised training to all users.

To arrange a training session or discuss your needs, contact us at ncis@ncis.org.au (External link).

ICD coding

The International Classification of Diseases (ICD) (External link) is the international standard used to classify the disease, morbid conditions or injuries which cause or contribute to death. The classification is published by the World Health Organisation (WHO) to enable the comparability of statistics over time and across countries.

ICD-10 Cause of Death codes are included in the NCIS data set to enable research into the causes of death. The codes are assigned by the Australian Bureau of Statistics (ABS) and the New Zealand Ministry of Health (MoH). The NCIS does not quality assure ICD-10 coding. The codes are integrated into the database as assigned by the ABS and MoH.

Australian ICD-10 coding is available for 2000-2017 cases in the NCIS. The coding is prepared by the ABS and provided annually via the Australian Coordinating Registry (ACR) in accordance with the annual ABS Causes of Death (External link) release. New Zealand ICD-10-AM (Australian Modification) coding is available for 2007-2016 cases.  The coding is prepared by the New Zealand Ministry of Health and provided to the NCIS periodically throughout the year.

Rates of coverage for NCIS cases which have at least one allocated ICD-10 (ICD-10-AM for NZ) code are available on the website.

Research publications

There are almost 100 active research projects approved for access to NCIS coronial data in 2019 and academic publications are produced every year as a result of these research activities. Publications and reports are listed on the NCIS website, dating from 2013.

Publications are listed by general topic area. The largest proportion of research is carried out into suicide and intentional self-harm, followed by research into drug and alcohol related fatalities and drowning/water related fatalities. Other areas of research focus include aged care and nursing home residents and farm related fatalities.

Closing date for applications

The next closing date for new and renewing applications is 8 May 2019. Applications received by this date will be considered at the Justice Human Research Ethics Committee (External link) (JHREC) meeting on 27 June 2019. Applications for Victorian data must be reviewed by the Coroners Court of Victoria in advance, contact NCIS for details.